Citation Nr: 18147276 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 13-28 050 DATE: November 2, 2018 REMANDED Service connection for hypertension is remanded. Service connection for a heart disability other than hypertension, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1972 to June 1974, with additional National Guard service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. In June 2015, the Board remanded for further development the issues of service connection for hypertension, a heart disability, hearing loss, tinnitus, and a left knee disability. The Board notes that an August 2018 rating decision granted service connection for hearing loss, tinnitus, and a left knee disability. Thus, those issues will not be addressed in this remand, as the August 2018 rating decision fully granted the benefits sought on appeal with respect to those issues. 1. Service connection for hypertension is remanded. 2. Service connection for a heart disability, to include ischemic heart disease with myocardial infarction and stenting, is remanded. The Board regrets the additional delay, but further development is necessary concerning the remaining issues in this appeal. The June 2015 Board remand directed that the Veteran be provided an examination and medical nexus opinion, as the only relevant opinion of record was inadequate. See February 2011 VA Medical Opinion; June 2015 Board Remand. However, the medical opinion provided by the May 2018 VA examiner is also inadequate, as her opinion is not responsive to the June 2015 Board remand directives and is premised on a lack of a diagnosis during active duty. (In this regard, the Board observes that it does not appear that the examiner was ever informed of the June 2015 Board remand directives.) Thus, an addendum opinion is required on remand. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998). Furthermore, the agency of original jurisdiction (AOJ) is again directed to verify the Veteran’s periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). See Stegall, 11 Vet. App. 268. Finally, the Board observes that the AOJ requested records for the wrong range of dates from one of the Veteran’s medical providers. Cf. August 2010 VA Form 21-4142; August 2010 Records Request. On remand, the AOJ should confirm that all outstanding relevant records are of record. The matters are REMANDED for the following action: 1. Obtain any VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant records from the Riverview Regional Medical Center dated from November 2004 to 2009. See August 2010 VA Form 21-4142. 3. Verify the Veteran’s specific dates of ACDUTRA or INACDUTRA. Please note that reports of retirement points do not contain the necessary information in this regard. 4. Then refer the claims file to a suitably qualified clinician but not the May 2018 VA examiner for preparation of an addendum opinion. No additional examination of the Veteran is needed, unless the examiner determines otherwise. Following a review of the claims file, the examiner should address each of the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension (i) had its onset during active service, or is otherwise etiologically related to the Veteran’s active duty service, to include an elevated blood pressure reading on his April 1974 separation examination as a result of any other in-service event, disease, or injury; (ii) initially manifested to a compensable degree as of June 1975; (iii) is the result of disease or injury during a verified period of ACDUTRA; or (iv) is the result of injury during a verified period of INACDUTRA? In addressing this question, please presume the Veteran sound at entrance with respect to hypertension, and please discuss the blood pressure reading of 130/78 and the Veteran’s report of hypertension at separation in April 1974. (b) For any diagnosed heart disease (not to include hypertension), is it at least as likely as not (50 percent probability or greater) that such disability (i) had its onset during active service, or is otherwise etiologically related to the Veteran’s service, to include as a result of an in-service disease, event, or injury; (ii) initially manifested to a compensable degree as of June 1975; (iii) is the result of disease or injury during a verified period of ACDUTRA; or (iv) is the result of injury during a verified period of INACDUTRA? In addressing these questions relating to heart disease (not to include hypertension), the examiner should discuss the September 1971 report of tachycardia and its April 1972 resolution, and explain the clinical significance (if any). (c) If the examiner determines that the Veteran’s hypertension is related to his service (i.e. provides an answer of “yes” to one or more question within question (a) relating to hypertension), the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed heart disease (not to include hypertension): (1) is proximately due to the Veteran’s hypertension; or (2) has been aggravated (worsened beyond its natural progression) by the Veteran’s hypertension. A comprehensive rationale must be provided for all opinions rendered. If the examiner cannot provide any requested opinion without resorting to speculation, the examiner should so state and explain why an opinion would be speculative. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.M. Badaczewski, Associate Counsel