Citation Nr: 19113121 Decision Date: 02/22/19 Archive Date: 02/22/19 DOCKET NO. 17-28 625 DATE: February 22, 2019 ORDER An initial rating higher than 10 percent for hypertension is denied. An effective date earlier than November 19, 2014, for the grant of service connection for hypertension is denied. REMANDED Entitlement to service connection for stroke is remanded. Entitlement to special monthly compensation (SMC) based on the need of regular aid and attendance is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1971 to December 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision. The April 2015 rating decision granted service connection for hypertension, rated as 10 percent disabling, effective November 19, 2014, denied special monthly compensation (SMC) based on aid and attendance, and denied service connection for stroke. The Veteran appealed the denials of service connection for stroke and SMC, as well as the initial rating and effective date assigned for his service-connected hypertension via a September 2015 notice of disagreement. The Board notes that, in December 2016, the Veteran also appealed a September 2016 rating decision, which granted an earlier effective date of March 22, 1976, for the grant of service connection for paranoid schizophrenia, assigned a higher rating of 100 percent for paranoid schizophrenia, effective May 8, 1979, and assigned the earlier effective date of May 8, 1979, for the grant eligibility to Dependents’ Educational Assistance (DEA) under 38 U.S.C. chapter 35. The RO has still not issued a statement of the case (SOC) for this appeal. Typically, the Board would remand the issues on appeal for issuance of an SOC. See Manlincon v. West, 12 Vet. App. 238, 240 (1999). Here, however, the Board’s Veterans Appeals Control and Locator System (VACOLS) shows that the appeal is ready for review at the RO level. As such, the Board finds that a Manlincon remand is not necessary. 1. Entitlement to a rating higher than 10 percent for hypertension is denied. The Veteran’s hypertension is rated as 10 percent disabling under DC 7101. For the Veteran to be entitled to the next available rating of 20 percent, the evidence must show diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. 38 C.F.R. § 4.104, DC 7101. The Board has reviewed the Veteran’s VA treatment records but found no indication that the Veteran’s hypertension meets the criteria for a rating of 20 percent. VA treatment notes for the period on appeal consistently show diastolic pressure under 110 and systolic pressure under 200. See 05/02/2017 & 01/30/2019, CAPRI. The highest blood pressure reading for this period was an April 2017 reading of 131/99. Treatment notes include indications that the Veteran’s blood pressure was well controlled and within normal limits. There is no argument or indication that these VA treatment records are an inaccurate representation of the severity of the Veteran’s hypertension. As the evidence shows that the Veteran’s hypertension does not meet the criteria for the next available rating of 20 percent, a higher rating for this disability is denied. 2. Entitlement to an effective date earlier than November 19, 2014, for the grant of service connection for hypertension is denied. The Veteran asserts that he is entitled to an effective date earlier than November 19, 2014, for the grant of service connection for hypertension. See 05/19/2015, NOD; 05/26/2017, Form 9. Generally, the effective date for the grant of service connection will be the day following separation from active service or the date entitlement arose, if the claim is received within one year after discharge from service. Otherwise, for an award based on an original claim, claim reopened after a final disallowance, or claim for an increased rating, the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Effective March 24, 2015, claims are required to be filed on standard forms, thus eliminating constructive receipt of claims and informal claims. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). This case involves dates prior to March 24, 2015, so the regulations in place prior to that date are applicable and are referred to in this section. A “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). A claim for VA compensation must generally be in the form prescribed by the VA Secretary. See 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Any communication or action, however, received from the claimant, or certain specified individuals on the claimant’s behalf, that indicates intent to apply for a benefit, and identifies that benefit, may be considered an informal claim. 38 C.F.R. § 3.155(a). After careful review of the record, the Board finds no indication that the Veteran raised the issue of service connection for hypertension at any point prior to November 19, 2014. Rather, the earliest indication of such a claim is a letter from the Veteran’s attorney, which VA received on November 19, 2014, and is the basis for the currently assigned effective date. The Board acknowledges the Veteran’s assertion that he is entitled to an earlier effective date, but notes that neither he or his attorney has pointed to an earlier claim or put forward a specific argument in support of his claim of an earlier effective date. For these reasons, the Board concludes that an effective date earlier than November 19, 2014, is not warranted. REMAND 1. Entitlement to service connection for stroke is remanded. The Veteran seeks service connection for residuals of a 2014 stroke, to include as secondary to his service-connected schizophrenia. In April 2015, a VA examiner noted that VA treatment records showed a diagnosis of ischemic stroke and opined that the latter was a deep vein thrombosis that originated in a lower extremity and, as such, unrelated to the Veteran’s service-connected schizophrenia. The Veteran has submitted medical literature indicating that patients with schizophrenia have a higher risk of stroke, and that hypertension is a known risk factor of stroke. See 11/19/2014, Correspondence, at 33. The April 2015 VA opinion does not show adequate consideration of this evidence. Furthermore, the VA opinion did not consider the extent to which the Veteran’s stroke is secondary to his service-connected hypertension. For these reasons, an adequate opinion is not of record. 2. Entitlement to SMC based on the need of regular aid and attendance is remanded. The Veteran seeks SMC based on the need of regular aid and attendance. This matter is, at least in part, based on his diagnosed stroke. See 11/19/2014, VA 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. As such, the issue of SMC is inextricably intertwined with the issue of service connection for stroke. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (stating that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). For this reason, a decision on the issue of SMC must be deferred until after the outcome of the claim of service connection for stroke. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran’s stroke. The examiner is to respond to the following: (a.) Is the Veteran’s stroke at least as likely as not related to proximately due to a service-connected disability? The Veteran is service-connected for paranoid schizophrenia and hypertension. (b.) Alternatively, are any stroke residuals at least as likely as not aggravated beyond its natural progression by a service-connected disability? The VA opinion should show adequate consideration of the relevant evidence, to include literature submitted by the Veteran. See 11/19/2014, Correspondence. (Continued on the next page)   A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. López, Associate Counsel