Citation Nr: 18143890 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 08-30 352 DATE: October 22, 2018 REMANDED The claims for service connection for hypertension, to include as secondary to posttraumatic stress disorder (PTSD), and for leukopenia and neutropenia/blood deficiency, low white blood cell count, to include as secondary to diabetes mellitus, are remanded. REASONS FOR REMAND The Veteran served on active duty from April 1961 to August 1970, including service in the Republic of Vietnam from September 1965 to August 1966 and from April 1968 to April 1969. He had additional service in the Army Reserves. These matters come to the Board of Veterans’ Appeals (Board) on appeal from February 2008 and June 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The RO initially denied service connection for leukopenia and neutropenia/blood deficiency in a June 2013 rating decision. In October 2013, the Veteran submitted a request to reopen his claim and he submitted new evidence. In June 2014, the RO treated the request to reopen as a request for reconsideration and continued the denial of service connection. The Veteran submitted a new claim for service connection in September 2014, however, he also submitted new and material evidence within one year of the June 2014 rating decision. Thus, the June 2014 rating decision did not become final. In March 2015, the RO denied the claim again and the Veteran submitted a timely notice of disagreement. Since the Veteran submitted new and material evidence within one year of the June 2013 and June 2014 rating decisions, the rating decisions did not become final and as such, the Board finds that this is an original claim for service connection. 38 C.F.R. § 3.156(b). In June 2017, the Board remanded the issue of entitlement to service connection for leukopenia and neutropenia/blood deficiency for the issuance of a statement of the case and to allow the Veteran the opportunity to perfect his appeal. The statement of the case was issued in July 2017, and the Veteran submitted a timely substantive appeal, VA Form 9. In March 2018, the Veteran appeared before the undersigned Veterans’ Law Judge and presented testimony on this issue. A transcript of the hearing has been associated with the claims file. Regarding hypertension, the Board denied service connection for hypertension in June 2017. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In January 2018, the parties submitted a Joint Motion for Partial Remand (JMPR), asking the Court to vacate the June 2017 Board decision as it pertained to hypertension and to remand the claim to the Board for action consistent with the terms of the JMPR. The Court entered the Order in January 2018. Therefore, the claim for service connection for hypertension is before the Board for further consideration. 1. Hypertension The Veteran seeks service connection for hypertension, to include as secondary to PTSD. In the January 2018 JMPR, the parties found that the December 2016 VA examination report addressing the relationship between hypertension and PTSD was inadequate for rating purposes. Accordingly, a remand is required to obtain an addendum opinion addressing whether the Veteran’s PTSD caused or aggravated the Veteran’s hypertension. 2. Leukopenia and Neutropenia The Veteran seeks service connection for leukopenia and neutropenia, also claimed as low white blood counts. The evidence includes opinions from the Veteran’s providers indicating that the condition is related to Agent Orange exposure during service and/or due to his diabetes mellitus. However, the providers did not provide rationales for their opinions. See Letters from Dr. J.H., dated November 2014, May 2015, and December 2017; Letter from Dr. A.T. dated December 2017. In March 2015, the Veteran had a compensation and pension examination. However, the examiner stated that the Veteran did not have a diagnosis of a hematologic or lymphatic condition; therefore, the examiner did not provide an opinion addressing the etiology of the condition. The examiner did not address the diagnoses as documented in the medical records prior to the examination. The Board observes that the Veteran has had diagnoses of leukopenia, leukocytopenia, leukocytosis, and neutropenia, and indication of low white blood counts throughout the entire pendency of the claim. Therefore, a remand is necessary to obtain an opinion to determine whether any of the Veteran’s diagnoses are related to service or to his diabetes mellitus. The matter is REMANDED for the following actions: 1. Obtain VA treatment records dated since January 2018. 2. Obtain an addendum opinion from the December 2016 VA examiner, or another qualified examiner, addressing the etiology of the Veteran’s hypertension. The examiner must be provided access to the electronic claims file and he or she must indicate review of the claims file in the opinion report. The examiner must provide an opinion indicating whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is related to service or due to his PTSD. If the answer to the foregoing is negative, the examiner must provide an opinion indicating whether it is at least as likely as not that the Veteran’s PTSD has aggravated, or permanently worsened, his hypertension. The examiner must support each opinion with rationale based on the facts and applicable medical principles. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. If an opinion cannot be provided without examining the Veteran, then an examination must be scheduled. 3. Obtain an opinion from an appropriate clinician addressing the nature and etiology of the Veteran’s leukopenia and neutropenia, also claimed as low white blood counts. The examiner must be provided access to the electronic claims file and he or she must indicate review of the claims file in the opinion report. The Veteran has had diagnoses of leukopenia, leukocytopenia, leukocytosis, and neutropenia, and indication of low white blood counts throughout the entire pendency of the claim. The examiner must determine whether it is at least as likely as not (i.e., probability of 50 percent or greater) that leukopenia or any other identified hematologic disorder identified since May 2011 is considered by the medical profession, in and of itself, to be a disability, as opposed to a laboratory finding and/or risk factor for other diseases. If leukopenia or any other identified hematologic disorder is a disability in and of itself, the examiner must indicate whether any of these diagnoses, or any other identified hematologic disorder identified since May 2011, are at least as likely as not (50 percent or greater probability) related to service, to include exposure to herbicides during service, or in the alternative, whether it is at least as likely as not that the disabilities are due to or have been aggravated (permanently worsened) by the Veteran’s diabetes mellitus. The examiner must address the letters from Dr. J.H. dated November 2014, May 2015, and December 2017, and letter from Dr. A.T. dated December 2017. The examiner should also address the significance, if any, of the May 1970 lab results indicating low white blood count. The examiner must support each opinion with rationale based on the facts and applicable medical principles. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. If an opinion cannot be provided without examining the Veteran, then an examination must be scheduled. 4. After completing the above development, and any other development deemed necessary, readjudicate the claims on appeal taking into consideration any newly acquired evidence. If the benefits sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board for appellate review, after the Veteran and his representative have had an adequate opportunity to respond. L. CHU Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Alderman, Amanda G.