Citation Nr: 20043896
Decision Date: 06/30/20	Archive Date: 06/30/20

DOCKET NO. 18-17 893
DATE: June 30, 2020

REMANDED

Entitlement to service connection for hypertension is remanded.

REASONS FOR REMAND

The Veteran served on active duty from December 1961 to April 1966, including service in the Republic of Vietnam. He testified before the undersigned Veterans Law Judge at an August 2018 video-conference hearing.  

Entitlement to service connection for hypertension is remanded.

Pursuant to the Board’s remand directives, a VA addendum opinion was associated with the record in May 2019 to include consideration of a potential secondary relationship between the Veteran’s hypertension and his service-connected coronary artery disease (CAD).  

In concluding that the disability was less likely than not related to service or a service-connected illness, the examiner opined that the hypertension “clearly and unmistakably existed prior to service.”  The examiner failed to explain this reasoning, especially in light of the December 1961 entrance examination failing to note any diagnosis of hypertension or elevated blood pressure.  Moreover, the Veteran has consistently claimed that illness was first diagnosed in the 1980s and despite citing this report in the addendum opinion, the examiner did not challenge the claimed onset.  

Additionally, in finding that the Veteran’s HTN was not proximately caused or aggravated by his CAD, the examiner did not provide an etiological discussion of the relationship of the two diseases.  Rather, the rationale merely noted that there were “no records” supporting the claimed aggravation.  In light of these deficiencies, the Board finds that it cannot rely upon the May 2019 addendum opinion and must seek development to procure another medical opinion.  

The matters are REMANDED for the following action:

1. Obtain the Veteran's VA treatment records for the period from March 2020 to present and assist the Veteran with the procurement of any relevant private treatment records documenting all attempts to assist in these endeavors.

2. Procure an addendum opinion from a different medical practitioner then the May 2019 VA examiner (if possible) and determine the nature and etiology of the Veteran’s hypertension.  The examiner must provide the following opinions:

a) Whether it is at least as likely as not (1) proximately due to, or (2) aggravated beyond its natural progression by the service-connected CAD.

b) Whether it clearly and unmistakably (undebatable) preexisted the Veteran’s service, to include a discussion of the May 2019 VA examiner’s opinion.  

If the examiner finds it did clearly and unmistakably preexist service, then the examiner must opine whether it was clearly and unmistakably not aggravated by service.

If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, then the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease.

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Marcus J. Colicelli

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.