Citation Nr: 20006274 Decision Date: 01/24/20 Archive Date: 01/24/20 DOCKET NO. 15-18 516A DATE: January 24, 2020 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Air Force from January 1969 to February 1977. This issue comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran asserts that he is entitled to service connection for hypertension. Hypertension for VA purposes is defined as diastolic pressure predominantly 90 or greater and systolic pressure predominantly 160 or greater with diastolic pressure less than 90. The minimum compensable rating is for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. A review of the service treatment records (STRs) reveals that the Veteran had a number of possibly elevated blood pressure readings and episodes of dizziness during service. In January 1969, his blood pressure was 124/86 and he complained of almost passing out while running. In August 1970, his blood pressure was 140-150/80 and he complained of ongoing dizziness with occasional ringing in his ears. In September 1970, his blood pressure was 140/80 and it was noted that he was to be referred to an in-service physician if his blood pressure remained “abnormal.” Shortly thereafter, the Veteran was referred for additional treatment regarding his complaints of dizziness. The physician noted a two month history of postural dizziness. He diagnosed the Veteran with dizziness, etiology unknown and prescribed Bonine for treatment. In October 1975, the Veteran complained of episodes of dizziness. His blood pressure was 122/96. Subsequent blood pressure test results in March 1976 and June 1976 were 120/80 and 118/74, respectfully. Of note, the Veteran marked “don’t know” regarding any episodes of high blood pressure on his separation report of medical history. A review of the Veteran’s post service VA and private treatment records note his long history of hypertension, as well as his family history of hypertension and diabetes. However, none of the Veteran’s treating physicians have given a positive opinion that his hypertension is the result of military service. The Board remanded this matter in July 2018 for a VA examination, which was conducted in June 2019. The June 2019 VA examiner noted the Veteran’s hypertension diagnosis. In addition, the examiner noted the Veteran’s reports of being diagnosed with hypertension in-service in 1970, but was not prescribed medication to treat this condition. He also stated that he has experienced high blood pressure since his service separation in 1977 and was started on blood pressure medication by his treating physician in 1978. The examiner then gave a negative opinion that the hypertension was the result of military service, stating as a rationale that there was no evidence of an in-service hypertension diagnosis. The examiner noted the Veteran’s blood pressure readings of 122/74 at separation in support of his opinion. He also noted the Veteran’s elevated blood pressure readings in August and September 1970 but did not provide any explanation for why this did not constitute evidence of hypertension while in service. In addition, the examiner did not note or address the Veteran’s elevated blood pressure readings in January 1969 and October 1975. Furthermore, the examiner did not address the Veteran’s contentions that he was told he had hypertension by his in-service treating physicians in 1970 and has been treated for hypertension since being released from service in 1977. The VA has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4). 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, 312 (2007). The Board finds that the VA examination is inadequate based on the examiner’s failure to provide an explanation as to why the Veteran’s in-service elevated blood pressure readings did not constitute hypertension for VA purposes, as well as addressing the Veteran’s contentions. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, the Board will remand this matter for the issuance of an addendum VA opinion. The matter is REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran's claims file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Once the above has been completed, obtain an addendum opinion from the VA examiner who conducted the Veteran's June 2019 examination. The electronic claims file must be made available to the examiner. The examiner should note in the examination report that the claims file has been reviewed. If the May 2019 VA examiner is not available, the claims file should be provided to an appropriate medical professional so as to render the requested opinion. If the examiner determines that another VA examination is necessary, one should be scheduled. Based on a review of the record, and a new examination if necessary, the examiner must address the following: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension first developed during service or within a year of discharge from service? The VA examiner is to address the elevated blood pressure readings recorded during service and state whether these readings would constitute evidence of hypertension during service. The term “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 certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the medical professional rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or rely solely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.T. Massey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.