Citation Nr: 22018105 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-38 869 DATE: March 28, 2022 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1981 to January 1985, from December 1990 to July 1991, from May 1999 to July 1999, from November 2001 to September 2002, and from February 2003 to August 2003, with additional periods of service with United States Air Force Reserve (Reserve). This matter comes before the Board of Veteran's Appeals (Board) from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2021 when it was remanded for development. The Board finds the September 2021 remand directives have not been substantially complied with, and the matter must be remanded again. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for hypertension is remanded. The Veteran seeks service connection for hypertension. In support of his claim the Veteran asserts the condition manifested during one of his periods of service, or is otherwise related to his service. Particularly, at a hearing before the RO, in September 2018, the Veteran explained that he was treated for hypertension as early as the year 1998 and that he was noted to have hypertension for the first time while on-duty with the Reserves. Additionally, he explained that he had been noted to have high blood pressure incidentally during treatment for kidney stones prior to 1998. See hearing transcript of November 2018. Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA or injury incurred or aggravated by INACDUTRA. 38 U.S.C. §§ 101(24), 106, 1110, 1131. For a member of a Reserve component, ACDUTRA means full-time duty performed by Reserves for training purposes. INACDUTRA means duty (other than full-time) prescribed for Reserves under section 206 of title 37 of the United States Code or any other provision of law. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In consideration of the above, particularly the distinction between ACDUTRA and INACDUTRA for service connection purposes, the Board remanded this matter with instruction to the RO to "determine all of the Veteran's periods of ACDUTRA and INACDUTRA, particularly from January 1997 through January 1998." See September 2021 Board remand. On remand, pay records were obtained from the Defense Finance and Accounting Service (DFAS) for the period covering February 1997 to January 1998. See Correspondence from DFAS, associated with the claims file in November 2021. However, the RO did not determine whether the Veteran's service during these months constituted ACDUTRA or INACDUTRA. The Board acknowledges the payment records obtained from DFAS show the Veteran was some type of duty during November 1997 and January 1998, in view of the payment worksheets showing codes "50" and "22" on certain dates for those months. However, the payment worksheets do not explain or provide a definition for the codes "50" and "22" listed on days of each month. As such, the Board is unable to determine whether the Veteran was on ACDUTRA or INACDUTRA during these dates, and subsequently, the Board is unable to find there has been substantial compliance with the Board remand directive to determine the "Veteran's periods of ACDUTRA and INACDUTRA, particularly from January 1997 through January 1998." On remand, verification should be sought from DFAS on the significance of the "50" and "22" codes listed on days of each month in the payment worksheets obtained. Additionally, the Board observes that pursuant to the remand directives a medical opinion was obtained in November 2021 addressing the likely etiology of the Veteran's hypertension. However, the opinion obtained did not address whether the elevated blood pressure readings noted in the November 1997 periodic examination report represented the initial onset of the Veteran's hypertension, as requested by the Board in the remand. As such, the Board is unable to find there has been substantial compliance with the prior remand directive. Furthermore, the Board observes the November 2021 opinion appears to be based on an incomplete review of the evidence of record, as the examiner only referenced some blood pressure readings for the Veteran's first period of active-duty service in 1982 and 1983, and omitted consideration of the blood pressure readings for 1997 and 1998. Thus, upon remand, a new opinion addressing the likely etiology of the Veteran's hypertension must be obtained. As requested in the prior remand, the medical opinion must address whether the elevated blood pressure readings noted in the November 1997 periodic examination report represented the initial onset of the Veteran's hypertension. Additionally, the examiner is asked to clarify whether blood pressure readings in 1982 and 1983 were consistent with "hypertension stage 1 or prehypertension" as suggested in the medical opinion of November 2021, and if so, whether the Veteran's hypertension had its onset during this period of service; in view of the available STRs. The matter is REMANDED for the following actions: 1. Request clarification from DFAS as to what the different codes, such as "50" and "22," represent when listed on days of the month on payment worksheets, e.g., active duty ACDUTRA, INACDUTRA, active duty for special work, etc. 2. Thereafter, determine all of the Veteran's periods of ACDUTRA and INACDUTRA, particularly from January 1997 through January 1998. 3. Obtain a new medical opinion addressing the likely etiology of the Veteran's hypertension. If the examiner determines an examination is necessary to provide the requested opinion, such examination must be scheduled. Following a review of the Veteran's claims file, the examiner is asked to address whether: a. Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension had its initial onset during active service or during a period of ACDUTRA, or is otherwise related to any in-service disease, event, or injury? i. Please address whether the elevated blood pressure readings noted in the November 1997 periodic examination report represented the initial onset of the Veteran's hypertension, and ii. Clarify whether blood pressure readings in 1982 and 1983 were consistent with "hypertension stage 1 or prehypertension" as suggested in the medical opinion of November 2021, and if so, whether the Veteran's hypertension had its onset during this period of service; in view of the available STRs. 4. After completing the above requested actions, and any additional notification and/or development deemed warranted, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, furnish to the Veteran and his representative an appropriate supplemental statement of the case that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Gonzalez-Maldonado 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.