BVA9506055 DOCKET NO. 93-10 965 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to a compensable disability evaluation for bilateral hearing loss. 2. Entitlement to service connection for diabetes mellitus. 3. Entitlement to service connection for coronary artery disease. 4. Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Theresa M. Catino, Associate Counsel INTRODUCTION The veteran served on active military duty from January 1945 to March 1956 and from June 1956 to November 1965. In the January 1992 rating decision the regional office (RO) granted service connection for bilateral hearing loss and rated the disability as noncompensably disabling and also denied service connection for coronary artery disease, hypertension, diabetes mellitus, glycometabolism (poor healing), deep vein thrombosis of the left leg, an abdominal disorder, an eye disorder described as loss of visual acuity correctable with glasses, and obesity. The veteran was notified of this rating decision in the same month. The appeal with respect to the claims of entitlement to service connection for glycometabolism (poor healing), deep vein thrombosis of the left leg, an abdominal disorder, an eye disorder described as loss of visual acuity correctable with glasses, and obesity has not been perfected. Although the RO informed the veteran in the February 1993 supplemental statement of the case that his appeal with respect to these issues had not been perfected and gave him an additional 60 days to submit a substantive appeal, no substantive appeal was received at the RO. Consequently, the Board of Veterans' Appeals (Board) does not have jurisdiction over these issues. Also, in the notice of disagreement and in the substantive appeal, the veteran requested copies of his service medical records. It does not appear that the RO has responded to this request, and the matter is referred to the RO for appropriate action. REMAND According to the service medical records, in May 1964 the veteran was found to have elevated blood pressure of 140/94, and the diagnosis of mild diastolic hypertension secondary to exogenous obesity was made. However, at the retirement examination, which was conducted in June 1965, the veteran's blood pressure was 148/86, and no findings of hypertension were noted on the examination report. Furthermore, the veteran reported at the retirement examination that he did not at that time, and never did have, trouble with high or low blood pressure. The first post-service evidence of high blood pressure or hypertension is dated in September 1971, when a possible blood pressure reading of 180/120 was noted, and the diagnosis of hypertensive vascular disease was made. At the November 1991 Department of Veterans Affairs (VA) examination, the examiner diagnosed essential hypertension under treatment. The examiner noted on the examination report that the veteran has had hypertension since May 1964 and has been under treatment for this disorder since 1970. Significantly, however, the examiner did not express an opinion as to whether or not the veteran's present hypertension is related to, or caused by, the May 1964 diagnosis of mild diastolic hypertension secondary to exogenous obesity. Neither the Board nor the RO can substitute its judgment for a medical opinion. The United States Court of Veterans Appeals has held that VA decisions must be based on medical evidence rather than on unsubstantiated opinion. If the medical record is insufficient or of doubtful weight or credibility, the RO is free to supplement the record by seeking an advisory opinion. Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). Moreover, in September 1956 during service, sugar in the veteran's urine was noted. In September 1971, diabetes mellitus was suspected. By March 1973, the veteran was considered diabetic. At the November 1991 VA examination, the diagnosis of diabetes mellitus was made. Significantly, however, the examiner did not express an opinion as to whether the veteran's diabetes is in any way related to, or was caused by, the in-service episode in which sugar was found in the veteran's urine. Such an opinion should be obtained prior to adjudication of the claim for service connection for diabetes mellitus. See, Colvin v. Derwinski, 1 Vet.App. at 175 (1991). The Board concludes that further assistance to the veteran is required. Accordingly, the case is REMANDED to the RO for the following: 1. The veteran should be contacted and requested to furnish a complete list of all medical personnel and facilities from which he has received treatment for his hypertension, coronary artery disease, and diabetes mellitus from November 1965 to September 1971. After obtaining the appropriate releases from the veteran where necessary, the health care providers should be contacted and requested to provide all treatment records in their possession pertaining to the veteran. If these records are unavailable, that fact should be annotated in the claims folder. Any available records should be associated with the claims folder. 2. The veteran should be accorded a VA endocrinology examination to determine the nature, extent, and etiology of his diabetes mellitus. The report of examination should include a detailed account of all manifestations of the disorder found to be present. All necessary tests should be conducted, and the examiner should review the results of any testing prior to completion of the report. The examination should be conducted in accordance with the diagnostic procedures outlined in the VA Physician's Guide for Disability Evaluation Examinations. The endocrinologist must review the claims file, including the service medical records and the post-service medical records, and express an opinion as to whether the veteran's present diabetes mellitus is in any way related to the September 1956 in-service episode of sugar found in his urine. The claims folder must be made available to and reviewed by the examiner prior to the examination. The specialist should provide complete rationale for all conclusions reached. 3. The veteran should also be accorded a special VA cardiovascular examination to determine the nature and extent of his arteriosclerotic heart disease as well as to determine the nature, extent, and etiology of his hypertension. The report of examination should include a detailed account of all manifestations of these disorders found to be present. The examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. All necessary tests should be conducted, and the examiner should review the results of any testing prior to completion of the report. The cardiologist must review the claims file, including the service medical records and the post-service medical records, and express an opinion as to whether the veteran's present hypertension is in any way related to the mild diastolic hypertension secondary to exogenous obesity noted in service in May 1964. The claims folder must be made available to and reviewed by the examiner prior to the examination. The cardiologist should provide complete rationale for all conclusions reached. 4. Following the above, the veteran should be accorded a VA audiological examination to determine the nature and extent his service-connected bilateral hearing loss. All necessary tests, including audiometric testing, should be conducted, and the examiner should review the results of any testing prior to completion of the reports. The examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations. 5. The RO should review the examination reports and determine if they are adequate for rating purposes and in compliance with this Remand. If not, they should be returned for corrective action. 6. Thereafter, the RO should formally adjudicate the issue of entitlement to an increased rating for bilateral hearing loss and the issues of service connection for coronary artery disease, hypertension, and diabetes mellitus. Following completion of these actions, and, if the decision remains unfavorable, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. The purpose of this REMAND is to obtain clarifying evidence. No action is required of the veteran until further notice is issued. WILLIAM J. REDDY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).