Citation Nr: 18150532 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 17-56 667 DATE: November 15, 2018 REMANDED Entitlement to service connection for hypertension, claimed as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had active service from June 1966 to January 1969. He received the Vietnam Campaign Medal and Vietnam Service Medal, among other decorations, for this service. These matters come to the Board of Veterans' Appeals (Board) on appeal from a June 2015 decision of the Regional Office (RO) in Los Angeles, California. 1. Service Connection for Hypertension is Remanded. The Veteran seeks service connection for hypertension, secondary to service-connected disabilities, including PTSD. After review of the evidence, both lay and medical, a remand for further development is necessary to allow the Board to make a fully informed decision. The Veteran has submitted evidence in support of the claim. Specifically, the Veteran submitted treatise evidence on possible links between PTSD and hypertension. The Veteran has also submitted a letter from his treating physician which appeared to determine the Veteran’s hypertension was less likely not related to military service, but failed to comment on any aggravation and provided no rationale. In August 2016, the Veteran underwent a VA examination to determine the etiology of the hypertension. The VA examiner opined that the Veteran’s hypertension was less likely than not aggravated by the service-connected PTSD. The rationale provided was that the Veteran had experienced PTSD symptoms since the 1960’s and did not develop hypertension until much later. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The August 2016 VA examiner failed to provide adequate rationale for the opinion provided because it was based off the diagnosis date of hypertension and not whether the Veteran’s hypertension was aggravated by the service-connected PTSD. Additionally, the examiner failed to address the treatise evidence submitted by the Veteran. Furthermore, the examiner did not comment on the relationship, if any, between the hypertension and the service-connected diabetes. As such, a new opinion on the etiology of the hypertension is necessary. The matter is REMANDED for the following action: 1. Associate any VA treatment records with the electronic claims file. 2. After completion of the above-specified development. Obtain an addendum medical opinion. The examiner must have the appropriate expertise and be provided access to the electronic claims file. The examiner must indicate review of the claims file in the examination report. If the VA examiner determines that an additional examination of the Veteran is necessary to provide reliable opinions as to causation, such examination should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary, The examiner is asked to provide the following opinions: a) Is it at least as likely as not (50 percent probability or greater) that the current hypertension had onset in service or is etiologically directly related to active service? b) Is it at least as likely as not (50 percent probability or greater) that the current hypertension is caused by the Veteran's service-connected disabilities, including PTSD and diabetes mellitus? c) If not caused by the service-connected disabilities, is it at least as likely as not (50 percent probability or greater) that the hypertension is aggravated (worsened in severity beyond the natural progression of the disease) by the Veteran's service-connected disabilities, including PTSD and diabetes mellitus? If the VA examiner opines that the hypertension is aggravated by the service-connected PTSD or diabetes mellitus; he/she should indicate the degree of disability before aggravation and the current degree of disability. The VA examiner must comment on the August 2008 Treatise evidence by Dr. H.J. (Continued on the next page)   A rationale should be given for all opinions and conclusions rendered. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Teague, Associate Counsel