Citation Nr: 18115201 Decision Date: 06/29/18 Archive Date: 06/29/18 DOCKET NO. 16-26 503 DATE: June 29, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for diabetes mellitus, type II is remanded. REASONS FOR REMAND The Veteran served in the United States Army National Guard from December 1971 to December 1977 and January 1996 to April 2012, with various periods of active duty or active duty for training (ACDUTRA) to include from April 1972 to August 1972, in December 2000, from June 2002 to July 2002, and from May 2009 to June 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. In April 2016, the Veteran requested a local hearing with a Decision Review Officer (DRO), and in his April 2016 VA Form 9 (substantive appeal), the Veteran declined a hearing before the Board. A January 2017 letter advised the Veteran that his hearing was scheduled for February 2017 at the RO. The Veteran failed to appear for the hearing, and his hearing request is therefore deemed withdrawn. 38 C.F.R. § 20.702(d) (2017). 1. Entitlement to service connection for hypertension is remanded. The Veteran seeks service connection for hypertension, which he asserts is related to service. Service treatment records from December 2000 reflect a diagnosis of uncontrolled hypertension. Post-service treatment records from May 2014 reflect a diagnosis of hypertension. VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with service, and the record does not contain sufficient information to make a decision on the claims. 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The requirement that the evidence “indicates” that the Veteran’s disability “may” be associated with his service is a low threshold. Id. Thus, in light of the Veteran’s contentions and the record on appeal, a VA examination should be obtained to determine the probable etiology of the Veteran’s hypertension, to include whether the Veteran’s hypertension was related to service. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, supra. 2. Entitlement to service connection for diabetes mellitus, type II is remanded. The Veteran seeks service connection for diabetes mellitus, type II, which he asserts is related to service. Post-service treatment records from May 2014 reflect a diagnosis of diabetes mellitus, type II. In light of the Veteran’s contentions and the record on appeal, a VA examination should be obtained to determine the probable etiology of the Veteran’s diabetes, to include whether the Veteran’s diabetes was related to service. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon, supra. The Veteran indicated that the onset of his hypertension and diabetes may have been during his service in the Army National Guard. The Agency of Original Jurisdiction (AOJ) should attempt to verify the Veteran’s periods of active duty and ACDUTRA. The Veteran’s claims file does not appear to contain his complete service records for his period of service in the Army National Guard. As they may contain information regarding the Veteran’s dates of service and treatment of hypertension and diabetes, a remand is required to obtain them. The matters are REMANDED for the following action: 1. The AOJ should obtain the Veteran’s complete service personnel records to determine the specific dates of active duty and/or ACDUTRA. The AOJ should prepare a summary/memorandum based on verified information from appropriate official sources of the specific dates of the Veteran’s active duty and/or ACDUTRA. Records concerning service merely denoting the amounts of points he obtained, including cumulatively, are not helpful in this regard insofar as determining exactly when the Veteran was on active duty or ACDUTRA. 2. Then, schedule the Veteran for a VA examination to ascertain the nature and etiology of the Veteran’s hypertension. All necessary tests should be conducted. The claims file and a copy of this remand should be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should address the following: (a.) whether hypertension existed prior to a period of qualifying active service or ACDUTRA. In making this determination, the examiner is requested to consider the Veteran’s medical history, accepted medical principles, evidence regarding the basic character, origin and development of the disorder, and lay and medical evidence concerning the inception, development and manifestations of the disorder. The examiner must outline the specific evidence in the record supporting this opinion. (b.) If the examiner determines that the evidence demonstrates that the Veteran’s hypertension preexisted a qualifying period of service, is there evidence that the preexisting hypertension was NOT aggravated in service beyond the natural progression of such disorder. The examiner must outline the specific evidence in the record supporting this opinion. (c.) If the evidence does not demonstrate that the Veteran had hypertension that preexisted a qualifying period of service and was not aggravated in service, then opine as to whether it is at least as likely as not (50 percent or greater likelihood) that any current hypertension manifested during a qualifying period of service, that hypertension was manifest to a compensable degree within one year of any active duty period of service, or that it is otherwise causally or etiologically related to a period of active duty service or ACDUTRA. The examiner should consider and discuss the following: (a.) Service treatment records which reveal blood pressure readings for the Veteran from November 1995 and December 1995. (b.) Military personnel records from December 1995 which reflect that a military examiner determined that the elevation recorded at a military entrance processing station (MEPS) was due to a transient nervous reaction, and it was not a true elevation in blood pressure, and recommended that the Veteran receive a P-2 waiver. (c.) Service treatment records from December 2000, which reflect a diagnosis of uncontrolled hypertension. (d.) Service treatment records from July 2002, which reflect a provisional diagnosis of essential hypertension, uncontrolled. (e.) An August 2002 VA examination which indicates that the Veteran had a past history of high blood pressure, which was seen on a DA Form 2173 on the claims folder dated July 2002. (f.) Post-service treatment records from May 2014, which reflect a diagnosis of hypertension. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. 3. Schedule the Veteran for a VA examination to ascertain the nature and etiology of the Veteran’s diabetes mellitus, type II. All necessary tests should be conducted. The claims file and a copy of this remand should be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should address whether it is at least as likely as not (50 percent or greater likelihood) that any current diabetes manifested during a qualifying period of service, that diabetes was manifest to a compensable degree within one year of a qualifying period of active service, or that it is otherwise causally or etiologically related to a period of active duty service or ACDUTRA. (Continued on the next page)   The examiner should consider and discuss the following: (a.) Service treatment records from November 1995, which reflect that the Veteran had a glucose reading of 95 mg/dL. (b.) Post-service treatment records from May 2014, which reflect a diagnosis of diabetes mellitus, type II. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Johnson, Associate Counsel