Citation Nr: 19190855 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 10-31 107 DATE: December 3, 2019 REMANDED The claim for service connection for hypertension, including secondary to diabetes mellitus or other service-connected disability, is remanded. The claim for service connection for vertigo, including secondary to diabetes mellitus or other service-connected disability, is remanded. The claim for service connection for stroke, including secondary to diabetes mellitus or other service-connected disability, is remanded. REASONS FOR REMAND As the Board of Veterans’ Appeals (Board) noted in its January 2018 decision, the issues of clear and unmistakable error with the assignment of the effective date of service connection for carpal tunnel syndrome in a May 2013 rating decision, entitlement to service connection for asthma as secondary to diabetes mellitus, type II, and entitlement to a total disability rating based on individual unemployability (TDIU) have been raised by the record in a January 2017 informal hearing presentation, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are again referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b) (2018). The Veteran served on active duty from January 1960 to July 1960 and from October 1961 to May 1968. The Department of Veterans Affairs is grateful for his service. Claims for service connection for hypertension, vertigo, and stroke, all including secondary to diabetes mellitus or other service-connected disability The Board of Veterans’ Appeals (Board) remanded the claims in May 2017 and again in January 2018 for additional development. Regrettably, further development is required prior to the Board’s adjudication of the claims. Addenda to a September 2008 VA examination have been obtained in September 2017, March 2018, and May 2019 which adequately address questions of causation or aggravation of claimed disabilities by service-connected diabetes mellitus or service-connected coronary artery disease, and whether the claimed disabilities were directly related to service. However, in its January 2018 remand the Board also requested an opinion whether any other disease may be present besides vertigo and whether such disease may be causally related to service including based on a March 1960 in-service treatment for dizziness. A further addendum is warranted to address this question. Additionally, the March 2018 addendum examiner noted that additional conclusions about the Veteran’s stroke could not be made in the absence of records of the Veteran’s hospitalization for stroke in 1980. Hence, records of that hospitalization may further the claim for service connection for stroke, and indeed as these records are more proximate to service, they may potential serve to further the Veteran’s claims for service connection for hypertension and vertigo as well. Hence, remand of all three claims is warranted. If such hospitalization records are obtained, addenda should then be sought to address whether any change to the prior opinions is warranted, including those addressing a direct link to service or causation or aggravation by service-connected disabilities. The Board notes that the United States Court of Appeals for Veterans Claims recently held that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). Upon review, the Board notes that opinions already obtained are already sufficiently distinct in findings and rationales to support opinions regarding causation and aggravation. Any further necessary opinions must also provide such distinct findings and rationales. The matters are REMANDED for the following actions: 1. Afford the Veteran and his representative opportunity to submit evidence and argument in furtherance of the remanded claims. 2. Undertake reasonable efforts, with the Veteran’s assistance as appropriate, to obtain records of the hospitalization in 1980 when the Veteran’s stroke was first diagnosed and treated. All requests, responses, and records received should be documented in the claims file. If any records cannot be obtained the Veteran and his representative should be appropriately notified. 3. Obtain any VA treatment records and any pertinent private treatment records not yet associated with the claims file. The Veteran’s authorization or assistance should be requested, as appropriate. All requests, responses, and records received should be documented in the claims file. If any records cannot be obtained the Veteran and his representative should be appropriately notified. 4. Then, obtain an additional addendum opinion for the claim disabilities. The examiner must determine whether the Veteran has a disability manifested by dizziness other than vertigo, and if so whether it is at least as likely as not (50 percent probability or greater) that this disease developed in service or is otherwise causally related to service, including based on the Veteran’s treatment for dizziness in service in March 1960. If the records of hospitalization in 1980 are obtained, then an examiner should review these records and the balance of the claims file, and address whether any changes are warranted to the previous opinions addressing: (a) whether the claimed hypertension, vertigo, and stroke at least as likely as not (50 percent or greater probability) developed in service or are otherwise causally related to service, and (b) whether the claimed hypertension, vertigo, and stroke were at least as likely as not (50 percent or greater probability) caused or aggravated (increased in severity beyond natural progress of the disease) by service-connected diabetes mellitus, depression, or coronary artery disease. If the examiner provides a positive opinion for hypertension having developed in or having been causally related to service or having been caused or aggravated by diabetes mellitus, depression, or coronary artery disease, then the examiner should also provide opinions whether stroke or vertigo was at least as likely as not (50 percent or greater probability) caused or aggravated (increased in severity beyond natural progress of the disease) by hypertension. The examiner must provide separate findings and rationales for opinions addressing causation and aggravation by service-connected disability. The examiner should provide an explanation for any opinions or changes to opinions provided. 5. Complete any other necessary development. 6. Then, readjudicate the appealed issues. If the benefits sought are not granted to the Veteran’s satisfaction, the Veteran and his representative must be furnished a supplemental statement of the case (SSOC) and must be given an opportunity to submit a written statement or other argument in response before the claims file is returned to the Board for further appellate consideration. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Schechter The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.