Citation Nr: 21003469 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 19-08 455 DATE: January 21, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus type II (diabetes), is remanded. Entitlement to service connection for macular degeneration, to include as secondary to diabetes mellitus type II (diabetes), is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1965 to August 1967. This matter comes before the Board of Veterans Appeals from the August 2018 rating decision of the Department of Veterans Affairs (VA) regional office (RO). The Veteran testified at a hearing with a Veterans Law Judge (VLJ) in August 2020. A copy of that hearing is associated with the record. This hearing was before a now-retired judge. In a November 2020 letter, the Board notified the Veteran that the VLJ who held the August 2020 hearing was no longer employed by the Board and offered the Veteran the opportunity to have an additional hearing; however, the Veteran did not respond to this letter within the allotted 30-day time period, as such, it is assumed that he declined the opportunity for another Board hearing. However, the Board must remand the claims to obtain VA medical records and to obtain addendums to the VA medical opinions. Outstanding VA Treatment Records During the Veteran’s hearing, the Veteran stated his hypertension and diabetes was identified by a VA physician in 2005 or 2006. The representative stated, and the Board found, the claims file was devoid of any VA treatment records prior to 2014. The VLJ who presided over the hearing granted a 90-day extension for the Veteran to attempt to obtain records prior to 2014. See Hearing Transcript, dated August 11, 2020, pages 6-8. The RO should contact the Veteran to obtain information regarding the location and approximate dates of his treatment and attempt to obtain the treatment records. VA Medical Opinions The Veteran asserts that his hypertension and bilateral macular degeneration are secondary to his service-connected diabetes. As a threshold matter, the Veteran is diagnosed with hypertension and macular degeneration. In conjunction with his claim, the Veteran was provided VA compensation examinations in August 2018. The examiner opined that the Veteran’s hypertension was less likely as not related to his diabetes. The examiner was unable to provide rationale due to lack of supporting evidence and stated there was substantial overlap of evidence that existed between diabetes and hypertension, reflecting overlap in their etiology and disease mechanisms. The examiner noted that hypertension occurs in approximately 50 to 80 percent of patients with diabetes mellitus type II; conversely diabetes mellitus type II was almost two- and one-half times more likely to develop in subjects with hypertension as in subjects with normal blood pressure. The examiner then noted the Veteran was diagnosed with diabetes in 2015 and hypertension was diagnosed in February 2015 and referenced to February 2017 rating decision as evidence the disabilities are unrelated. Although the VA examiner stated she did not have sufficient evidence to provide a rationale she seemingly discussed the relatedness of the diabetes and hypertension. In other words, the rationale does not support the conclusion. Furthermore, the examiner only opined as to causation, and did not opine as to whether the diabetes aggravated his hypertension beyond its natural progression. See El-Amin v. Shinseki, 26 Vet. App. 136 (2012). The examiner opined that the Veteran’s macular degeneration is less likely as not related to his diabetes. The examiner stated that macular degeneration occurs due to the aging process as well as the genetic tendency of some individuals to lose certain pigments located in the macula of the retina, but the depletion of these pigments is in no way related to diabetes, and having a history of diabetes did not put someone at higher risk for the development of macular degeneration. While the examiner addressed the question of causation, she did not specifically opine as to whether the macular degeneration is aggravated by his diabetes. See El-Amin, supra. Accordingly, remand is also necessary to obtain additional VA medical opinions as to the etiology of the Veteran’s hypertension and macular degeneration. Lastly, the examiner should be asked to address a more recent medical opinion authored by the Veteran’s treating physician. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file, particularly prior to 2014. The Veteran reports that he received VA treatment for claimed disabilities in 2005 or 2006. Contact him and ask him to identify the VA Medical facility where he received such treatment and the approximate dates of treatment. Then obtain the identified records. 2. Then, obtain a medical opinion from an appropriate VA examiner regarding the etiology of the Veteran’s hypertension. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review these materials. The need for another examination is left to the discretion of the medical professional offering the opinion. After a review of the record, the examiner is asked to respond to the following: (a) Provide an opinion as to whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s hypertension is aggravated by his service-connected diabetes mellitus type II. *In doing so, address the VA treating physician’s November 2018 medical opinion that hypertension and diabetes together cause significantly more vascular disease than either one alone. 3. Then, return the claims file to the August 2018 VA examiner or, if unavailable, another qualified examiner, and obtain an addendum opinion regarding the etiology of the Veteran’s macular degeneration. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review these materials. The need for another examination is left to the discretion of the medical professional offering the opinion. After a review of the record, the examiner is asked to respond to the following: (b.) Provide an opinion as to whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s macular degeneration is aggravated by his service-connected diabetes mellitus type II. *In doing so, address the VA treating physician’s November 2018 medical opinion. A complete rationale should be provided for all opinions. 3. Thereafter, readjudicate the remanded claims. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moldawer, 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.