Citation Nr: 18153741 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 10-25 603 DATE: November 28, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus or service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Army from January 1968 to January 1971. In January 2014 and July 2016, the Board remanded the appeal for further development. In August 2017, the Board issued a decision which denied the claim on appeal. The Veteran filed a timely appeal to the Court of Appeals for Veterans’ Claims (Court). In a May 2018 Joint Motion for Remand, the parties agreed to remand the appeal to the Board for further development. Service connection for hypertension, to include as secondary to service-connected diabetes mellitus or service-connected PTSD, is remanded. The Veteran contends that his current hypertension is due to his period of service, to include as secondary to his service-connected diabetes or service-connected PTSD. In February 2014, the Veteran was afforded a VA examination. The examiner found that the Veteran’s hypertension was less likely than not caused by the Veteran’s diabetes. In July 2016, the Board found this examination to be inadequate because it did not address direct service connection for hypertension, to include exposure to herbicides. In August 2016, the Veteran was afforded a VA examination. The examiner concluded that the Veteran’s hypertension was less likely than not caused by the Veteran’s PTSD or diabetes or directly related to service. The examiner reasoned, in part, that the medical literature did not support PTSD and/or depression as a cause for hypertension. The examiner further explained that diabetes does not cause hypertension; rather, it can cause a severe kidney disorder which can trigger hypertension. The examiner noted that the Veteran had normal kidney function. The examiner also stated that the Veteran had a diagnosis of obesity and history of alcohol dependency. The examiner noted that the medical literature did support both obesity and alcoholism as causes of hypertension. Pursuant to the May 2018 Joint Motion for Remand, while the August 2016 VA examination addressed secondary service connection on a causal basis, the opinion did not address whether the Veteran’s hypertension was aggravated by his service-connected PTSD or his service-connected diabetes. VA regulations pertaining to secondary service connection also require a determination of whether the Veteran’s hypertension is aggravated by his service-connected disabilities. See 38 C.F.R. § 3.310. Moreover, the Board notes that obesity may be an ‘intermediate step’ between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). While the prior medical record indicates obesity as a factor to the Veteran’s hypertension, there is no medical evidence of record determining whether the Veteran’s obesity is the result of his service-connected diabetes or PTSD. For these reasons, a remand is necessary. The matter is REMANDED for the following action: Send the Veteran’s file to an appropriate VA examiner. The examiner should receive a copy of this remand and review the Veteran’s file. An examination should be scheduled only if the examiner deems it necessary. The examiner should consider all medical records associated with the file. Based on review of the record, the examiner should determine: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is aggravated beyond natural progression by his service-connected PTSD. The examiner is also asked to consider and discuss whether the Veteran’s obesity is an “intermediate step” between the service-connected PTSD and the Veteran’s current hypertension. b. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is aggravated beyond natural progression by his service-connected diabetes. The examiner is also asked to consider and discuss whether the Veteran’s obesity is an “intermediate step” between the service-connected diabetes and the Veteran’s current hypertension. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ford, Associate Counsel