Citation Nr: 21075636 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-14 519 DATE: December 21, 2021 REMANDED Entitlement to service connection for a bilateral hand disability is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for diabetes mellitus, to include as secondary to service-connected PTSD, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1980 to February 1984, and from July 1984 to March 1988. In December 2019, the Board remanded this case for additional development. The Board finds that there has been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a bilateral hand disability is remanded. The Veteran asserts that a bilateral hand disability is the result of service. During an August 2019 Board hearing, the Veteran testified that he injured the hands while in service. An October 1983 medical record shows a right hand injury. The Veteran has several diagnosed bilateral hand disabilities. The Veteran has not been provided a VA examination to determine any possible relationship between a bilateral hand disability and service. The Board finds that while the Veteran's statements may not be competent to be dispositive of the claim, those statements are sufficient to overcome the low threshold necessary to trigger VA's duty to provide an examination. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, remand is necessary to schedule a VA examination. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD, is remanded. The Veteran asserts that hypertension is the result of service. Alternatively, the Veteran asserts that hypertension is secondary to service-connected PTSD. A June 2014 VA examiner opined that hypertension was not related to service because there was not enough evidence that hypertension began in service and remained a chronic condition requiring treatment after service. The examiner stated that although there were intermittent elevated blood pressure readings in service, the 1988 separation examination was not of record. There was no evidence of any three days of blood pressure checks. And, hypertension was not treated until 1991, three years after separation from service. The Board finds that opinion incomplete. The Board notes that for VA purposes, hypertension is defined as a diastolic blood pressure predominantly 90 millimeters or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 millimeters or greater with a diastolic blood pressure of less than 90 millimeters. 38 C.F.R. § 4.104, Diagnostic Code 7101. The service medical records show that the Veteran's blood pressure reading was 122/90 on December 13, 1982; 132/90 on March 23, 1983; 120/80 on March 24, 1983; and 130/100 on May 1983. The average of consecutive office blood pressure readings during that five-month period was 126/90. The Veteran's blood pressure reading was 120/104 on January 8, 1986; 120/86 on March 10, 1986; and 120/80 on March 17, 1986. The average of consecutive office blood pressure readings during that three-month period was 120/90. The Veteran's blood pressure reading was 140/100 on August 8, 1986; 134/94 on August 19, 1986; 124/88 on December 9, 1986; 118/88 on December 10, 1986; and 136/88 on December 15, 1986. The average of consecutive office blood pressure readings during that four-month period was 130/92. While the examiner noted instances of elevated blood pressure, the examiner did not explain why the noted readings did not meet the criteria for hypertension. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Moreover, post-service medical records show that in February 1999, the Veteran "reported a medical history including hypertension, (12 years)..." and in January 2003, the Veteran reported that he had had hypertension since 1988. Additionally, the Veteran testified during the August 2019 Board hearing that he had been taking medication for hypertension since 1988. An opinion based on the absence of medical records without consideration of a Veteran's competent reports is incomplete. Buchannan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In a September 2021 statement, the Veteran's representative stated that hypertension was secondary to service-connected PTSD. The Board is obligated to consider theories of entitlement suggested by the record. Robinson v. Mansfield, 21 Vet. App. 545 (2008). Therefore, remand to schedule a VA examination is necessary. 3. Entitlement to service connection for diabetes mellitus type II, to include as secondary to service-connected PTSD is remanded. In a September 2021 statement, the Veteran's representative stated that diabetes mellitus was secondary to service-connected PTSD. The Board is obligated to consider theories of entitlement suggested by the record. Robinson v. Mansfield, 21 Vet. App. 545 (2008). Therefore, a VA examination is necessary. The matters are REMANDED for the following action: 1. After obtaining any necessary releases, obtain all relevant VA and private treatment records not already associated with the claims file. All attempts to locate records must be documented in the claims file. 2. Then, schedule the Veteran for a VA examination to determine the etiology of any right and left hand disabilities. The examiner must review the claims file, to include a copy of this Remand, and consider the Veteran's lay statements. A clearly stated rationale with references to the record, and medical literature should be provided for each opinion. For each disability diagnosed, the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that any right or left hand disability is related to service or any event, injury, or disease in service. If any hand disability is attributed to another etiology, the examiner should explain why the other etiology is more likely. The examiner should also opine whether it is at least as likely as not (50 percent probability or greater) that any event, injury, or disease in service contributed to or aggravated any current hand disability. 3. Schedule the Veteran for a VA examination to determine the etiology of hypertension. The examiner must review the claim file and should note that review in the report. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension is related to service or any incident of service, to include elevated blood pressures during service. The examiner should specifically address whether it is at least as likely as not (50 percent or greater probability) that elevated blood pressure readings constituted hypertension. The examiner should explain why the blood pressure readings did or did not meet the diagnostic criteria for hypertension. If the rationale is that blood pressures were not taken on three consecutive days, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the available blood pressures indicated the presence of hypertension. The examiner should also comment on any significance of the blood pressure readings in service. A complete rationale must be provided for all opinions. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that hypertension manifested within one year following separation from service. The examiner is asked to specifically comment on the Veteran's reports noted in the February 1999 and January 2003 medical reports. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that hypertension is due to, the result of, or caused by any service-connected disability, to include PTSD. The examiner should address the medical treatise submitted in September 2021 which links hypertension to PTSD. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension has been aggravated (increased in severity beyond the natural progress) by any service-connected disability, to include PTSD. The examiner should address the medical treatise submitted in September 2021 which links hypertension to PTSD. 4. Schedule the Veteran for a VA examination to determine the etiology of diabetes mellitus. The examiner must review the claim file and should note that review in the report. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that diabetes mellitus is related to service or any incident of service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that diabetes mellitus manifested within one year following separation from service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that diabetes mellitus is due to, the result of, or caused by any service-connected disability, to include PTSD. The examiner should address the medical treatise submitted in September 2021 which links diabetes mellitus to PTSD. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that hypertension has been aggravated (increased in severity beyond the natural progress) by any service-connected disability, to include PTSD. The examiner should address the medical treatise submitted in September 2021 which links diabetes mellitus to PTSD. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.O., 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.