BVA9505719 DOCKET NO. 93-10 679 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUE Whether new and material evidence has been submitted to reopen the veteran's claim for service connection for hypertensive cardiovascular disease. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Alice A. Booher, Counse INTRODUCTION The veteran had active service from April 1966 to April 1968. Entitlement to service connection for hypertension was initially denied by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado, in July 1986; the veteran was so informed and did not file a timely appeal. At a personal hearing held at the RO in 1988, the veteran attempted to reopen his claim. In March 1991, the Board of Veterans' Appeals (the Board) found that new and material evidence to ropen a claim for service connection for hypertension had not been presented. In 1992, the veteran applied to reopen his claim for service connection for hypertensive cardiovascular disease, status post myocardial infarction, coronary artery bypass graft, and peripheral vascular disease. This appeal is taken from the rating action by the RO in September 1992. In his Substantive Appeal, a VA Form 1-9, dated in January 1993, the veteran sought to add to his appeal the issues of entitlement to an increased evaluation for his back disorder and service connection for liver disease (previously denied by the RO including claimed as hepatitis). Service connection for liver/urethral problems was denied in January 1993 on the basis that the claim was not reopened. In March 1993, the veteran filed a VA Form 21-4138 relating to service connection for liver disease. A rating action in April 1993 continued the prior denials of service connection and confirmed the 20 percent rating for his back disorder. Only the issue of new and material evidence as regards service connection for hypertension has been subject to a Statement of the Case and otherwise fully developed for appellate review. The case was administratively remanded to the RO by the Board in July 1993 so the veteran, who is a physician, could provide testimony before a member of the Board at a personal hearing held at the RO. A hearing was held at the RO in December 1993; a Transcript is of record, hereinafter known as Tr. At that hearing, the veteran submitted evidence on which he waived RO consideration. In August 1994, a copy of a letter from the veteran to P. Schroeder, M.C., was received by the Board, in which the veteran sought service connection for a mole on the right optic nerve as a result of Vietnam service. That issue is not part of the current appeal, and is not inextricably intertwined therewith. However, the attention of the RO is directed to that claim for appropriate initial consideration. REMAND At the personal hearing, the representative argued that the veteran's initial claim for service connection for hypertension was on a direct basis; that he sought now to reopen that claim, as well as introduce a claim for service connection for hypertension as being secondary to his service-connected anxiety reaction; and that the secondary hypothesis had not been considered by the RO. Tr. at 3. The veteran subsequently clarified that he intended that his claim reflect that the hypertension was not secondary to anxiety reaction, per se, but that the syncopathy that brought on the diagnosis of anxiety reaction was in fact a symptom of the hypertensive heart disease. Tr. at 6. It was argued, in substance, that while extensive evidence has been submitted over recent years relating to care for heart problems (i.e., report of a VA evaluation in 1968, private hospitalization in 1971, a statement by S. Levitsky, M.D. in November 1991 relating to treatment for hypertension in service, etc.) that none of this appears to have been considered by the RO. He further testified that the decision to deny his claim had been made as a predetermination rather than with the benefit of medical opinion. Tr. at 4. The veteran testified that while in a combat situation in service, another physician, who specialized in cardiology, thought he was hypertensive and suggested diuretics, but he declined because of the circumstances. Tr. at 8-10. He further reported that he had experienced elevated blood pressure on another occasion while in Hawaii; and that a physician had diagnosed (what he personally thought was labile) hypertension in 1967. Tr. at 9. The veteran testified that he had been found to have elevated blood pressure when he was 16 years old when he was at Western Washington College. Tr. at 11-12. He reported that in service, he had been a heavy smoker, and under a great deal of stress, all of which were substantial risks for hypertension in addition to predisposing congenital aspects such as a hypercholesteremia. Tr. at 4. As a physician, he argued that in general, he believed that his records had not been interpreted correctly, and that on retrospect, it might well have been that he had a myocardial infarction within 11 months of separation from service. He reported chest pain intermittently since 1969. Based on the evidence of record, the Board finds that additional development might be beneficial. Accordingly, the case is REMANDED for the following actions: 1. After appropriate release from the veteran, the RO should obtain all of the veteran's clinical records from the Western Washington College or University, High Street, Bellingham, NY, which the veteran reportedly entered in September 1956 [Tr. at 12]. These records should be added to the claims folder. 2. After completion of the above, the veteran should be afforded an examination by a VA cardiologist, who should offer an opinion regarding the duration, extent, chronology and etiology of the veteran's hypertension and hypertensive vascular disease. The entire claims folder as well as all records obtained pursuant to this REMAND must be made available to the specialist prior to the examination. 3. Thereafter, the case should be reviewed by the RO. If the decision remains unsatisfactory, a supplemental statement of the case should be prepared, including all pertinent law and regulations and citing, in detail, all pertinent evidence; and the veteran and his representative should be afforded a reasonable opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. The veteran need do nothing further until so notified. THOMAS J. DANNAHER 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).