Citation Nr: 21040958 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-15 271A DATE: July 7, 2021 REMANDED The claim for service connection for hypertension is remanded. The claim for a rating in excess of 10 percent for a disability impacting the fingers of the right hand is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Army from October 1953 to October 1955. His military specialty (MOS) was general construction worker. Military personnel records show that he served in Korea from July 1954 to October 1955. A September 2017 Board decision denied the Veteran's claims for service connection for hypertension and a rating in excess of 10 percent for his right hand finger disabilities, which the Veteran appealed to the United States Court of Appeals for Veterans Claims ("CAVC" or "the Court"). In August 2018, the Court issued an order vacating the September 2017 Board decision on these two issues and remanded the above referenced claims for compliance with a Joint Motion for Partial Remand (JMPR). Hypertension Pursuant to JMPR, a July 2019 Board decision remanded the issue of service connection for hypertension for further development to conduct a VA examination and obtain a nexus opinion. The Board specifically requested the examiner address the lay statement that his hypertension was incurred coincidental to his military service or as result of it, as well as the April 2019 private medical opinion by Dr. Maron stating that although the Veteran did not participate in actual combat activity, he was subject to the worry and stress of standing guard in a war zone during Korea war, and chronic stress had been long presumed to be a factor in the development of hypertension. A VA medical opinion was obtained in July 2020 stating that the Veteran's hypertension was less likely (less than 50 percent probability) caused by his service. The examiner explained that service treatment records (STRs) did not show any complaint, management, or treatment of hypertension while in active service, that the only information on the Veteran's high blood pressure was in the post service Progress Note of December 06, 1989, with a BP: 136/78, (34 years after being discharged from active duty), and that this did not support the Veteran's lay statement. However, the examiner did not address the April 2019 private medical opinion (contained in 4/15/2019 document entitled "Correspondence"). Another VA medical opinion was obtained in June 2021 stating that the Veteran's hypertension was less likely (less than 50 percent probability) caused by his service. The examiner explained that the Veteran's hypertension was diagnosed in 2003 and that there was no evidence of high blood pressure during service or a year from discharge. Again, this VA medical opinion did not address the April 2019 private medical opinion (contained in 4/15/2019 document entitled "Correspondence"). As the Board's July 2019 remand directives requesting the examiners to address the April 2019 private opinion were not complied with, another remand of this matter is required to ensure such compliance. Stegall v. West, 11 Vet. App. 268 (1998). Right Finger Pursuant ot JMPR, the July 2019 Board decision remanded the issue for further development to conduct a VA examination to assess the severity of the Veteran's right finger disabilities, as well as to provide the Veteran with an opportunity for a new hearing for his increased rating claim for the right finger disabilities. The hearing officer was to inform the Veteran that a rating in excess of 10 percent may be available on an extraschedular basis or if the evidence shows ankylosis in one or more digits. Subsequently, the Veteran was afforded VA hand examinations in July 2020 and June 2021. However, the claim's file does not appear to contain a document showing that agency of original jurisdiction (AOJ) has provided the Veteran with an opportunity for a new hearing for his right finger disabilities. In addition, in a May 2021written argument, the Veteran's representative requested a 70 percent rating for the Veteran's right finger disabilities based on a private opinion by Dr. Pascuale dated May 2021that "it is more likely than not that the functional impairment of the right hand is of such an extent that no effective function remains other than that which would be equally well served by amputation with prosthesis." However, Dr. Pascuale's opinion is contradictory to the findings in the VA examinations in July 2020 and June 2021. Further development is thus warranted. Therefore, the matters are REMANDED for the following actions: 1. Obtain a VA medical opinion to address the etiology of the Veteran's hypertension. The examiner should answer the following questions: Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension either began during or was otherwise caused by his active service, to include his wartime military service? Why or why not? In doing so, the examiner should address (1) the Veteran's lay statement that his hypertension was incurred coincidental to his military service or as result of it, and (2) the April 2019 private medical opinion by Dr. Maron (See 4/15/2019 document entitled "Correspondence.) 2. Provide the Veteran with an opportunity for a new hearing for his increased rating claim for the right finger disabilities, the hearing officer should inform the Veteran that a rating in excess of 10 percent may be available on an extraschedular basis or if the evidence shows ankylosis in one or more digits. 3. Obtain a VA medical opinion to address Dr. Pascuale's opinion in May 2021 stating that "it is more likely than not that the functional impairment of the right hand is of such an extent that no effective function remains other than that which would be equally well served by amputation with prosthesis." (See 5/28/2021 document entitled Medica Treatment Record-Government Facility). The examiner should provide adequate rationale to support his or her conclusions. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Wang, 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.