Citation Nr: 21008561 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 12-31 405 DATE: February 17, 2021 REMANDED Entitlement to service connection for a heart disorder, including coronary artery disease (CAD), to include as secondary to service-connected major depressive disorder (MDD), is remanded. Entitlement to service connection for hypertension, to include as secondary to service connected MDD, is remanded. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service connected MDD, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to service connected MDD, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service connected MDD, is remanded. Entitlement to a rating in excess of 40 percent for a bilateral hearing loss disability for the period prior to July 15, 2011 is remanded. Entitlement to a rating higher than 50 percent for hearing loss from July 15, 2011 is remanded. REASONS FOR REMAND The Veteran had active service from August 1964 to February 1967. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2015, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Video Conference hearing. A transcript of his testimony is of record. These matters were last before the Board in October 2018, when they were remanded for additional development. 1. Entitlement to service connection for a heart disorder, including CAD, to include as secondary to service connected MDD, is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to service connected MDD, is remanded. 3. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service connected MDD, is remanded. 4. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to service connected MDD, is remanded. 5. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service connected MDD, is remanded. 6. Entitlement to a rating in excess of 40 percent for a bilateral hearing loss disability for the period prior to July 15, 2011 is remanded.   7. Entitlement to a rating higher than 50 percent for hearing loss from July 15, 2011 is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. In pertinent part, the August 2017 and October 2018 remands directed that various records from VistA Imaging be associated with the claims file. Specifically, VA treatment records from July18, 2018, April 2, 2018, March 13, 2018, March 8, 2018, February 20, 2018, February 5, 2018, October 30, 2017, July 21, 2017, July 3, 2017, April 13, 2017, March 29, 2017, March 22, 2017, February 9, 2017, February 7, 2017, January 23, 2017, January 5, 2017, December 29, 2016, November 21, 2016, October 6, 2016, July 19, 2016, June 8, 2016, May 26, 2016, March 30, 2016, January 20, 2016, October 6, 2015, July 7, 2014, June 12, 2014, April 22, 2014, April 16, 2014, March 24, 2014, March 10, 2014, September 4, 2013, May7, 2013, May 6, 2013, January 29, 2013, January 22, 2013, January 16, 2013, December 14, 2012, December 6, 2012, October 18, 2012, October 17, 2012, October 15, 2012, April 14, 2011, April 1, 2010, November 27, 2009, and November 23, 2009 indicate that potentially relevant neurology, hematology, endocrinology, and cardiology records had been scanned into VistA Imaging. While the RO obtained copies of the VA record entries referencing the scanned VistA Imaging records, it does not appeal that copies of the actual scanned records that were purported to have been stored in VistA Imaging were obtained. Accordingly, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The October 2018 remand also requested an addendum opinion to address whether the Veteran’s hypertension was secondary to his MDD. While an addendum opinion was obtained in September 2020, the clinician did not, as requested, address the Veteran’s assertion that psychological stress from his MDD resulted in blood pressure elevations that worsened his hypertension. Finally, the evidence indicates there may be other outstanding relevant VA treatment records. Specifically, VA treatment records from August 12, 2020, August 5, 2020, July 20, 2020, June 2, 2020, March 6, 2020, January 15, 2020, September 5, 2019, August 25, 2019, July 21, 2019, July 20, 2019, April 4, 2019, June 6, 2018, January 8, 2018, July 19, 2017, July 17, 2014, and February 7, 2014 indicate that home health records, neurology, cardiology records from had been scanned into vista imaging. It does not appear that these records have been associated with the claims file. Additionally, VA audiology notes from August 20, 2009, November 15, 2011, May 1, 2013, December 1, 2014, and September 17, 2019 indicate that audiograms had been obtained and were “viewable via the tools menu of CPRS.” The referenced audiogram results are not of record. A remand to obtain the outstanding records is required. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records dated since October 9, 2020, all audiogram test results from May 20, 2009 to present available “via the tools menu of CPRS” and referenced in the August 20, 2009, November 15, 2011, May 1, 2013, December 1, 2014, and September 17, 2019 audiology records, as well as the VistA Imaging records referenced in the August 12, 2020, August 5, 2020, July 20, 2020, June 2, 2020, March 6, 2020, January 15, 2020, September 5, 2019, August 25, 2019, July 21, 2019, July 20, 2019, April 4, 2019, July 18, 2018, June 6, 2018, April 2, 2018, March 13, 2018, March 8, 2018, February 20, 2018, February 5, 2018, January 8, 2018, October 30, 2017, July 21, 2017, July 19, 2017, July 3, 2017, April 13, 2017, March 29, 2017, March 22, 2017, February 9, 2017, February 7, 2017, January 23, 2017, January 5, 2017, December 29, 2016, November 21, 2016, October 6, 2016, July 19, 2016, June 8, 2016, May 26, 2016, March 30, 2016, January 20, 2016, October 6, 2015, August 13, 2015, July 17, 2014, July 7, 2014, June 12, 2014, April 22, 2014, April 16, 2014, March 24, 2014, March 10, 2014, February 7, 2014, September 4, 2013, May 7, 2013, May 6, 2013, January 29, 2013, January 22, 2013, January 16, 2013, December 14, 2012, December 6, 2012, October 18, 2012, October 17, 2012, October 15, 2012, November 15, 2011, April 14, 2011, April 1, 2010, November 27, 2009, and November 23, 2009 VA record entries. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above is completed to the extent possible, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's hypertension. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the hypertension is worsened beyond natural progression (aggravated) by his service connected MDD. In so opining, the clinician must address the assertion that the psychological stress related to the Veteran’s MDD resulted in elevations of his Veteran’s blood pressure that worsen his hypertension. (b.) If the clinician finds that the Veteran's hypertension was aggravated by his service connected MDD, the clinician should attempt to quantify the level of aggravation beyond the baseline level of they hypertension. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Anderson 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.