Citation Nr: 1329426 Decision Date: 09/13/13 Archive Date: 09/20/13 DOCKET NO. 08-24 915 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD T. Mainelli, Counsel INTRODUCTION The Veteran served on active duty from February 1996 to September 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO adjudicated multiple claims, to include denying a claim of service connection for hypertension. The case was before the Board in February 2011 at which time the Board finally adjudicated all claims except for hypertension, which was remanded to the RO, via the Appeals Management Center (AMC) in Washington, DC, for further evidentiary development. A review of the Virtual VA electronic records storage system reveals additional VA clinic records and examination reports, as well as an Appellant's Post-Remand Brief, which are not associated with the paper claims folder. The appeal is again REMANDED to the RO via the AMC in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran seeks to establish his entitlement to service connection for hypertension. He has alleged being placed on anti-hypertensive medications in service due to blood pressure readings above 140/90. See Veteran's statement received in July 2007. His VA clinic records reflect that the Veteran was prescribed anti-hypertensive medications within one year from service discharge. See VA clinic record dated August 29, 2005. In pertinent part, the Veteran can establish his entitlement to service connection for hypertension on three separate bases - either that hypertension first manifested in service or is related to an event during service pursuant to 38 U.S.C.A. § 1110 or that hypertension manifested to a compensable degree within one year of service discharge. 38 C.F.R. § 3.309(a). As for direct service connection, VA considers systolic pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg, or more to be indicative of Stage 1 hypertension. See Veterans Benefits Administration (VBA) Training Letter 00-07 (July 17, 2000) (citing to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (1997)). A diagnosis of hypertension requires 2 or more readings on at least 3 different days. Id. See 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, Note (1). The Veteran's service treatment records (STRs) do not corroborate his report of being prescribed anti-hypertensive medications. However, the STRs reflect 23 different occasions where the Veteran's systolic readings were 140 mm Hg or more. There are no blood pressure readings meeting the definition of hypertension based upon 2 or more readings on at least 3 different days. The Veteran was diagnosed with hypertension within one year of service discharge. To date, the available postservice medical records do not reflect that hypertension was diagnosed based upon readings of diastolic pressure of 100 or more, or systolic pressure of 160 or more, as required for presumptive service connection under 38 C.F.R. § 3.309(a). See 38 C.F.R. § 4.104, DC 7101. This case was remanded in February 2011, in part, to afford the Veteran the opportunity to submit private medical records which could potentially support an award of service connection for hypertension on a presumptive basis under 38 C.F.R. § 3.309(a). Unfortunately, the Veteran did not respond to the RO's request for assistance in obtaining these records. The Board remand discussion section also indicated that VA examination was necessary to decide this claim. Unfortunately, the Board decision attached to the record is missing page 25 which included a remand directive for VA examination. The Board has attached to the record a complete copy of the Board's February 2011 decision and remand. As such, the Board remands this case to afford the Veteran another opportunity to substantiate his claim. The Board urges the Veteran to read the contents of this remand which advises him of two separate bases which could lead to a service connection award. The Board also reminds the Veteran that his private medical records within one year of service discharge may be critical for adjudicating his claim, and that he holds the ultimate burden to assist VA in obtaining these records which require his assistance in obtaining. See Dusek v. Derwinski, 2 Vet. App. 519, 522 (1992) (quoting Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (claimant cannot wait passively for VA assistance in circumstances where claimant may or should have information in obtaining the putative evidence). After the Veteran has been afforded a reasonable opportunity to submit additional evidence in support of his claim, the Veteran should be provided with a VA hypertension examination to obtain an opinion as to whether such is related to active service. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following action: 1. Ask the Veteran to provide the name and address of the medical provider who first diagnosed his hypertension. After securing any necessary release, the RO/AMC should obtain these records. 2. Obtain relevant VA outpatient treatment records dating from August 2004 to August 2005, and since November 19, 2012 from the VA Medical Center in Fayetteville, North Carolina. 3. After the above has been completed to the extent possible, schedule the Veteran for a VA hypertension examination to obtain an opinion as to the possible relationship between his current hypertension and active service. The claims folder must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's current hypertension arose during service, or is otherwise related to his military service, including the elevated systolic blood pressure readings contained therein. The examiner should set forth the complete rationale for all opinions expressed and conclusions reached. 4. Following the completion of the above, the RO/AMC should review the evidence and determine whether the Veteran's claim may be granted. If not, he and his representative should be furnished an appropriate supplemental statement of the case and be provided an opportunity to respond. 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 of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims 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). _________________________________________________ MARJORIE A. AUER 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).