Citation Nr: 18160396
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 16-24 483
DATE:	December 27, 2018

REMANDED
Entitlement to service connection for hearing condition is remanded.
Entitlement to service connection for hypertension is remanded.
Entitlement to service connection for right knee condition, claimed as weak right knee, is remanded.
Entitlement to service connection for a brain condition, claimed as cerebellar atrophy with old left cerebral infarctor contusion in temporal lobe, is remanded.
Entitlement to service connection for an acquired psychiatric condition, claimed as severe/neurotic depression and mental illness, is remanded.
REASONS FOR REMAND
Missing Treatment Records
There appears to be missing post-service treatment records. On at least two occasions, the Veteran has reported seeing civilian and VA physicians related to his disabilities. Upon remand, the AOJ should contact the Veteran for the names of his private physicians from which he sought treatment for the disabilities on appeal and obtain the authorizations necessary to request the records. Once the authorizations are submitted by the Veteran, the AOJ should take the necessary steps to request the treatment records. Additionally, the AOJ should obtain VA treatment records for the period between March 1988 and 1996, and from 1998 and 2014, to include records from VAMC Ann Arbor, Michigan, and any other VA facilities.
The Board recognizes that the claimed conditions are multi-faceted and multi-layered. The Veteran’s complete treatment records should be obtained for review as an accurate factual history is required for an adequate opinion. The Board defers consideration of additional VA examination pending receipt of the additional development directed above in order to make proper factual determinations. See generally Kahana v. Shinseki, 24 Vet. App. 428 (2011) (discussing the "chicken-or-egg" dilemma faced by the Board when requesting opinions and making credibility determinations with an undeveloped record).
1. Entitlement to service connection for hearing loss.
The Veteran’s treatment records show a current diagnosed condition of hearing loss. The Veteran’s reserve service treatment records show a change in audiological testing results. However, there are no records from after service to address when the hearing loss was first diagnosed or any other treatment for a hearing condition. Therefore, the Board finds that the AOJ should obtain any outstanding records, and then readjudicate the claim.
2. Entitlement to service connection for hypertension
For reference purposes, VA considers systolic pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more, to be indicative of Stage 1 hypertension. A compensable, 10 percent rating for hypertension is warranted for hypertension with diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101.
The Veteran has a diagnosis of hypertension. See, e.g., February 2017 VA Treatment Records.
A review of the Veteran's service treatment records does not reveal any complaints, findings, treatment or diagnoses relating to hypertension. On the January 1985 induction examination, the Veteran's blood pressure reading was 116/74, while on the January 1988 separation examination, the Veteran's blood pressure reading was 120/80. There are no other blood pressure readings available in the Veteran's service treatment records. These readings do not qualify for a diagnosis of hypertension for VA purposes. 38 C.F.R. § 4.104, Diagnostic Code 7101 (2016).
The Veteran has reported seeking treatment for hypertension after service. He notes that he was placed on hypertension medication in 2012. However, there are no records of this treatment.
As such, the Board finds that this issue must be remanded pending the association of all medical records with the claims file.
3. Entitlement to service connection for right knee condition, claimed as weak knee, is remanded.
The Veteran claimed that he had bilateral knee weakness and pain as a result of his service-connected right ankle condition.
In a December 2016 treatment note, the treating physician diagnosed the Veteran with degenerative arthritis of the right and left knee.
In a February 2018 rating decision, the RO deferred evaluation of the left knee, but not the right knee, pending the results of a VA examination.
In a March 2018 VA knee examination, the examiner opined that the left knee condition was caused by the Veteran’s service-connected right ankle condition. However, the examiner did not examine or otherwise address the claimed right knee condition.
The Board finds that a VA examination of the right knee condition is necessary to adjudicate this issue.
4. Entitlement to service connection for a brain condition, to include cerebellar atrophy with old left cerebral infarctor contusion in temporal lobe, is remanded.
The claims file includes evidence of a brain condition, to include the possibility of a stroke, prior to 1998. However, the claims file does not contain medical records prior to 1997. The records are needed to determine whether the Veteran’s claim of service-connection is warranted.
The medical records currently associated with the claims file indicate complaints of memory deficits while in service and following service. Additionally, the Veteran submitted lay statements which indicate problems with memory and other behavioral changes which may indicate that he had a stroke of other condition, either prior to or during active service. 
Therefore, the Board finds that the missing records are needed for adjudication. After the records are obtained, the RO should determine whether a VA examination is needed to determine whether the claimed condition had its onset in service or is otherwise related to service.
5. Entitlement to service connection for acquired psychiatric condition, claimed as severe/neurotic depression and mental illness, is remanded.
The Veteran is claiming service connection for an acquired psychiatric condition. The Veteran has submitted lay evidence indicating a potential onset in service, although there is no evidence of complaints or treatment for psychiatric conditions in the Veteran’s service treatment records. However, there is evidence of significant mental health treatment after service. As noted above, the medical evidence is incomplete and is needed to adjudicate the brain condition, as well as the claimed psychiatric condition.
Further, the Veteran has also submitted a claim for traumatic brain injury (TBI). His claim for service connection for a psychiatric disorder is inextricably intertwined with that unadjudicated claim, as well as the remanded issue of entitlement to service connection for a brain condition and must be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).
The matters are REMANDED for the following action:
1. Obtain any available updated VA treatment records dated since 1988 and associate them with the claims file. 
Ask the Veteran to provide the names and addresses of all private medical care providers. After securing any necessary releases, the AOJ should request any relevant records identified that have not already been associated with record. If any requested records are not available, the Veteran should be notified of such.
2. After the development directed above is completed, schedule the Veteran for a VA examination for his right knee.
The examiner is asked to opine whether it is as least as likely as not (50 percent probability or more) that the Veteran's claimed knee condition had its onset in or is otherwise related to his military service, to include the documented in-service right knee injury?
The examiner should also opine as to whether it is as least as likely as not (50 percent probability or more) that the Veteran's claimed knee condition was caused by or aggravated by the Veteran’s service-connected orthopedic disorders. In so doing, the examiner should consider the opinion of the March 2018 VA examiner as it pertained to the Veteran’s left knee.
3. After completing the requested actions, and any additional action deemed warranted, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran should be furnished a supplemental statement of the case and an opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration, if in order.


 
T. MAINELLI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Michael J. O'Connor 

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