06-12 201
06-12 201
| Board of Vet. App. | Jan 31, 2017Background
- Veteran served on active duty March 1976–January 1986 and appealed VA RO decisions denying service connection for multiple cardiovascular disorders and denying higher ratings for chronic low back pain with sacroiliitis; TDIU was later added to the appeal.
- VA granted service connection for posttraumatic headaches with anisocoria (June 2010) and a 20% rating for low back pain effective December 22, 2008 (May 2012); Veteran seeks higher ratings and service connection for cardiovascular disorders.
- At a May 2016 Board hearing the Veteran asserted in-service elevated blood pressure and that NSAID treatment for his service‑connected back condition aggravated his cardiac disorders; he also reported non‑VA treatment through the Veterans Choice Program.
- The Board found the October 2014 VA cardiology opinion deficient because it did not address in‑service elevated BP readings or possible NSAID aggravation and ordered an addendum opinion or new examination as appropriate.
- The Board also found outstanding VA and non‑VA medical records (post‑June 2016 and Veterans Choice records) must be obtained and associated with the claims file before final adjudication; TDIU was remanded as inextricably intertwined with other claims.
- The Board remanded for development (records collection, claimant notice, assistance obtaining non‑VA records, and a detailed medical opinion addressing onset, causation, and possible NSAID‑related aggravation) and emphasized compliance with VCAA and Stegall requirements.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for cardiovascular disorders | Veteran: elevated in‑service BP readings show hypertension related to service and NSAID use for back pain aggravated heart disease | VA: existing opinion found against service connection/causation but did not address Veteran’s recent contentions | Remanded for addendum opinion addressing in‑service BP and possible NSAID aggravation; obtain further records if needed |
| Increased rating for chronic low back pain with sacroiliitis | Veteran: severity warrants rating >10% before 12/22/2008 and >20% after | VA: previously awarded 20% effective 12/22/2008; did not concede higher staged ratings | Remanded to obtain outstanding non‑VA/Veterans Choice records and reevaluate rating based on complete record |
| Entitlement to TDIU | Veteran: unable to secure substantially gainful employment due to service‑connected disabilities | VA: TDIU decision premature while primary claims unresolved | Remanded as inextricably intertwined with development on service connection and rating claims |
| Adequacy of prior VA medical opinion | Veteran: prior opinion failed to consider in‑service BP readings and NSAID aggravation evidence | VA: relied on prior opinion without addressing new assertions | Remanded for a new/addendum opinion that addresses evidence and provides rationale; exam only if clinician requests |
Key Cases Cited
- AB v. Brown, 6 Vet. App. 35 (1993) (presumption that claimant seeks maximum benefit requires continuing claim for higher rating)
- Parker v. Brown, 7 Vet. App. 116 (1994) (issues are inextricably intertwined when one decision significantly impacts another)
- Harris v. Derwinski, 1 Vet. App. 180 (1991) (discussion of intertwined issues and adjudicative sequencing)
- Dunn v. West, 11 Vet. App. 462 (1998) (VA constructive possession of relevant VA treatment records)
- Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA's duty to obtain and consider relevant records)
- Stegall v. West, 11 Vet. App. 268 (1998) (requirement that AOJ comply with Board remand directives)
- Kutscherousky v. West, 12 Vet. App. 369 (1999) (remand order protects claimants' due process rights and is not a final merits decision)