Citation Nr: 18157972
Decision Date: 12/14/18	Archive Date: 12/13/18

DOCKET NO. 16-58 871
DATE:	December 14, 2018
REMANDED
Entitlement to service connection for hypertension, to include as secondary to service connected amputation of the left leg above the knee.
REASONS FOR REMAND
The Veteran served on active duty from July 1967 to September 1969.  
This matter comes before the Board of Veterans’ appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. 
The Veteran appeal a November 2015 denial of service connection for hypertension.  In August 2015, the Veteran submitted a claim for service connection for hypertension as secondary to his left leg amputation above the knee.  Regulations provide that hypertension developed in a veteran with a service connected amputation above the knee is held to be the result of the service connected amputation.  38 C.F.R. § 3.310(c).  Medical records indicate the Veteran’s left leg was amputated above the knee in November 2008.
In May 2016, a VA examiner diagnosed the Veteran with hypertension.  The Veteran told the examiner that he had first been treated for hypertension in 2006.  The examiner opined that the Veteran’s hypertension is less likely than not the result of his left leg amputation.  The examiner further opined that the Veteran’s hypertension is less likely than not aggravated beyond the natural progression of that condition by his amputation because “The Medical Literature does not support a connection or relationship of any kind between hypertension and a left knee amputation.”
The Board finds that the medical rationale provided is inadequate given that VA appears to recognize some association between hypertension and leg amputation given 38 C.F.R. § 3.310(c).  See Barr v. Nicholson, 21 Vet. App. 303 (2007).
The matter is REMANDED for the following actions:
1. Obtain all pertinent updated treatment records.
2. Obtain a medical opinion from an appropriate clinician to determine whether it is at least as likely as not the Veteran’s hypertension is proximately due to or aggravated beyond the natural progression of the condition by his left leg amputation.  Remind the clinician that, given VA regulations allow for service connection of hypertension developed in veterans with a service connected amputation above the knee under 38 C.F.R. § 3.310(c), it appears that there is an association between hypertension and above knee amputation for VA purposes.  Address the Veteran’s theory that he required an additional medication to control hypertension following amputation, which supports “aggravation” of preexisting hypertension.
A complete rationale for the medical opinion is required. The clinician should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s).  If an opinion cannot be expressed without resort to speculation, the clinician should so indicate and discuss why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.
3. Readjudicate. 
 
C.A. SKOW
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P. Mucklow, Associate Counsel