Citation Nr: 0001999 Decision Date: 01/27/00 Archive Date: 02/02/00 DOCKET NO. 97-06 902 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Fort Harrison, Montana THE ISSUE Entitlement to service connection for hypertension on a secondary basis. REPRESENTATION Appellant represented by: Montana Veterans Affairs Division WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James R. Siegel, Counsel INTRODUCTION The veteran served on active duty from June 1954 until his retirement in June 1975. This matter comes to the Board of Veterans Appeals (Board) from a June 1996 rating decision of the Regional Office (RO) which, in pertinent part, denied the veteran's claim for service connection for hypertension secondary to his service- connected psychiatric disability. When this case was previously before the Board in June 1998, it was remanded for additional development of the record. The Board points out that it denied the claim for an increased rating for a skin disorder in the June 1998 determination. Effective March 1, 1999, the name of the United States Court of Veterans Appeals was changed to the United States Court of Appeals for Veterans Claims ("the Court"). REMAND The veteran argues that service connection should be established for hypertension on the basis that it is secondary to his service-connected anxiety neurosis. As noted in June 1998, various medical records refer to a relationship between hypertension and the veteran's psychiatric disability. In this regard, the Board notes that in July 1996, a physician commented that anxiety increased hypertension, although it was not the cause. Later that month, the examiner indicated that the veteran had been in high stress, demanding positions and that she had not doubt that his hypertension and the state of his blood vessels had been aggravated by his lifestyle, induced by his military service. The Board notes that on Department of Veterans Affairs (VA) examination in July 1997, it was concluded that there was no evidence that the veteran's anxiety was a causative agent in his hypertension. However, no comment was rendered concerning whether anxiety aggravated hypertension. Following the Board's remand in June 1998, the veteran was afforded a VA examination. The examiner, a physician, failed to provide the opinions requested by the Board. The RO subsequently referred the veteran's claims folder to a physician's assistant, who concluded that anxiety will cause increased blood pressure readings, but did not cause the medical condition of essential hypertension or make the condition worse. In Allen v. Brown, 7 Vet. App. 439 (1995), an en banc Court held that "disability" as set forth in 38 U.S.C.A. § 1110 (West 1991) "refers to impairment of earning capacity, and that such definition mandates that any additional impairment of earning capacity resulting from an already service- connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, shall be compensated." Thus, when aggravation of a veteran's non- service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Thus, the question currently before the Board is whether the veteran's service-connected anxiety neusosis caused or aggravated the veteran's hypertension. The veteran's representative argues that the opinion obtained by the RO was given by a physician's assistant, not a medical doctor. The Board notes that it had requested an examination by a specialist in cardiovascular disease, and this was not accomplished. The Board is obligated by law to ensure that the RO complies with its directives, as well as those of the Court. The Court has stated that compliance by the Board or the RO is neither optional nor discretionary. Where the remand orders of the Board or the Court are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). The veteran's claims folder should be referred to a specialist in cardiovascular disease, and the physician should be asked to render an opinion as to whether it is at least as likely as not that that the veteran's anxiety neurosis caused his hypertension or aggravated it beyond its normal course. If the examiner concludes that anxiety neurosis resulted in an increase in the severity of hypertension, he should specify the extent to which the disability was aggravated. If this cannot be done, the examiner should so state. The examiner should set forth the rationale for all opinions expressed. Following completion of the above, the RO should review the evidence and determine whether the veteran's claim may now be granted. If not, he and his representative should be furnished an appropriate supplemental statement of the case, and the case should then 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. Deborah W. Singleton Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (1999).