Citation Nr: 21027795 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-40 035 DATE: May 6, 2021 REMANDED Entitlement to service connection for hypertension is remanded Entitlement to service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1985 to July 1990. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision. In October 2018, the Veteran testified at a videoconference hearing at the Regional Office (RO) before the undersigned Veterans Law Judge (sitting in Washington, D.C.). A transcript of that proceeding is of record. In March 2019, the Board remanded the issues on appeal for further development. It is now returned to the Board. After further review of the record, including newly obtained VA treatment records, additional development is needed prior to final adjudication of the issues on appeal. 1. Entitlement to service connection for hypertension The Veteran contends that his claimed hypertension is related to active service. In the April 2021 written brief presentation, the Veteran, through his representative stated that he believes that evidence from service records shows that he had a diagnosis of hypertension at some point while on active duty, and that his service-connected "chronic pain issue that he has had is a contributing factor towards the hypertension." Service treatment records (STRs) show that the Veteran had various blood pressure readings throughout service. An October 1986 record shows a blood pressure reading of 130/90, while an April 11, 1990 medical evaluation board record shows a reading of 116/64. In an August 1988 report of medical examination, clinical evaluation revealed that all was normal except for tenderness of L-S area, and the Veteran's blood pressure at that time was noted as 110/70. STRs also show blood pressure readings of 120/76 in June 1986, 122/80 in February 1988, 110/68 in February 1989, and 124/82 in August 1989. In the March 1989 report of medical history, the Veteran noted yes for high or low blood pressure, and in a July 1989 report of medical history, the Veteran noted cramps in his legs and car, train, sea, or air sickness. The Veteran should be scheduled for a VA examination regarding his claimed hypertension. During the October 2018 Board hearing, the Veteran testified that he has been taking medication ever since separating from service and that when he medically separated from service, the doctor's summary mentioned high blood pressure. VA treatment records show that the Veteran has a current diagnosis of hypertension, and STRs show that during service the Veteran had some high blood pressure readings and reported high blood pressure on the March 1989 report of medical history. However, a VA examination has not been obtained addressing the Veteran's hypertension. Hence, a VA examination and opinion must be obtained. 2. Entitlement to service connection for diabetes mellitus The Veteran contends that his claimed diabetes mellitus is related to active service. In the April 2021 written brief presentation, the Veteran, through his representative, stated that he believes he has developed diabetes as a result of injury incurred in the military, service connected depressed mood and lack of movement and exercise that "plagued" him with the disease. During the October 2018 Board hearing, the Veteran stated that his (service-connected) back pain and other ailments caused him to be sedentary, noting that it got to the point that he was not physically moving. He stated that his last couple of years in the military, he never ran PT and was on a permanent profile and that after service the pain has continued, causing him to sit at home, eventually unable to "bend down to tie his shoe or do anything." He stated that before he knew it, his diabetes snuck up on him when he went in for a regular checkup and learned that he had diabetes. STRs do not show a diagnosis of diabetes mellitus; however, they do show that the Veteran's back was injured, he complained of lower back pain throughout service, and he was placed on a physical profile as a result. In March 2013, the Veteran underwent a VA examination for diabetes. The examination report provides a diagnosis of diabetes mellitus, Type II from March 10, 2003. The examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service-connected back condition. However, the opinion does not address whether the Veteran's sedentary lifestyle may be a result of his service-connected disability and may have led to the Veteran's current diagnosis of diabetes mellitus. In Walsh v. Wilkie, 32 Vet. App. 300 (2020), the Court of Appeals for Veterans Claims held that obesity, although itself ot a disability for which compensation may be awarded, can constitute an "intermediate step" in demonstrating service connection on a secondary basis for another condition. In other words, obesity may be an intermediate step between a service-connected disability and a current disability that may be service connected on a secondary basis. Additionally, an opinion addressing direct service connection is not of record. Hence, a new VA examination and opinion must be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and likely etiology of his hypertension. The examiner must review the claims file in conjunction with the examination, including, but not limited to the Veteran's lay statements, the October 2018 Board hearing transcript, medical treatment records, and medical research cited by the Veteran. (a.) The examiner must provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension had its onset in service, has been continuous since service, or is otherwise related to in-service injury or disease. (b.) The examiner must provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension has been caused or aggravated by a service-connected disability, including his adjustment disorder, right elbow disability, and mechanical low back pain and related radiculopathy. The examiner must support any opinion rendered with a detailed rationale. If the examiner cannot provide the above opinion, the examiner is advised that he or she must explain why the requested opinion cannot be provided. 2. Schedule the Veteran for a VA examination to determine the nature and likely etiology of his diabetes. The examiner must review the claims file in conjunction with the examination, including but not limited to the Veteran's lay statements, the October 2018 Board hearing transcript, medical treatment records, and medical research cited by the Veteran. (a.) The examiner must provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diabetes mellitus had its onset in service, has been continuous since service, or is otherwise related to in-service injury or disease. (b.) The examiner must provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diabetes mellitus has been caused or aggravated by a service-connected disability, including his adjustment disorder, right elbow disability, and mechanical low back pain and related radiculopathy. In this regard, the examiner should opine as to whether the Veteran's obesity was an intermediate step between his service-connected disabilities and his diabetes The examiner must support any opinion rendered with a detailed rationale. If the examiner cannot provide the above opinion, the examiner is advised that he or she must explain why the requested opinion cannot be provided. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Labi, 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.