Citation Nr: 18144313 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 12-11 866 DATE: October 24, 2018 REMANDED Entitlement to service connection for hypertension, to include as due to service-connected disabilities or exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to May 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2016, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In August 2017, the Board remanded the issue on appeal, as well as a claim for service connection for peripheral neuropathy of the bilateral upper extremities, for additional development. In a July 2018 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for peripheral neuropathy of the right and left upper extremities. As the rating decision represents a full grant of benefits sought on appeal with regard to such claim, it is no longer before the Board. The claim for service connection for hypertension now returns for further appellate review. Entitlement to service connection for hypertension, to include as due to service-connected disabilities or exposure to herbicide agents. As an initial matter, the Board observes that the Veteran originally claimed service connection for hypertension as secondary to his service-connected diabetes mellitus, type II, or due to exposure to herbicide agents. In this regard, at an April 2012 VA examination, the examiner opined that it was less likely than not that the Veteran’s hypertension was caused by his service-connected diabetes, citing to numerous medical records showing the Veteran’s hypertension was diagnosed prior to his diabetes. Furthermore, at a November 2017 VA examination, the examiner reviewed the record and relevant medical literature, and opined that the Veteran’s hypertension was less likely than not related to his military service, to include his exposure herbicide agents, noting that the medical literature regarding the subject does not support such a relationship, and the etiology of his hypertension was multifactorial, primarily due to risk factors not related to service. The examiner also opined that the Veteran’s hypertension was less likely than not aggravated by his diabetes, stating that there was no evidence to support that his hypertension was permanently worsened beyond the natural progression of the disease. However, in an October 2018 Appellant’s Post-Remand Brief, the Veteran’s representative raised new theories of entitlement. Specifically, he contends that the Veteran’s service-connected disabilities other than diabetes, to include prostate cancer and posttraumatic stress disorder (PTSD), may have caused or aggravated his hypertension. Specifically, he contends that PTSD has been associated with cardiovascular problems, citing to the Cecil Textbook of Medicine. He further contends that PTSD would cause or aggravate his hypertension because one symptoms of his PTSD is sleep impairment, and in citing to a Center for Disease Control report, Harvard University study, and WebMD, he contends that such sleep impairment has been linked with the development and management of cardiovascular disease. Consequently, the Board finds another remand is necessary in order to obtain an addendum opinion addressing whether the Veteran’s hypertension is caused or aggravated by his other service-connected disabilities of prostate cancer and PTSD. In this regard, the examiner should consider the Veteran’s representative’s arguments and cited references. The matter is REMANDED for the following action: Return the record to the VA examiner who completed the November 2017 opinion for an addendum opinion. The record and a copy of this Remand must be made available to, and reviewed by, the examiner. If the November 2017 VA examiner is not available, the record should be provided to an appropriate examiner so as to render the requested opinion. The need for an additional examination of the appellant is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that the Veteran’s hypertension is caused or aggravated by his service-connected PTSD and/or prostate cancer. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In offering such opinion, the examiner should consider the Veteran’s representative’s arguments in the October 2018 Appellant’s Post-Remand Brief as well as the cited reference material from the Cecil Textbook of Medicine, Center for Disease Control, a Harvard University study, and WebMD that suggests that PTSD has been associated with cardiovascular problems, and sleep impairment associated with PTSD has been linked with the development and management of cardiovascular disease. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jonathan M. Estes, Associate Counsel