Citation Nr: 18160577
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 16-52 671
DATE:	December 27, 2018
REMANDED
Entitlement to service connection for gouty arthritis is remanded.
Entitlement to service connection for a heart disorder is remanded.
Entitlement to service connection for hypertension is remanded.
Entitlement to service connection for the residuals of a hiatal hernia is remanded.
REASONS FOR REMAND
The Veteran served in the New York Air National Guard and had verified periods of active duty from October 1988 to April 1990, from April 1995 to June 1995, and from April 2007 to July 2007.  
These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision.
The Board also notes that the appeal originally included the issue of entitlement to service connection for posttraumatic stress disorder (PTSD).  However, the Agency of Original Jurisdiction (AOJ) granted service connection for a mild persistent depressive disorder with anxious mood (claimed as PTSD) in an August 2016 rating decision.  The Veteran did not express disagreement with that decision. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997).  Therefore, the issue is no longer on appeal.
In an October 2016 statement, the Veteran’s representative noted that the August 2016 statement of the case (SOC) acknowledged that the Veteran had been a member of the Air National Guard for many years and that he was activated on many occasions with several periods of active duty.  He argued that the AOJ has not provided the Veteran sufficient information as to which periods of service constituted active duty or active duty for training (ACDUTRA) for purposes of compensation.  He also noted that the October 2013 rating decision included periods of service from August 1993 to September 1993, from April 1995 to June 1995, from February 2002 to June 2002, and from April 2007 to July 2007, but a DD Form 2014 within the claims file also indicated that the Veteran had active service from October 1988 to April 1990.  The representative stated that the claims file also confirmed that the Veteran had active duty deployments in September 1994, September 1997, September 1998, from April 1999 to May 1999, October 2001, September 2005, and from April 2007 to July 2007.  He further noted that the record contained several pre-deployment health assessments, which he contended implied additional deployments that have not been verified.  Therefore, on remand, the AOJ should verify the Veteran’s Air National Guard service and obtain any additional service personnel records and service treatment records pertaining to such service.
In addition, a review of the record reflects that the Veteran has received private medical treatment for his claimed disorders.  Although some private treatment records have been submitted in support of his claims, there appear to be outstanding records that have not been obtained.  Specifically, in a June 2013 VA treatment note, the Veteran reported that he went into cardiac arrest and was hospitalized at Peconic Bay Medical Center in May 2013 and that he subsequently underwent a cardiac catheterization and defibrillator placement at Stony Brook Hospital in June 2013.  The Veteran also identified a private primary care physician and a private cardiologist in June 2013 and July 2013 VA treatment notes.  Therefore, on remand, the AOJ should attempt to obtain any outstanding private treatment records.
The Veteran was afforded VA hypertension, heart, and hand examinations in September 2013.  The September 2013 VA examiner opined that the Veteran’s hypertension and heart disorders were at least as likely as not incurred in or caused by the Veteran’s service.  The VA examiner noted that the Veteran’s hypertension originated in service and that he continued to receive treatment for his hypertension.  She also noted that the Veteran started having arrhythmias while in service, which eventually led to cardiac arrest, and implantation of an automatic implantable cardioverter-defibrillator (AICD).  However, the VA examiner did not provide etiology opinions for the Veteran’s gouty arthritis or residuals of a hiatal hernia.   
In his October 2016 statement, the Veteran’s representative noted that the record contained an April 1990 line of duty determination indicating that doctors had determined that the Veteran’s hernia was caused by the increased physical fitness program required by the military.  In addition, he noted that the September 2013 VA examiner did not address whether the Veteran’s heart disorder was aggravated by service and that she did not address whether the Veteran’s hypertension had progressed from earlier reports of high blood pressure within the service treatment records dated in October 1989.  
On remand, the AOJ should afford the Veteran additional VA examinations to address these contentions.  The VA examiner should also be provided with a list of the Veteran’s verified periods of qualifying service.
The matters are REMANDED for the following action:
1.  The AOJ verify the Veteran’s service in the New York Air National Guard from August 1988 to June 2011.  The AOJ should also secure all available service personnel and treatment records pertaining to such service.
The AOJ should verify any periods of active duty, ACDUTRA, and inactive duty for training (INACDUTRA) in the Air National Guard and determine whether such periods were federal service.  A summary of those dates should be documented in the record.
As set forth in 38 U.S.C.A. § 5103A (b)(3) and 38 C.F.R. § 3.159(c)(2), the AOJ should continue efforts to locate such records until it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile.  The Veteran should be notified of any action to be taken.
2.  The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his gouty arthritis, heart disorder, hypertension, and residuals of a hiatal hernia.  After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file.  Specific requests should be made for any outstanding private treatment records from the Veteran’s private primary care physician, Dr. K.; his private cardiologist, Dr. L.; and any private hospitalization records, as identified in VA treatment records dated in June 2013 and July 2013.
The AOJ should also secure any outstanding VA medical records.
3.  After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any current gouty arthritis that may be present.  The AOJ should provide the examiner with a summary of the periods of verified active service that may be considered for VA compensation purposes.
Any studies, tests, and evaluations deemed necessary by the examiner should be performed. 
The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements.
It should also be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation.
The examiner should opine as to whether it is at least as likely as not that the Veteran has gouty arthritis that manifested during a verified period of active service or is otherwise causally or etiologically related to a period of active service, to include any injury or symptomatology therein.
(The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.)
A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review.
4.  After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any current heart disorder that may be present.  The AOJ should provide the examiner with a summary of the periods of verified active service that may be considered for VA compensation purposes.
Any studies, tests, and evaluations deemed necessary by the examiner should be performed. 
The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements.
It should also be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation.
The examiner should opine as to whether it is at least as likely as not that the Veteran has a heart disorder that manifested during a verified period of active service or is otherwise causally or etiologically related to a period of active service, to include any injury or symptomatology therein.
(The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.)
A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review.
5.  After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any current hypertension that may be present.  The AOJ should provide the examiner with a summary of the periods of verified active service that may be considered for VA compensation purposes.
Any studies, tests, and evaluations deemed necessary by the examiner should be performed. 
The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements.
It should also be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation.
The examiner should opine as to whether it is at least as likely as not that the Veteran has hypertension that manifested during a verified period of active service or is otherwise causally or etiologically related to a period of active service, to include any injury or symptomatology therein.
In rendering this opinion, the examiner should specifically address reports of increased blood pressure in October 1989 service treatment records.
(The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.)
A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review.
6.  After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any current residuals of a hiatal hernia that may be present.  The AOJ should provide the examiner with a summary of the periods of verified active service that may be considered for VA compensation purposes.
Any studies, tests, and evaluations deemed necessary by the examiner should be performed. 
The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements.
It should also be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation.
The examiner should opine as to whether it is at least as likely as not that the Veteran has any residuals of a hiatal hernia that manifested during a verified period of active service or are otherwise causally or etiologically related to a period of active service, to include any injury or symptomatology therein.
(The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.)
A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review.
 
J.W. ZISSIMOS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. Osegueda, Counsel

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