Citation Nr: 18155995 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 04-14 864 DATE: December 6, 2018 REMANDED Entitlement to service connection for hypertension, to include secondary to medication for service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to October 1973 and from November 1974 to August 1975. In January 2009, the Board denied, in pertinent part, entitlement to service connection for hypertension. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In May 2013, the Court, in pertinent part, vacated and remanded the Board’s denial of entitlement to service connection for hypertension. In July 2015, the Board remanded the claim of entitlement to service connection for hypertension, to include as secondary to sinusitis or medication used to treat sinusitis for additional development. The Veteran was afforded a hearing at the VA’s Central Office in August 2008 before a Veterans Law Judge who is not able to continue his participation in this case. A transcript from that hearing is of record. The Veteran also testified in support of these claims during a videoconference hearing before the undersigned in February 2016. In October 2016, the Board again, in pertinent part, denied entitlement to service connection for hypertension. The appellant appealed, and in an April 2018 memorandum decision, the United States Court of Appeals for Veterans Claims (Court) set aside and remanded the portion of the October 2016 decision that denied entitlement to service connection for hypertension. The Court specifically found that the Board provided an inadequate statement of reasons or bases to support its finding that the Veteran’s hypertension was not “aggravated” by the claimant’s use of pseudoephedrine for sinusitis and rhinitis. The Board based its finding on an August 2015 opinion of a VA examiner that hypertension was aggravated by pseudoephedrine use, but only during actual use, in combination with its finding that pseudoephedrine use had not been chronic. The Court found that the Board failed to consider certain specific instances of pseudoephedrine use, as well as the Veteran’s lay testimony that his pseudoephedrine use was “ongoing.” In retrospect the August 2015 VA examiner’s opinion is ambiguous as it relates to the fundamental point of contention here, i.e., whether the aggravation of hypertension caused by pseudoephedrine use constituted a permanent worsening of the underlying condition, rather than a temporary or intermittent flare-up of symptoms. 38 C.F.R. § 3.310 (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Therefore, remand for a clarifying medical opinion is necessary. Additionally, in July 2018 the Veteran alleged that his hypertension was also aggravated by medications taken for his service-connected asthma and chronic obstructive pulmonary disease. Therefore, remand is also necessary to obtain a medical opinion regarding whether hypertension was caused or aggravated by medication for those disabilities. Accordingly, the matter is REMANDED for the following action: 1. Obtain a medical opinion from a physician addressing whether the Veteran’s hypertension is at least as likely as not proximately due to medication used to treat rhinitis, sinusitis, asthma and/or chronic obstructive pulmonary disease. If not, the reviewer must address whether it is at least as likely as not that hypertension is aggravated beyond its natural progression by medications used to treat rhinitis, sinusitis, asthma or chronic obstructive pulmonary disease. The reviewer is advised that “aggravation” is a worsening of the underlying condition beyond the natural progression of the disorder, other than a temporary or intermittent flare-up of symptoms. If aggravation is found, the reviewer must state, to the extent possible, the baseline level of disability prior to aggravation. If any additional examinations are needed, they must be conducted. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the   examiner does not have the needed knowledge or training. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Paul J. Bametzreider, Associate Counsel