Citation Nr: 18140836
Decision Date: 10/09/18	Archive Date: 10/09/18

DOCKET NO. 16-29 757
DATE:	 
REMANDED
Entitlement to service connection for hypertension is remanded.
REASONS FOR REMAND
The Veteran served on active duty from April 1989 to June 1994.  This matter comes on appeal before the Board of Veterans’ Appeals (Board) from a July 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office.
The Veteran maintains that her currently diagnosed hypertension first manifested during active duty service and was therefore incurred in service. Hypertension may also be presumptively service-connected as a chronic disease under 38 C.F.R. §§ 3.307 and 3.309(a) if it manifests to a disabling degree (10 percent rating) within one year of separation of service.
VA must provide a VA medical examination or medical opinion when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.  See McClendon v. Nicholson, 20 Vet App. 79, 81 (2006).
In the present case, the Veteran has been diagnosed with hypertension.  The Veteran contends that her hypertension first manifested in service as demonstrated by in-service dizzy spells and fainting spells.  Service treatment records include a February 1991 note where the Veteran complained of fainting spells, black-outs, and lightheadedness, which mostly occurred from a sitting or lying position to a standing position.  In a May 1992 note, the Veteran was again seen for lightheadedness and dizziness; her blood pressure at that time was 132/78.  In a Prenatal and Pregnancy medical report, the Veteran’s blood pressure was 140/80 in February 1993 and 158/88 in March 1993.
The Centers for Disease Control and Prevention indicates that systolic pressure from 120-139 mmHg is “prehypertension.”  Systolic pressure that is 140 mmHg or higher is considered “high.” 
The Veteran has not been afforded a VA examination.  A VA examination should be obtained to assist in determining whether currently diagnosed hypertension first manifested in service or is otherwise related to service.
The matters are REMANDED for the following actions:
1. Schedule the Veteran for an appropriate VA examination to assist in determining the etiology of her hypertension.  After reviewing all pertinent documents in the record and obtaining a complete medical history from the Veteran, the examiner should address the following:
(a.) State whether it is as least as likely as not that currently diagnosed hypertension first manifested in service and was incurred in service.
(b.) State whether it is at least as likely as not that by June 1995:
1.	Diastolic pressure was predominantly 100 or more
2.	Systolic pressure was predominantly 160 or more
3.	There was a history of diastolic pressure of predominantly 100 or more and continuous medication was required for control.
**The examiner must address service treatment records dated in February 1991 noting that the Veteran complained of fainting spells, black-outs, and lightheadedness, which mostly occurred from a sitting or lying position to a standing position.  See also May 1992 note, where the Veteran was seen for lightheadedness and dizziness.  See Prenatal and Pregnancy medical report (blood pressure was 140/80 in February 1993 and 158/88 in March 1993).
(c.) A complete rationale should be provided for the opinion given. 
 
LAURA E. COLLINS
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Casadei, Counsel