Citation Nr: 20022565 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 16-38 561 DATE: April 1, 2020 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected back disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1979 to September 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision by the Department of Veterans Affairs (VA) RO in St. Louis, MO. The Veteran timely filed a notice of disagreement (NOD) in July 2015, and in June 2016, the RO issued a statement of the case (SOC). In August 2016, the Veteran perfected his substantive appeal, and in September 2016, the RO issued a supplemental SOC. In November 2018, the Board remanded for additional development the claims of service connection for hypertension, left hip strain, and right hip strain. Regarding the Veteran’s claims for service connection left hip strain and right hip strain, the Board notes that, in an October 2020 rating decision, the RO granted service connection for these claims. As such is a full grant of the benefits sought on appeal, the claims for service connection for left hip strain and right hip strain are no longer before the Board. Regarding the Veteran’s claim for service connection for hypertension, in January 2020, the RO issued a supplemental statement of the case. This matter is again before the Board for adjudication. Entitlement to service connection for hypertension, to include as secondary to service-connected back disability. The Veteran is seeking service connection for his hypertension. Specifically, he contends that his hypertension is related to his service-connected back disability. The Board finds that the VA medical opinions following the November 2018 Board decision are inadequate and a remand is therefore necessary for an additional examination and opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Stegall v. West, 11 Vet. App. 268 (1998). In accordance with the Board remand directives, the Veteran was afforded a VA examination in July 2019. The examiner diagnosed the Veteran with hypertension and noted a history of taking atenolol for the management of his hypertension. In his medical opinion, the examiner determined that the Veteran’s hypertension had no correlation to his service-connected back disability as pain can cause a small increase in the blood pressure but once stabilized on medication the blood pressure should normalize. As the Veteran takes pain medication for his service-connected back disability but his blood pressure remains elevated, the examiner opined that the Veteran’s hypertension was not connected to his service-connected back disability. He further opined that the Veteran’s hypertension was not aggravated beyond natural progression by the Veteran’s service-connected back disability as the veteran’s blood pressure remained controlled on a single agent. In a subsequent December 2019 VA addendum medical opinion, an examiner opined that the Veteran’s disability is less likely than not related to the Veteran’s service-connected back disability as the two conditions are not medically related. Rather, hypertension is a separate entity from the Veteran’s service-connected disability. The examiner also noted the Veteran’s medications for his service-connected disability and explains that hypertension can appear suddenly and cause high blood pressure. Furthermore, the examiner also indicates that various conditions and medications can also lead to hypertension and then opines that the Veteran’s hypertension is not aggravated beyond a natural progression. As noted above, the Board finds the VA opinions of record inadequate for adjudicative purposes. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Specifically, the July 2019 VA examiner fails to address the possibility of direct service connection. Likewise, in the December 2019 VA addendum medical opinion, direct service connection is not considered. And, although the examiner notes that the Veteran is currently taking medications for his service-connected condition, and that medications can cause hypertension, he does not opine as to whether in this case, the Veteran’s hypertension is due to or aggravated beyond a natural progression by the medications or treatment the Veteran requires for his service-connected disability. As such, remand for a new VA medical addendum opinion is warranted. The matters are REMANDED for the following action: 1. The AOJ should obtain all outstanding VA treatment records and any private treatment records identified by the Veteran. All obtained records should be associated with the evidentiary record. 2. After all outstanding treatment records have been associated with the claims file, obtain an addendum opinion from an appropriate physician regarding the Veteran’s hypertension. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran. The VA examiner should address the following: (A) Whether it is at least as likely as not (i.e. a 50 percent probability) that the Veteran’s hypertension began during or is otherwise due to active service. (B) If not, whether it is at least as likely as not (i.e. a 50 percent probability) that the Veteran’s hypertension is (1) proximately due to his service-connected back disability, to include medications necessary to treat the disability, or (2) aggravated beyond its natural progression by his service-connected back disability, to include medications necessary to treat the disability. If the examiner determines that the Veteran’s hypertension was aggravated by his back disability, then the examiner should cite medical records which show the baseline severity of his hypertension prior to aggravation. If the examiner is unable to establish a baseline for the hypertension prior to the aggravation, he or she should state such and explain why a baseline cannot be determined. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a 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). 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.