Citation Nr: 18151556 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 14-35 183A DATE: November 19, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service special monthly compensation based on the need for aid and attendance or housebound status is remanded. REASONS FOR REMAND The Veteran had active service from September 1950 to May 1953. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions in May 2013 and April 2017. In October 2017, the Board reopened the Veteran’s claim for service connection for hypertension and remanded the underlying service connection claim for additional development. 1. Entitlement to service connection for hypertension is remanded. The Board regrets the additional delay involved in remanding this claim again but finds that it cannot make a fully-informed decision on the issue of entitlement to service connection for hypertension because the rationales for the medical opinions of record need to be clarified in light of the medical evidence of record. The VA examinations and opinions provided in September 2014 and February 2018 each indicated that the Veteran’s hypertension was less likely than not related to his in-service hopsitalization for his leg injury during which he had a high blood pressure reading because this incident was isolated. Non-VA physicians in opinions received in October 2013 and March 2014 indicated that the Veteran’s hypertension was diagnosed during service and has been consistent since that time. However, the medical evidence appears to be somewhat more mixed. While the Veteran’s service treatment records do document high blood pressure readings during his in-service hospitalization in June 1952, the Veteran’s blood pressure was normal at separation in April 1953 and his service treatment records do not otherwise indicate an ongoing treatment for hypertension during service. He had a high blood pressure reading during a VA examination in September 1953, but a normal reading in August 1955. He had two high blood pressure readings in July and August 1956. He had another high blood pressure reading in January 1959. Statements from the doctors who treated the Veteran in the 1960s make no mention of hypertension. However, a June 1975 treatement record documents that the Veteran was prescribed a beta blocker, a class of drug that could indicate the Veteran was under treatment for hypertension but could also have been used to treat a heart condition. No diagnosis of hypertension was noted at that time. A July 1987 VA treatment record that recounted the Veteran’s relevant history for a coronary artery disease made no mention of a history of hypertension and found normal blood pressure prior to beginning a stress test, and the Veteran reported that he was not taking his medications and had not been since the 1970s. A 1989 statement by the Veteran’s longtime physician mentions heart conditions and the Veteran’s history of myocardial infarction but makes no mention of hypertension. The Veteran then began to test in the hypertensive range or have other indications of hypertension in the 1990s. By 2000, VA physicians were tracking and managing this condition. It is not clear from this record that the Veteran’s hypertension was continuous since his hospitalization in 1952, but it is also clear that the Veteran’s condition cannot fairly be characterized as a single isolated reading while hospitalized in 1952 separated from his later ongoing treatment by decades. Consequently, the Board requires an addendum opinion that clarifies whether the Veteran’s hypertension is caused by or related to his in-service treatment in light of the Veteran’s history of normal and high blood pressure readings. 2. Entitlement to service special monthly compensation based on the need for aid and attendance or housebound status is remanded. The Veteran’s claim for special monthly compensation (SMC) based on the need for aid and attendance or housebound status was denied in an April 2017 rating decision. He filed a timely notice of disagreement (NOD) in May 2017. The Veteran had not received a statement of the case (SOC) at the time of the last Board remand. The Board decided not to issue a formal remand at that time because the Agency of Original Jurisdiction (AOJ) had indicated that the Veteran’s SMC claim was being worked. However, in the intervening year, no SOC regarding that issue has been issued. Consequently, this matter is remanded for a responsive SOC. Manlincon v. West, 12 Vet. App. 238 (1999). The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to his in-service high blood pressure reading. A complete rationale should be provided and should account for the Veteran’s history of presenting with both normal and high blood pressure readings throughout his history as detailed above. (Continued on the next page)   2. Send the Veteran and his representative a statement of the case that addresses the issue of entitlement to SMC based on the need for aid and attendance or housebound status. If the Veteran perfects an appeal by submitting a timely VA Form 9, substantive appeal, the issue should be returned to the Board for further appellate consideration. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steven H. Johnston, Associate Counsel