Citation Nr: 18143361 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 11-10 621 DATE: October 18, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for renal disease is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Army from October 1969 to October 1971, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2009 and October 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The July 2009 rating decision denied the Veteran’s claim of entitlement to service connection for hypertension, and the October 2009 rating decision denied the Veteran’s claim of entitlement to service connection for renal disease. These matters were most recently before the Board in October 2017, at which time they were remanded for further development. Regrettably, for reasons discussed below, yet another remand is necessary before the Board may adjudicate the Veteran’s claims.   1. Entitlement to service connection for hypertension is remanded. In an August 2017 Informal Hearing Presentation (IHP), the Veteran’s representative cited several peer-reviewed medical sources to support the Veteran’s contention that his hypertension was caused or aggravated by his service-connected posttraumatic stress disorder (PTSD). Consequently, the Board remanded the Veteran’s claim for a new VA examination, specifically directing the examiner to consider the material in reaching an opinion. The Veteran was afforded a new VA examination in November 2017. Unfortunately, the examiner did not address the newly submitted material in reaching an opinion concerning the connection between the Veterans PTSD and hypertension. Therefore, the Board finds the examination to be inadequate for purposes of adjudication, and remand is necessary to obtain an addendum opinion. 2. Entitlement to service connection for renal disease, to include as secondary to a service-connected disability is remanded. The Veteran claims renal disease as secondary to hypertension. As the Veteran’s claim of entitlement to service connection for hypertension will necessarily impact his claim for service connection for renal disease, the two issues are inextricably intertwined and the claim for renal disease must also be remanded pending adjudication of the Veteran’s claim for hypertension. See Harris v. Derwinski, 1 Vet. App. 180, 183. The matters are REMANDED for the following actions: 1. Return the file, including a copy of this Remand, to the VA examiner who provided the examination in November 2017 for an addendum opinion. If that examiner is unavailable, the opinion should be obtained from another suitable examiner. The need for an in-person clinical examination is left to the examiner’s discretion. Following review of the claims file and the Remand, the following must be addressed: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was proximately caused by any of the Veteran’s service-connected disabilities (i.e. PTSD and diabetes mellitus, type II)? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was aggravated by any of his service-connected disabilities, to include his service connected PTSD and diabetes mellitus, type II. Aggravation is defined as chronic exacerbation beyond the natural progression of the condition. A complete and thorough rationale must be provided for all opinions. In doing so, the examiner must specifically address the literature supporting a causal link between PTSD and hypertension referenced by the Veteran’s representative in his August 2017 Informal Hearing Presentation. (Continued on the next page)   If the examiner cannot provide an opinion without resorting to speculation, he or she must provide a complete and thorough rationale as to why an opinion cannot be provided. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. T. Raftery, Associate Counsel