Citation Nr: 18154418 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 15-23 156A DATE: November 29, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected type II diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to August 1975, which included service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was afforded a VA examination in connection with his claim for service connection for hypertension in August 2011. The examiner noted that the Veteran’s service treatment records did not document any treatment or diagnosis of hypertension and that there was no suspected hypertension during his military service. He stated that he could not provide a nexus opinion regarding the Veteran’s current hypertension and military service without resorting to mere speculation The Board notes that medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. Jones v. Shinseki, 23, Vet. App. 382, 389-90 (2010) (noting that the phrase, “without resort to mere speculation,” must not become a mantra that short circuits the careful consideration to which each claimant’s case is entitled and holding that, before the Board can rely on an examiner’s conclusion that an etiology opinion would be speculative, the examiner must explain the basis for such an opinion or the basis must otherwise be apparent in the Board’s review of the evidence). Applicable regulations also provide that a finding of service connection may not be based on a resort to speculation or a remote possibility. See 38 C.F.R. § 3.102 (2016). The Board also notes the Veteran has asserted that his hypertension is secondary to his service-connected diabetes mellitus. However, there is no opinion in the record that addresses service connection on a secondary basis. For these reasons, the Board finds that an additional VA examination and opinion are needed. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request the Veteran provide the names and addresses of any and all healthcare providers who have provided treatment for his hypertension. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any hypertension that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has hypertension that is causally or etiologically related to his military service, to include herbicide exposure therein (notwithstanding the fact that such an association may not be presumed). The examiner should also opine as to whether it is at least as likely as not the Veteran’s hypertension is either caused by or aggravated by his service-connected type II diabetes mellitus. In rendering the opinion, the examiner should not resort to mere speculation, but rather should consider that the phrase “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. Thus, unless the examiner concludes that the current disability is either likely or unlikely the result of an event, injury, or disease incurred in service, the examiner should state whether it is at least as likely that the current disability is the result of an event, injury, or disease incurred in service as opposed to its being the result of some other factor or factors. A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability is viewed in relation to its history”, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing the above actions, the AOJ should conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.M. Walker, Associate Counsel