Citation Nr: 18123937
Decision Date: 08/06/18	Archive Date: 08/03/18

DOCKET NO. 14-25 246A
DATE:	August 6, 2018
Entitlement to a rating in excess of 10 percent for service-connected hypertension is remanded.
The Veteran served on active duty from February 1978 to October 1987.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision which, in pertinent part, denied a disability rating in excess of 10 percent for the Veteran’s service-connected hypertension.
1. Entitlement to a rating in excess of 10 percent for service-connected hypertension is remanded.
The Veteran contends that his service-connected hypertension is more severe than it is currently rated.
The Veteran last attended a VA examination in October 2015.  He alleges that his blood pressure is not under control despite taking multiple medications, and that his blood pressure has worsened since his last VA examination.  As there is an indication that the disability on appeal may have increased in severity, the Board finds it necessary to remand the claim for a contemporaneous examination to ensure that VA meets its duty to assist. 38 C.F.R. § 3.159 (c)(4)(i) (2017); see Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (indicating that a Veteran is entitled to a new examination after a two-year period between the last VA examination and the veteran’s contention that the pertinent disability had increased in severity); see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (holding that VA’s statutory duty to assist includes a thorough and contemporaneous medical examination); Littke v. Derwinski, 1 Vet. App. 90, 93 (1990) (noting that remand may be required if the record before the Board contains insufficient medical information for evaluation purposes).
In addition, the Veteran testified that he saw one physician both at a private clinic and a VA medical facility.  It is not clear that the Veteran’s current medical records are associated with the claims file.  On remand, the RO should make attempts to locate any relevant medical records that are not already associated with the claims file before scheduling the Veteran for a new VA examination.  
The matter is REMANDED for the following action:
1. Obtain any outstanding VA treatment records related to the Veteran’s hypertension disability and associate those records with the claims file.
2.  Ask the Veteran to complete a VA Form 21-4142 for any private physician who has provided treatment for the Veteran’s service-connected hypertension disability.  Make two requests for the authorized records from any physician identified by the Veteran, unless it is clear after the first request that a second request would be futile.
3. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension disability.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria.  The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups.  To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s hypertension disability alone and discuss the effect of the Veteran’s hypertension disability on any occupational functioning and activities of daily living.  If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Boal, Associate Counsel

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