Citation Nr: 19151069 Decision Date: 07/01/19 Archive Date: 07/01/19 DOCKET NO. 12-24 147 DATE: July 1, 2019 REMANDED Entitlement to service connection for hypertension, to include as secondary to and/or aggravated by service-connected diabetes mellitus and/or renal insufficiency, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from November 1967 to November 1970. In May 2014, the Veteran and his wife testified at a videoconference Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The Board denied this claim in February 2018, based on the findings of an October 2017 VA addendum opinion, in which the VA examiner first opined that it is less likely than not that the Veteran’s hypertension was caused by or aggravated specifically by his renal insufficiency, because according to the literature reviewed there is no known cause of hypertension and there was no evidence located that provided support for the Veteran’s claim that renal insufficiency aggravated or caused his hypertension, noting that hypertension was diagnosed in 1997, diabetes type II was diagnosed in 1999 and renal insufficiency did not manifest itself until approximately 2017. The October 2017 VA examiner further opined that it is less likely than not that the Veteran’s diabetes predated his hypertension, explaining that, according to the records, the Veteran reported to his primary care physician in 2006 that his hypertension was diagnosed in 1996 and his diabetes was diagnosed in 1999, and that there was “no other objective evidence found” that supports his claim that his diabetes predated the diagnosis of hypertension. The October 2017 VA examiner also added that “[l]ay statements were reviewed and all medical finding [sic] located were considered.” On appeal to the United States Court of Appeals for Veterans Claims (the Court), the matter has been remanded to the Board for action consistent with the Joint Motion for Remand (JMR), submitted by the parties. The JMR asserts that the Board erred when it relied on the October 2017 VA addendum medical opinion to deny the Veteran’s claim because the October 2017 examiner failed to comment specifically on whether the symptoms described by the Veteran and his wife during their May 2014 hearing testimony were indicative of early onset diabetes, as specified in the Court’s August 2017 remand to the Board. The JMR added that the October 2017 VA examiner’s statement that the lay statements were reviewed does not meet the remand’s directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The JMR further asserts that, while the October 2017 VA examiner opined that it is less likely than not that the Veteran’s hypertension was caused by or aggravated by his renal insufficiency, that opinion appears to be predicated on an inaccurate factual predicate – that his renal insufficiency did not manifest until approximately 2017, when, as the Board had noted in its February 2018 decision, the record shows renal insufficiency was diagnosed as early as November 2010, with other renal diagnoses as early as 1999. The JMR therefore contends a remand is warranted in which the Board should obtain a new addendum or opinion that adequately addresses (1) whether the Veteran’s hypertension was caused or aggravated by his service-connected diabetes mellitus, type II, to include a discussion of whether his lay evidence of symptomatology could be indicative that his diabetes predated his diagnosis of hypertension, and (2) whether his hypertension was caused or aggravated by his service-connected renal insufficiency, associated with diabetes. For these reasons, the Board remands the claim for addendum opinions addressing the above issues. The matter is REMANDED for the following action: 1. Contact the Veteran and his representative for information pertaining to any current treatment for hypertension at any VA facility and by any private treatment provider. Obtain any records of the above treatments not yet associated with the claims file and associate them with the claims file. The assistance of the Veteran and/or his representative should be requested in obtaining any records of recent treatment as indicated. All attempts to obtain records should be documented in the claims file. 2. After all additional records have been obtained and associated with the claims file, but whether or not records are obtained, arrange for a VA examiner with an appropriate specialty for producing findings for hypertension, diabetes mellitus, type II, and renal insufficiency to review the claims file. If the examiner determines a new examination of the Veteran is necessary, arrange for the examination. The complete electronic claims file must be made available to the examiner in conjunction with the examination. The examiner should detail all findings. The examiner is requested to render opinions addressing the following questions: (a) Whether the Veteran’s hypertension was caused or aggravated by his service-connected diabetes mellitus, type II, to include a discussion of whether the symptomatology stated by both the Veteran and his wife in their lay evidence could be indicative of his diabetes pre-dating his diagnosis of hypertension. (b) Whether his hypertension was caused or aggravated by his service-connected renal insufficiency, associated with diabetes. The examiner should take note that, although the October 2017 VA examiner found renal insufficiency did not manifest until approximately 2017, the treatment record in fact shows renal insufficiency was identified in a November 2010 VA treatment note and included among the diagnoses of a September 2011 VA examination for diabetes mellitus. The examiner is further requested to address directly and with specificity the lay evidence provided by the Veteran and his wife in their testimony at the May 2014 Board hearing, as well as their lay statements as they appear throughout the record, which pertain to their observations of symptomatology, to include excessive thirst, cloudy urine, and urine with a distinctive odor, and whether it is indicative of diabetes manifesting prior to the Veteran’s 1999 diagnosis of diabetes mellitus, type II. The examiner should be mindful that merely stating that the lay testimony and statements were “reviewed” or “considered” or any similar phrase will be legally insufficient for the purposes of this appeal. The examiner must discuss why or why not the lay observations of symptomatology indicate the manifestation of diabetes at a date prior to its diagnosis and the examiner should support the conclusion with clinical findings from the record and references to current, accepted medical literature. The examiner should comment on the findings and opinions of other examiners, which appear in the record. In addition, the examiner should acknowledge, address, consider, and discuss all other lay evidence in the record pertaining to hypertension, diabetes mellitus, type II, and renal insufficiency. 3. After completing the above development and any other indicated development, review the record to assure all appropriate development has been undertaken, if no take appropriate corrective action. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Franke, Associate Counsel 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.