Citation Nr: 20024976 Decision Date: 04/10/20 Archive Date: 04/10/20 DOCKET NO. 13-15 917 DATE: April 10, 2020 REMANDED An increased rating higher than 10 percent for the Veteran's service-connected hypertension is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to October 1969 and from September 1976 to September 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2011 rating decision In December 2016 and October 2017, the Board remanded this matter for further evidentiary development. In a November 2018 decision, the Board denied the Veteran’s claims for TDIU and an increased rating for hypertension. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2019 Order, the Court granted a Joint Motion for Remand (JMR), thereby vacating the Board’s denial of an increased rating and TDIU and remanding the issues for development consistent with the terms of the JMR. 1. An increased rating higher than 10 percent for the Veteran's service-connected hypertension is remanded. After re-reviewing the evidence, the Board finds that there was not substantial compliance with its October 2017 remand directives as specifically explained below. See Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, despite the additional and regrettable delay, yet another remand is needed to arrange a VA examination to assess the severity of the Veteran’s service-connected hypertension. 2. TDIU is remanded. TDIU is remanded as intertwined with the Veteran’s increased rating claim and pursuant to the terms of the JMR. The matters are REMANDED for the following action: 1. Please note that, by law, ALL remanded claims must be processed expeditiously. 2. Obtain and associate with the record all outstanding VA treatment records, dated from March 2019 forward. 3. Send the Veteran a letter advising of the following information, which will hopefully be helpful to the Veteran in developing the remanded claims. VA is assisting with developing evidence for these claims by arranging a VA examination as directed below. However, you are strongly encouraged to submit additional evidence to support your claims. For example, you could submit a letter from your doctor describing your blood pressure readings and treatment and stating, as you have reported, that your diastolic blood pressure is predominately higher than 110. Any such letter MUST include a DETAILED explanation for the writer’s conclusion. In addition, if you are measuring your blood pressure at home, you are strongly encouraged to document the readings in a journal/diary/notebook and bring those readings to the VA examination and/or to an appointment with your regular doctor. For TDIU, it would be very helpful for VA if you were to submit a written statement describing how your service-connected disabilities prevent you from working. 4. Once this development is completed to the extent feasible, please schedule the Veteran for an appropriate VA examination to determine the severity of his service-connected hypertension. 5. The Board recognizes that the detailed medical questions require significant work on the part of the medical examiner. The Board regrets the need to remand the matter to the RO, however, the Board is unable to adjudicate the Veteran’s case until it has the requested information. Therefore, the Board must ask the VA examiner and the RO to ensure compliance with these directives (that is, full and thoroughly explained answers to each of the questions) to avoid additional delays in adjudication. Examination Instructions The examiner should have available for review a copy of the criteria in 38 C.F.R. § 4.104, Diagnostic Code 7101, and the findings reported should be sufficiently detailed to allow for application of all pertinent criteria. All indicated diagnostic testing and evaluation should be performed, and all clinical findings reported in detail. The appropriate Disability Benefits Questionnaire (DBQ) should be completed. The examiner’s attention is drawn to the following records (the following is a brief factual background and not intended to be a substitute for your review of the claims folder): • The Veteran’s January 2011 written statement reporting that 1) VA had tripled his blood pressure medication, and 2) that he was hospitalized at VA Bay Pines due to his hypertension. • The Veteran’s February 2011 written statement reporting high blood pressure readings despite medication use • The Veteran’s July 2011 notice of disagreement (NOD) again stating that he was hospitalized in January 2011 for hypertension and that his blood pressure medications had been increased. • The October 2018 appellate brief stating that the Veteran has flare-ups associated with diastolic blood pressure readings higher than 110, dizziness, and blurred vision. The examiner should answer the following questions based on (1) a review of the claims file and (2) interview and examination of the Veteran. Please note that the Veteran is able to report observable symptoms, and, for the purposes of this examination, please assume the Veteran’s reports to be credible. a) Please specifically measure and report the Veteran’s blood pressure at the beginning of the examination and at the end of the examination. In other words, two specific readings must be reported. b) Please describe any symptoms the Veteran experiences due to his hypertension. The examiner MUST specifically state if the Veteran experiences dizziness and/or blurred vision due to his hypertension. Please provided a DETAILED explanation for this answer. c) Please review the entire record, to specifically include the Veteran’s treatment records and lay statements describing blood pressure flare-ups, and state whether during the appeal period (January 2011 to the present) the Veteran’s diastolic blood pressure has been predominately 110 or more. d) Please review the entire record, to specifically include the Veteran’s treatment records and lay statements describing blood pressure flare-ups, and state whether during the appeal period (January 2011 to the present) the Veteran’s systolic blood pressure has been predominately 200 or more. e) Please describe any functional impairment associated with the Veteran’s hypertension. f) Has the Veteran been hospitalized during the appeal period for his hypertension? Please specifically address the Veteran’s report that he was hospitalized in January 2011 due to his hypertension. A detailed explanation (rationale) is requested for all opinions provided and is very much appreciated. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. 6. The AOJ should then review the file and determine 1) if any additional development is warranted regarding the Veteran’s TDIU claim, and 2) if extraschedular referral for either the Veteran’s increased rating or TDIU claim is warranted. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Robinson, 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.