BVA9507605 DOCKET NO. 93-14 058 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for hypertension. 2. Whether new and material evidence has been received to reopen the veteran's claim for service connection for calcification of the carotid arteries. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Thomas H. Tousley, Associate Counsel INTRODUCTION The veteran had active military service from September 1950 to May 1952 and from December 1956 to June 1987. By a rating decision in April 1988, the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, denied the veteran's claims for service connection for hypertension and for calcification of the carotid arteries. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions in March 1992 and August 1992 by the Louisville, Kentucky RO. The RO determined that the April 1988 rating decision was final, and that the veteran had not submitted new and material evidence to reopen his claims for service connection for hypertension and for calcification of the carotid arteries. In November 1992, the veteran testified at a hearing at the RO. That same month, the hearing officer determined that new and material evidence had been received to reopen the veteran's claim for service connection for hypertension, but that the evidence did not establish service connection for the disorder. REMAND Initially, the Board finds that the veteran has submitted a well- grounded claim for service connection for hypertension and for calcification of the carotid arteries within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The service medical records show the veteran was seen during the early 1970's for drainage from the rectum. His blood pressure reading was 154/90. A weight control worksheet dated in October 1983 shows a blood pressure reading of 146/80. In addition, it was noted on the report of an electrocardiogram (EKG) performed in February 1980 that there was a history of elevated blood pressure readings. Elevated cholesterol and triglyceride levels were noted in January 1985 and on the retirement examination in February 1987. Hyperlipidemia was diagnosed in January 1985. The veteran testified at a hearing at the RO in November 1992 that he was advised on different occasions during service that he had elevated blood pressure readings. The first time was at an annual physical examination in California between January 1965 and June 1966. The second time was at an annual physical examination in Vietnam around January or February 1971. The third time was around 1981 or 1982 when he received a flu shot while stationed in Japan. In December 1992, the RO requested specific service medical records from the National Personnel Records Center (NPRC) pertaining to the incidents described by the veteran. In February 1993, the NPRC informed the RO that no service medical records were available for the period prior to 1970 as well as the report of a physical examination in 1971. The Board finds that the RO fulfilled its duty to assist the veteran in the procurement of additional service medical records. Within one year of separation from service, the veteran had three consecutive blood pressure readings on separate occasions with diastolic measurements that exceeded 90. His blood pressure reading on December 8, 1987 was 152/92. His blood pressure reading on December 11, 1987 was 132/94. At that time, an X-ray of the cervical spine showed calcification of the carotid arteries. His blood pressure reading on January 25, 1988 was 162/100 with a notation that his blood pressure had not been lowered due to change in diet. A provisional diagnosis of hypertension was made at the time of the last blood pressure reading. In February 1988, the results of a Doppler study were interpreted to show no significant evidence of carotid artery occlusive disease. In November 1988, shortly after the one year presumptive period ended, the veteran began taking anti-hypertensive medication. Blood pressure readings throughout 1990, 1991, and 1992, showed systolic measurements in excess of 140 and diastolic measurements in excess of 90. As the result of a VA Compensation and Pension examination in May 1992, an examining physician diagnosed mild hypertension. The Board notes that the RO denied the veteran's claim for hypertension on the basis that the hypertension shown during the one year presumptive period following service was not manifested to a degree of 10 percent to establish service connection on a presumptive basis. However, 38 C.F.R. § 3.303(d) (1994) provides that the presumptive period is not intended to limit service connection when it is warranted based on all the evidence. The veteran contends that since he had almost 30 years of service, the hypertension and calcification of the carotid arteries must have been present during service. The veteran does not possess the medical expertise to offer such a medical opinion, see Espiritu v. Derwinski, 2 Vet.App. 492, 494-495 (1992), but the diagnoses of hypertension and calcification of the carotid arteries soon after almost 30 years of service raises a medical question as to whether these disorders were present during service. The VA is not free to ignore 38 C.F.R. § 3.303(d) (1994). See Schafrath v. Derwinski, 1 Vet.App. 589, 593 (1991). In addition, the Board is not free to offer its own medical opinion. See Colvin v. Derwinski, 1 Vet.App. 171, 175 (1991). Although the veteran received a VA examination in May 1992 as requested, a medical opinion was not obtained as to whether the hypertension and calcification of the carotid arteries were related to service. The duty to assist includes the procurement of a medical opinion to clarify diagnostic doubt. See Green v. Derwinski, 1 Vet.App. 121, 124 (1991). Accordingly, the case is REMANDED to the RO for the following action: 1. The RO should obtain and associate with the claims folder all VA treatment records pertaining to the veteran since December 1992. The RO should also associate with the claims folder page 413 of the Merck Manual (16th ed. 1993) mentioned in the November 1992 decision of the hearing officer. 2. Once the VA treatment records have been obtained, the veteran should be afforded a VA examination by a cardiologist in conformity with the VA's Physician's Guide for Disability Evaluation Examinations (1985) to determine the nature, severity, and etiology of the veteran's hypertension and bilateral carotid artery calcification and any other current cardiovascular disease. The examiner is requested to review the claims folder, including the copy of this remand, the service medical records, and the veteran's testimony at the November 1992 RO hearing, as well as the current examination findings. Based on this evidence, the examiner is requested to offer an opinion as to the probable time of onset of the veteran's essential hypertension and calcification of the carotid arteries and any other cardiovascular disorder diagnosed by the cardiologist. A complete rationale for any opinion expressed is requested. Therefore, the claims folder must be made available to the examiner for review prior to, and during the examination. 3. After the action requested in the above indented paragraphs has been completed, the RO should adjudicate service connection for hypertension and whether new and material evidence has been received to reopen a claim for service connection for calcification of the carotid arteries. In the event that the RO does not accept the medical opinion of the examining cardiologist, the RO is requested to furnish specific reasons for rejecting the physician's medical opinion. For any reopened claims, the RO should also specifically address whether service connection has been established on a presumptive basis under 38 C.F.R. §§ 3.307, 3.309 (1994), or on a direct basis under 38 C.F.R. § 3.303(d) (1994) based on a review of all the evidence. 4. If any of the benefits sought on appeal are not granted, the veteran and his representative should be provided a supplemental statement of the case and provided the applicable period of time to respond before the case is returned to the Board for further review. The purpose of this REMAND is to assist the veteran in the development of his claims for service connection. The Board does not intimate any opinion as to the merits of this case, either favorable or unfavorable, at this time. No action is required of the veteran until he is notified. WARREN W. RICE, JR. 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).