Citation Nr: 0001673 Decision Date: 01/20/00 Archive Date: 01/28/00 DOCKET NO. 99-04 185 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Alabama Department of Veterans Affairs ATTORNEY FOR THE BOARD D. Orfanoudis, Associate Counsel INTRODUCTION The appellant served in the Alabama Army National Guard from 1977 to 1996, to include a period of active duty for training (ACDUTRA) from March 1977 to August 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1999 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, which denied the appellant's claim for entitlement to service connection for hypertension. The appellant filed a timely notice of disagreement and perfected a substantive appeal. This matter was previously before the Board in May 1999, wherein it was remanded for additional development. FINDING OF FACT The appellant's claim for entitlement to service connection for hypertension is plausible. CONCLUSION OF LAW The appellant's claim for entitlement to service connection for hypertension is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION The threshold question which must be determined is whether the appellant's claim is well grounded. An appellant who submits a claim for benefits to VA shall have the burden of offering sufficient evidence to justify a belief by a fair and impartial individual that the claim is well grounded. See 38 U.S.C.A. § 5107(a) (West 1991). In the absence of evidence of a well-grounded claim, the Board is unable to assist the appellant in developing the facts pertinent to his claim. Morton v. West, 12 Vet. App. 477 (1999). A claim for service connection is well-grounded if three criteria are met: (1) there is competent medical evidence of a current disability/medical diagnosis; (2) there is competent lay or medical evidence that a disease or injury was incurred in service or aggravated by military service; and (3) there is competent medical evidence of a nexus, or of a causal relationship between the inservice incurrence/aggravation and the current disability. See Caluza v. Brown, 7 Vet.App. 498 (1995). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may also be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty for training (ACDUTRA) or injury incurred or aggravated by inactive duty for training (INACDUTRA). 38 U.S.C.A. §§ 101(24), 106, 1110, 1131 (West 1991). Direct service connection may be established for a current disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(a), (b), (d) (1999). A review of the appellant's service medical records reveals that the November 1976 enlistment examination showed a blood pressure reading of 140/90. In the report of medical history the appellant indicated that he did not then have, nor did he ever have high blood pressure. The June 1977 separation examination showed a blood pressure reading of 138/100. The associated report of medical history also dated in June 1977 and completed by the appellant, shows that he indicated that he did not know whether he then had, or whether he ever had high blood pressure. Subsequent to the appellant's period of active duty for training, periodic examinations and chronological records of medical care which were conducted throughout the appellant's periods of inactive duty training in the National Guard show that the appellant was treated for high blood pressure and hypertension. The first apparent indication subsequent to the period of active duty for training of elevated blood pressure is in a chronological record of medical care dated in June 1981 which shows a blood pressure reading of 160/110, and a report of medical examination dated in September 1981 wherein a notation was made that the appellant was taking high blood pressure medication. The veteran's blood pressure was 154/90. Also of record are a number of private medical records dated from 1994 to 1995 which show that the appellant continued to be treated for hypertension, at times uncontrolled. To summarize, current evidence tends to show that the current hypertension may be related the veteran's period of ACDUTRA, either directly or by aggravation. Accordingly, the Board finds that the claim is plausible and is, thus, well grounded. ORDER The claim for entitlement to service connection for hypertension is well grounded and to this extent only, the claim is granted. REMAND Having determined that the appellant's claim for entitlement to service connection for hypertension is well grounded, the VA has a statutory duty to assist the appellant in the development of evidence pertinent to his claim. 38 U.S.C.A. § 5107 (West 1991). As indicated hereinabove, this matter was previously before the Board in May 1999, wherein it was remanded for additional development, to include a VA examination. A review of the appellant's claims folder reveals that he was scheduled for a VA examination in June 1999, but that he failed to report. Thereafter, the case was returned to the Board for review. During the pendency of the appeal, the appellant submitted a Statement In Support Of Claim dated in October 1999 wherein he indicated he did not attend the scheduled examinations due to his health and that he would like to have a VA examination rescheduled. Accordingly, the Board is of the opinion that additional development is required prior to further adjudication of this matter. Additionally, in June 1999, the appellant indicated that he had treatment for his high blood pressure at the Panama Hospital during his annual training in Panama in 1978. He also indicated that he received treatment for high blood pressure during basic training in El Paso, Texas, in 1977. Accordingly, the case is REMANDED to the RO for the following actions: 1. The RO should furnish appellant the appropriate release of information forms in order to obtain copies of any additional VA and private medical records regarding treatment for his hypertension that are not already on file. The RO should then obtain all records, which are not on file. The RO should ask the veteran to identify the dates, locations and the name of the treating facilities regarding treatment for the hypertension in Texas and in Panama in 1978. The appellant should be informed that he has the opportunity to submit additional evidence and arguments in support of his claim. 2. The RO should contact the appropriate sources in order to obtain any additional service medical records based on the information furnished by the appellant. The RO should also verify all pertinent ACDUTRA dates not previously verified. 3. The appellant should be rescheduled for a VA examination by a specialist in cardiovascular disorders in order to determine the severity and etiology of the hypertension. The claims folder and a copy of this REMAND are to be made available to the physician for review in conjunction with the examination. Following the examination it is requested that the examiner render an opinion as to when the hypertension was initially manifested? If it is determined that the hypertension was present at the time of the veteran's entry into ACDUTRA ( March 1977) the examiner is requested to render an opinion as to whether it is as likely as not that the hypertension underwent a chronic increase in service beyond normal progression during ACDUTRA. A complete rational for any opinion expressed should be included in the examination report. 4. It is requested that the RO inform the veteran of the consequences of failing to report for a VA examination per 38 C.F.R. § 3.655 (1999). 5. After the development requested above has been completed to the extent possible, the RO should readjudicate the issue in appellate status. If the benefit sought on appeal remains denied, the appellant and his representative should be furnished a supplemental statement of the case and an opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. ROBERT P. REGAN Member, Board of Veterans' Appeals