Citation Nr: 1329409 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 11-00 211 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to increased ratings for hypertension, currently assigned "staged" ratings of 40 percent from March 13, 2007, 60 percent from January 29, 2009, and 20 percent from June 30, 2010. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Chapman, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1978 to May 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA), which assigned staged ratings for hypertension (40 percent from March 13, 2007; 60 percent from January 29, 2009; and 20 percent from June 30, 2010). A notice of disagreement was received in October 2010, a statement of the case was issued in December 2010, and a substantive appeal was received in December 2010. A Travel Board hearing was held in October 2011. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND A preliminary review of the record reveals that additional evidentiary development is necessary prior to adjudication of the claim on the merits. The Veteran testified in October 2011 that his blood pressure is unstable and that he receives ongoing private treatment. A review of the private treatment records shows that the most recent treatment records are dated in 2011. The Veteran's statements suggest that updated treatment records may be available, and as such records may contain pertinent (even critical) evidence in the matter at hand, they must be secured. Additionally, the Veteran's representative noted that the Veteran's private treatment records show "high highs to low highs, very high to low highs." The representative stated that the Veteran has "some really abnormally high blood pressure readings" and they contend that the VA examination was inadequate as the readings were taken "sitting down in a five-minute span, where there's really no chance for variation of the blood pressure." Although there is no indication to suggest this VA examination was inadequate, the Board notes that the examiner did note that the Veteran's blood pressure was "still not adequately controlled." In fact, a review of the private treatment records and the VA examination report shows fluctuations in diastolic pressure from 80 to 152. Accordingly, as the Veteran's hypertension appears to fluctuate, and as new treatment records may be associated with the file showing additional fluctuations, a new VA examination and opinion is necessary to assess the current severity of his hypertension. Accordingly, the case is REMANDED for the following actions: 1. The RO should ask the Veteran to provide any authorizations necessary for VA to obtain records of any such private treatment. The RO should obtain complete updated clinical records (those not yet secured) from all sources identified. If any provider does not respond to an RO request for records, the Veteran and his representative should be so advised, and reminded that ultimately, it is his responsibility to ensure that private records are received. 2. After completion of the above to the extent possible, the Veteran should be afforded a VA examination to ascertain the current severity of his service-connected hypertension. The claims file must be reviewed in conjunction with the examination. Any medically indicated special tests should be accomplished, and all special tests and clinical findings should be clearly reported to allow for application of VA rating criteria for hypertension as outlined in 38 C.F.R. § 4.104, Diagnostic Code 7101. Based upon current clinical data and a review of the available historical data (including private treatment records submitted), the examiner should provide a medical opinion as to whether the Veteran's hypertension from June 2010 is best described as manifested by diastolic pressures predominantly less than 100; predominantly between 100 and 109; predominantly between 110 and 119; predominantly between 120 and 129; or predominantly 130 or higher. The examiner should also provide an opinion as to whether the Veteran's hypertension is best described as manifested by systolic pressures predominantly less than 160; predominantly between 160 and 199; or predominantly 200 or higher. The examiner should indicate whether continuous medication is required for control of the Veteran's hypertension, and should fully describe all noted symptomatology associated with the condition. A complete rationale for all opinions should be provided. 3. After completion of the above, the RO should review the expanded record and determine if the benefits sought can be granted. The RO should furnish the Veteran and his representative with a supplemental statement of the case and an opportunity to respond. Thereafter, the case should be returned to the Board, if in order, for further appellate review. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).