Citation Nr: 20046850 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 14-29 764 DATE: July 13, 2020 REMANDED The issue of entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to June 1970 and from December 1976 to May 1990. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in December 2017 and a transcript of the hearing has been associated with the claims file. This matter was previously before the Board in September 2018 at which time it was remanded for further development. Entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. In September 2018 the Board remanded the Veteran’s claim to obtain a VA opinion addressing whether the Veteran’s hypertension was related to his military service, including his presumed exposure to herbicide agents, including Agent Orange. In this regard, in a November 2019 Hypertension Disability Benefits Questionnaire report an examiner opined that the condition was less likely than not incurred in or caused by service. The examiner reasoned that the Veteran was diagnosed with hypertension 11 years post discharge from service not in the one-year time frame as inquired; and the Veteran had new onset essential hypertension with no clear relation to any service-related event. The examiner also opined that there was no direct causal relationship between obstructive sleep apnea and hypertension. The examiner reasoned that there might be a common predisposing factor, which is obesity. However, hypertension in the Veteran’s case was likely an essential hypertension with no secondary cause. The examiner explained that obstructive sleep apnea can affect blood pressure control but that was not the direct causal factor for hypertension in this case. The Board finds the November 2019 Hypertension Disability Benefits Questionnaire inadequate to decide the Veterans claim for service connection for hypertension. The September 2018 Board remand instructions specifically asked the examiner to discuss the contention that the Veteran has hypertension as a result of in-service herbicide exposure, including Agent Orange. However, the November 2019 Hypertension Disability Benefits Questionnaire did not address this theory of entitlement. See Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand.) Additionally, the November 2019 examiner did not provide adequate rationales for his opinions that the Veteran’s “new onset” of essential hypertension has no clear relation to any service-related event and his opinion that obstructive sleep apnea can affect blood pressure control but is not the direct causal factor for the Veteran’s essential hypertension. Adequate opinions must provide an explanation as to why the 11 years post-service hypertension diagnosis is significant and why obstructive sleep apnea (which can affect blood pressure) is not the direct causal factor for the Veteran’s essential hypertension. See Nieves-Rodriguez, 22 Vet. App. at 304 (noting that most of the probative value of a medical opinion comes from its reasoning and that it must be clear that the medical expert applied valid medical analysis to the significant facts of a particular case). Finally, in addressing secondary service connection the examiner did not address aggravation. A medical opinion regarding secondary service connection must address both causation and aggravation. See El Amin v. Shinseki, 26 Vet. App. 140 (2013). In light of the aforementioned inadequacies of the November 2019 Hypertension Disability Benefits Questionnaire, the Board finds that an addendum opinion should be requested on remand. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the claims file to the VA examiner who conducted the Veteran's November 2019 Hypertension Disability Benefits Questionnaire, if available. If that examiner is not available, send the claims file to another qualified examiner. The claims file and this remand should be made available to the examiner and review of the file should be noted in the requested report. After reviewing the claims file the examiner should respond to the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension had its onset in service, or within one year of his separation from service, or is otherwise related to service? The examiner is asked to specifically address the contention that the Veteran has hypertension as a result of in-service herbicide exposure, including Agent Orange. The examiner is advised that the Veteran's exposure to herbicide agents is presumed. (a.) Is it at least as likely as not (50 percent probability or greater) that the diagnosed hypertension was caused or aggravated by the Veteran's service-connected obstructive sleep apnea? The examiner is asked to specifically address the November 2019 examiner’s statement that obstructive sleep apnea can affect blood pressure control. (b.) If the examiner finds that hypertension has been worsened beyond normal progression (aggravated) by the Veteran's service-connected disability, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to the service-connected disability. (c.) If the examiner finds that the Veteran’s hypertension is essential in nature, the examiner must provide a detailed explanation as to why this is the most likely etiology of hypertension in the Veteran’s particular case. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.