Citation Nr: 20047553 Decision Date: 07/16/20 Archive Date: 07/16/20 DOCKET NO. 15-43 410 DATE: July 16, 2020 REMANDED Service connection for hypertension is remanded. Service connection for heart disease, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Marine Corps (USMC) from July 1984 to December 1991. The issues are on appeal from a July 2014 rating decision. 1. Service connection for hypertension is remanded. 2. Service connection for heart disease, to include as secondary to hypertension, is remanded. The Board of Veterans’ Appeals (Board) remanded the Veteran’s claims for service connection for hypertension and heart disease in March 2019. In the remand, the Board’s instructions included scheduling the Veteran for VA examinations to determine the nature and etiology of his hypertension and heart disease. The Board found new VA examinations were necessary as further development was required. Per remand instructions, the Veteran’s file reveals a September 2019 Exam Scheduling Request. Subsequently, October 2019 reports and an invoice state the Veteran did not show up for his VA examinations, scheduled for September 30, 2019. However, the evidence of record does not indicate that a letter notifying the Veteran, or his representative, of the date, time, and location of the scheduled VA examinations were sent to either of them. Thus, the Board finds that another remand is needed to properly schedule the necessary VA examinations. To review, in the March 2019 remand, the Board noted that the Veteran’s service treatment records and a post-separation January 1993 VA examination revealed elevated blood pressure readings. The Veteran was afforded a VA examination in November 2009 where the examiner stated that hypertension is a silent disease, which could be overlooked until producing organ damage. The examiner indicated that the Veteran could have had high blood pressure for more than a decade, damaging his heart without his awareness, but that there was no medical evidence supporting this situation had occurred. Initially, the Board finds that the examiner’s rationale appears contradictory. In this regard, the examiner indicates that hypertension could go undiagnosed for many years, and then subsequently states that there was no medical evidence to support this conclusion. However, it would seem that if hypertension had gone undiagnosed, medical evidence indicating complaints of, treatment for, and diagnosis would not exist. As discussed above, the Veteran’s service treatment records and January 1993 VA examination are indicative of high blood pressure readings. Further, the Board notes that the Veteran currently receives treatment for hypertension at VA medical centers. VA treatment records reveals he takes medication for both hypertension and congestive heart failure. Additionally, the November 2009 examiner did not address the January 1993 VA examination, which was conducted shortly after the Veteran’s December 1991 separation from active duty service; nor were the Veteran’s lay statements of pertinent symptomatology considered. The Veteran testified in an October 2018 hearing that he had experienced hypertension symptoms since service, and that his heart disease was secondary to his hypertension. Finally, the examiner stated that he could not provide an etiology opinion as to whether the Veteran’s hypertension was related to service without resorting to mere speculation, with no explanation as to why. In Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the United States Court of Appeals for Veterans Claims (Court) addressed the adequacy of “mere speculation” opinions. The Court held that VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of veterans. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. Therefore, the Board finds that the November 2009 examiner did not proffer a sufficient rationale for his inability to provide an opinion. See Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). As such the Board finds that the Veteran should be afforded a new VA examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hypertension and heart disease. All necessary diagnostic testing and evaluations should be performed, and all findings presented in detail. Based upon review of the entirety of the claims file, including this remand, the Veteran’s lay statements, and medical history, the examiner should opine on the following: (a.) Whether it is at least as likely as not (i.e. 50 percent or greater) that any hypertension began during active service, manifested within one year of discharge from active service, was noted during service with continuity of the same symptomatology since active service, or is related to an in-service injury, event, or disease. (b.) Whether it is at least as likely as not (i.e. 50 percent or greater) that any heart disease began during active service, manifested within one year of discharge from active service, was noted during service with continuity of the same symptomatology since active service, or is related to an in-service injury, event, or disease. (c.) If the examiner determines that the Veteran’s hypertension is related to service, whether the Veteran’s heart disease is at least as likely as not (i.e 50 percent or greater) proximately due to his hypertension or aggravated beyond natural progression by his hypertension. Sufficient rationale must be submitted for any opinions provided. (Continued on next page) 2. Readjudicate the appeals. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Lee 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.