Citation Nr: 18131193
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 14-31 560
DATE:	August 31, 2018
Service connection for hypertension is remanded.
The Veteran had active duty from December 20, 1995 to December 19, 1999 (honorable) and from December 20, 1999 to May 3, 2000 (dishonorable for VA benefits purposes).  
This matter is on appeal to the Board of Veterans’ Appeals (Board) from a January 2012 rating decision of a regional office of the Department of Veterans Affairs (VA). 
In July 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge of the Board.  A transcript of the hearing is associated with the record. 
Remand is warranted to reconcile the conflicting medical evidence of record and to obtain an adequate medical opinion.
The record reflects a December 2011 VA medical opinion opining that the Veteran’s claimed hypertension is less likely caused by or had onset in service.  The examiner noted that the Veteran had “4 isolated marginally elevated [blood pressure] readings among 17 normal BP readings” with no three-day blood pressure monitoring and no diagnosis of hypertension during service.  The examiner further explained that having isolated, slightly elevated blood pressure readings are “not indicative of hypertension” or that hypertension began in military service. See Hypertension Disability Benefits Questionnaire (DBQ) dated December 2011.   
The record also reflects an August 2017 statement from the Veteran’s treating physician, J.M.D., M.D., concluding that “based on elevated diastolic pressure of 90 on several occasions” the Veteran had hypertension while in military service and the “disease is as likely as not related to his military service.”  The physician indicated that he was provided a list of blood pressure values and that based on the blood pressures that were obtained, the physician found the “frequency of the diastolic pressure of 90 or nearly 90 [as] excellent support for [the Veteran’s] claim of hypertension while in military service.” See Statement by J.M.D., M.D. of Dauphin Orthopedics dated August 16, 2017.   
First, the December 2011 VA examiner’s medical opinion is inadequate as it, necessarily, could not reflect consideration of the Veteran’s lay statements and onset of symptoms of headaches, dizziness, and nausea in service as asserted during the Veteran’s July 2017 Board hearing. See Hearing Transcript pp. 4-5.  Also, the VA opinion reflects the Veteran’s inaccurate report of first being diagnosed in 2001.  During the hearing, the Veteran testified that he was not diagnosed until approximately 2004.
Similarly, the August 2017 private opinion is inadequate. Although Dr. J.M.D. indicated that his opinion was based on an “abundance of data” and blood pressure values obtained, it is unclear what evidence was used or reviewed by the physician in rendering his opinion.  Specifically, it is unclear if Dr. J.M.D. was provided blood pressure readings from the Veteran’s period of dishonorable service which is barred from consideration.
To that end, the Board notes that the dishonorable character of the Veteran’s discharge from period of active duty from December 20, 1999 to May 3, 2000 constitutes a bar to VA benefits. See 38 U.S.C. § 5303; 38 C.F.R. § 3.129(a).
Given the conflicting December 2011 and August 2017 medical opinions, remand is needed to reconcile the above and to obtain a new etiological opinion that also takes into consideration the Veteran’s lay statements.
The matter is REMANDED for the following action:
1. Copies of updated treatment records should be obtained and added to the claims file.
2. Following completion of the above, obtain an opinion from an appropriate VA medical professional to determine the nature and etiology of the Veteran’s hypertension. The Veteran’s claims file, to include a copy of the remand, along with any other information the medical professional deems pertinent must be made available.  A note that it was reviewed should be included in the opinion.  If the reviewer determines that an examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled.  
After reviewing the claims file, the examiner is to provide an opinion as to whether the Veteran’s hypertension at least as likely as not (a 50 percent or greater probability) had its onset in or is directly linked to the Veteran’s period of honorable service (from December 20, 1995 to December 19, 1999).
The provided examination opinion must reflect consideration of both the medical (including private opinion from Dr. J.M.D. dated August 2017) and lay evidence of record (the Veteran’s July 2017 hearing testimony) setting forth a complete rationale for all findings and conclusions.  
The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion.  
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. An, Associate Counsel

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