Citation Nr: 18139578 Decision Date: 10/01/18 Archive Date: 09/28/18 DOCKET NO. 12-31 405 DATE: October 1, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected major depressive disorder (MDD) is remanded. Entitlement to service connection for a heart disorder, including coronary artery disease (CAD), to include as secondary to service-connected MDD is remanded. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service-connected MDD is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to service-connected MDD is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service-connected MDD is remanded. Entitlement to a rating higher than 40 percent for hearing loss prior to July 15, 2011, and a rating higher than 50 percent thereafter is remanded. REASONS FOR REMAND The Veteran had active service from August 1964 to February 1967. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2015, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Video Conference hearing. A transcript of his testimony is of record. 1. Entitlement to service connection for a heart disorder, including coronary artery disease (CAD), to include as secondary to service-connected MDD is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected major depressive disorder (MDD) is remanded. 3. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service-connected MDD is remanded. 4. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to service-connected MDD is remanded. 5. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service-connected MDD is remanded. 6. Entitlement to a rating higher than 40 percent for hearing loss prior to July 15, 2011, and a rating higher than 50 percent thereafter is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. In pertinent part, the August 2017 remand directed that various VA, fee basis, and non-VA records from Vanderbilt University Medical Center that were contained within VistA Imaging be associated with the claims file. While some records of the VistA Imaging records from Vanderbilt University Medical Center were obtained, numerous potentially relevant VistA Imaging records have not associated with the claims file. Specifically, VA treatment records from January 5, 2017, November 21, 2016, October 6, 2016, July 19, 2016, June 8, 2016, May 26, 2016, March 30, 2016, January 20, 2016, October 6, 2015, July 7, 2014, June 12, 2014, April 22, 2014, April 16, 2014, March 24, 2014, March 10, 2014, September 4, 2013, May 7, 2013, May 6, 2013, January 29, 2013, January 22, 2013, January 16, 2013, December 14, 2012, December 6, 2012, October 18, 2012, October 17, 2012, October 15, 2012 neurology, hematology, endocrinology, and cardiology records from Vanderbilt University had been scanned into VistA Imaging. Likewise, VA treatment records from December 29, 2016, December 6, 2012, April 14, 2011, April 1, 2010, November 27, 2009, and November 23, 2009 indicate that fee basis neurology records and an EKG report had been scanned into VistA Imaging. Accordingly, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The evidence indicates there may be other outstanding relevant VA treatment records. An August 16, 2018 VA treatment record indicates that the Veteran had follow up appointments scheduled on September 6, 2018. To date, VA treatment records subsequent August 20, 2018 have not been associated with the claims file. Additionally, VA treatment records from July 18, 2018, April 2, 2018, March 13, 2018, March 8, 2018, February 20, 2018, February 5, 2018, October 30, 2017, July 21, 2017, July 18, 2018, July 3, 2017, April 13, 2017, April 2, 2018, March 29, 2017, March 22, 2017, February 9, 2017, February 7, 2017, January 23, 2017, January 5, 2017 indicate that non-VA endocrinology, neurology, and cardiology records had been scanned into VistA Imaging. However, it does not appear that the referenced records have been associated with the claims file. Thus, a remand to obtain the records is required. Regarding the Veteran’s hypertension claim, while a VA opinion was obtained in October 2017, the examiner did not address the representative’s assertion that stress from the Veteran’s service-connected psychiatric disorder caused blood pressure elevations that aggravated the Veteran’s hypertension. Accordingly, an addendum opinion is warranted. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records dated since August 20, 2018 as well as the VistA Imaging records referenced in the July 18, 2018, April 2, 2018, March 13, 2018, March 8, 2018, February 20, 2018, February 5, 2018, October 30, 2017, July 21, 2017, July 18, 2018, July 3, 2017, April 13, 2017, April 2, 2018, March 29, 2017, March 22, 2017, February 9, 2017, February 7, 2017, January 23, 2017, January 5, 2017, December 29, 2016, November 21, 2016, October 6, 2016, July 19, 2016, June 8, 2016, May 26, 2016, March 30, 2016, January 20, 2016, October 6, 2015, July 7, 2014, June 12, 2014, April 22, 2014, April 16, 2014, March 24, 2014, March 10, 2014, September 4, 2013, May 7, 2013, May 6, 2013, January 29, 2013, January 22, 2013, January 16, 2013, December 14, 2012, December 6, 2012, October 18, 2012, October 17, 2012, October 15, 2012, April 14, 2011, April 1, 2010, November 27, 2009, and November 23, 2009VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above is completed to the extent possible, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's hypertension. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the hypertension is worsened beyond natural progression (aggravated) by his service- connected MDD. In so opining, the clinician must address the assertion that the psychological stress related to the Veteran’s MDD resulted in elevations of his Veteran’s blood pressure that worsen his hypertension. (b.) If the clinician finds that the Veteran's hypertension was aggravated by his service-connected MDD, the clinician should attempt to quantify the level of aggravation beyond the baseline level of they hypertension. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Anderson