Citation Nr: 18144238 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 12-30 647 DATE: October 24, 2018 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served in the United States Army from August 1962 to February 1963, and in the United States Navy from July 1963 to September 1963. This matter comes to the Board of Veterans' Appeals (Board) from an April 2012 rating decision. In December 2014 and April 2017, the Board remanded the claim for service connection for hypertension. The Board regrettably finds that a remand for further development is warranted as there has not been substantial compliance with the April 2017 Board remand. The current claim that the hypertension was related to the Veteran’s service or, caused or aggravated by, the Veteran’s service connected posttraumatic stress disorder (PTSD) disability, needs to be re-evaluated with a VA examination. The May 2018 VA examiner stated that there was no basis to favorably link the Veteran’s hypertension to any in-service event, symptom, sign or complaint, and the examiner also found no basis for linking the Veteran’s hypertension as caused or aggravated by the Veteran’s psychiatric disability. According to the examiner, the basis for these opinions was that the Veteran had an extensive psychiatric background as far back as 1958, and did not develop hypertension until after 2000. However, the opinion is provided prior to the RO’s August 2018 decision to service connect the Veteran’s PTSD that arose out of his service in the 1960’s and does not adequately explain how such disability, which has been assigned a 70 percent rating since December 2011, did not aggravate the Veteran’s hypertension beyond its natural progression. Additionally, the Board’s prior remand also specifically requested that the examiner further consider whether the Veteran’s hypertension was aggravated by the medications that the Veteran takes to treat his service-connected psychiatric disorders, and this question was not addressed. Thus, a new examination with an adequate rationale is warranted. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. Any outstanding VA treatment records should be associated with the claims file. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After the above development has been completed and all records have been associated with the claims file, the Veteran must be afforded a VA examination by an examiner who has not yet examined the Veteran with appropriate expertise to determine the nature and etiology of the Veteran's claimed hypertension. Any and all studies, tests, and evaluations that are deemed necessary should be conducted. The Veteran’s claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records and specifically the Veteran's hearing testimony, VA and private treatment records, and the VA examination report. The examiner should then: (a) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that any currently diagnosed hypertension originated during, or is etiologically related to, active duty service. (b) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the currently diagnosed hypertension was caused or aggravated by the Veteran's service-connected PTSD, to include the medication the Veteran takes to treat his acquired psychiatric disorders. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. R. Montalvo, Associate Counsel