Citation Nr: 20031626 Decision Date: 05/05/20 Archive Date: 05/05/20 DOCKET NO. 15-29 790 DATE: May 5, 2020 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1969 to March 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2017, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. The appeal was remanded for further development in August 2018. Unfortunately, another remand is required. Pursuant to the Board’s August 2018 remand directives the Veteran was afforded a VA examination in January 2020. The Board asked the examiner to opine on whether it is at least as likely as not that the Veteran’s hypertension had its onset in service or is otherwise related to the Veteran’s military service or his service-connected ischemic heart disease and/or posttraumatic stress disorder (PTSD). However, in rendering the secondary opinion for hypertension in relation to ischemic heart disease, the examiner provides the same negative opinion for both proximate causation and aggravation and the opinions are conclusory and lack adequate rationale. Additionally, in rendering the secondary opinion for hypertension in relation to PTSD, the examiner did not address the Veteran’s statements that when his PTSD flares ups, his blood pressure goes up, as specifically requested by the Board. Thus, this opinion is inadequate. For these reasons, an addendum opinion is needed to ensure substantial compliance with the Board’s August 2018 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records. 3. Then, obtain an addendum opinion from an examiner other than the January 2020 examiner that addresses the etiology of the Veteran’s hypertension. The claims file, to include a copy of this remand, must be made available to the examiner for review, and the examination report must reflect that such a review was accomplished. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should opine on whether it is at least as likely as not (50 percent or greater probability) that diagnosed hypertension (see January 2020 VA examination report): (i) had its onset in service or is otherwise related to service, to include as a result of a stressful incident during service when the Veteran was fearful that he was going to be killed an/or conceded exposure to herbicide agents therein. See April 2017 Board Hearing Transcript at 15. In addressing this question, please discuss the 2018 NAS findings of “sufficient evidence of an association” between herbicide agent exposure and hypertension. Please also consider the Veteran’s reports of continuous high blood pressure problems since service, and do not rely on the lack of objective documented treatment in your opinion. While true the Veteran cannot diagnose hypertension or opine as to its etiology, he is competent to report continuous hypertension symptoms since service separation, and this information should be considered in rendering an opinion. (ii) is proximately due to his service-connected ischemic heart disease; (iii) has been aggravated (worsened beyond natural progression) by his service-connected ischemic heart disease; (iv) is proximately due to his service-connected PTSD; or (v) has been aggravated (worsened beyond natural progression) by his service-connected PTSD. The examiner should also comment on the Veteran’s statement that when his PTSD flares up, his blood pressure also goes up. See April 2017 Board Hearing Transcript at 17. The examiner should note that inquiries (ii) – (v) require separate opinions: one for proximate causation and another for aggravation for both ischemic heart disease and PTSD, and a rationale must be provided for each opinion. A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resort to speculation, the examiner must so state and then provide a rationale for why the requested opinion could not be provided without resorting to speculation. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Asante 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.