Citation Nr: 18148146 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 11-11 239 DATE: November 6, 2018 REMANDED Entitlement to service connection for a heart condition is remanded. Entitlement to service connection for hypertension, to include as secondary to the service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND Service connection for a heart condition and for hypertension were both denied by the Board in September 2017. The Veteran appealed the Board’s decision to the Court of Appeals for Veterans Claims (Court). In May 2018, the Court signed an Order granting a Joint Motion for Remand (joint motion) and remanding the matters to the Board for action in accordance with that joint motion. 1. Entitlement to service connection for a heart condition is remanded. The Veteran contends she experienced chest pain in service and that this symptom was the initial manifestation of her currently diagnosed heart condition. In May 2016 at her Board hearing, she reported experiencing chest pain and seeking medical attention at a hospital in 1985. Following the hearing, the Board remanded this issue for examination and opinion as to the likelihood that the Veteran’s current heart condition initially had its onset during service. The Board noted the Veteran’s service treatment record dated in February 1985 related to treatment of virus type symptoms and the Veteran’s report of experiencing chest pain at this time. The remand then directed the examiner to provide an opinion and to include a discussion of the February 1985 treatment in the rationale. The Veteran was afforded a VA examination in November 2016. The examiner indicated in the report that the 1985 record could not be found and provided a negative nexus opinion due to a lack of in-service indication of chest pain or other symptoms. The Board then denied the claim in September 2017. The May 2018 joint motion suggests that both parties to the appeal to the Court “agree that a service treatment record reflecting treatment for ‘virus type’ symptoms in February 1985 cannot now be located in the record. The parties therefore agree that remand is warranted for the Board to attempt to locate or obtain the February 1985 STR noting treatment for ‘virus type’ symptoms and weakness.” The joint motion then instructed an addendum opinion to be obtained if the missing February 1985 record is located. This February 1985 record noting ‘virus type’ symptoms does not appear to have ever been missing from the claims file. It is within the electronic claims file at page 7 of a document noted as received into the record on January 19, 2007, and coded as document type: Medical Treatment Record – Non-Government Facility. This matter must be remanded for an addendum opinion to be obtained to comply with both the Board’s August 2016 remand and the May 2018 joint motion. 2. Entitlement to service connection for hypertension, to include as secondary to the service-connected PTSD, is remanded. The Veteran claims her hypertension was caused or aggravated by her service-connected PTSD. The November 2016 VA examiner opined that the Veteran’s hypertension was not caused by, related to or the result of her active service, and also indicated that the hypertension “was not caused by or the result of her service connected PTSD in whole or in part or was aggravated by her PTSD as this theory is not supported by the current general consensus of evidence based medicine.” The examiner’s rationale for this opinion noted some studies suggesting PTSD has a direct relationship with the risk of developing hypertension, but found these studies were not supported by general consensus of current evidence based medicine. Further discussion was related to a cause and effect relationship between PTSD and hypertension. The joint motion considered this to lack a rationale for the conclusion that hypertension was not aggravated by PTSD. The matter was remanded by the Court for action in accordance with the joint motion, which requires an addendum opinion with a fully explained rationale as to whether the Veteran’s PTSD has aggravated her hypertension. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s heart condition is at least as likely as not related to the Veteran’s active service. The examiner should provide a fully explained rationale for any opinion expressed, to include a discussion of the Veteran’s report at her Board hearing that she experienced chest pain in 1985 at the time she sought care. The examiner should include reference to the February 1985 treatment for “virus type” symptoms (this record is within the Veteran’s claims file at page 7 of a document noted as received into the record on January 19, 2007, and coded as document type: Medical Treatment Record – Non-Government Facility). 2. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not the Veteran’s hypertension has been aggravated beyond its natural progression by her service-connected PTSD. The examiner should provide a fully explained rationale for any opinion expressed, to include a discussion of the Veteran’s PTSD symptoms and whether they have as likely as not caused a permanent increase in severity of the Veteran’s hypertension. 3. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If any claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Adamson, Counsel