Citation Nr: 20049909 Decision Date: 07/27/20 Archive Date: 07/27/20 DOCKET NO. 15-07 632 DATE: July 27, 2020 REMANDED Entitlement to service connection for hypertension as secondary to service-connected thoracolumbar spine disability is remanded. Entitlement to service connection for right elbow epicondylitis (tennis elbow) is remanded. Entitlement to service connection for arthritis of the hands is remanded. REASONS FOR REMAND The Veteran had an initial period of active duty service (ACDUTRA) from September 1971 to February 1972. He also served in the North Carolina Army National Guard Reserves with periods of ACDUTRA and inactive duty training (INACDUTRA) from July 1971 to March 1996. These matters come before the Board of Veteran’s Appeals (Board) from a May 2012 rating decision of the Department of Veteran Affairs (VA), Regional Office (RO). The Veteran and his wife testified at a Board hearing in March 2018 before the undersigned. A copy of the transcript is of record. The issue was previously before the Board in June 2018 and remanded to provide VA examinations. The Board finds the opinions incomplete. Thus, there has not been substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The Board also remanded the issue of entitlement to service connection for sleep apnea. Service connection was granted by the RO in an April 2020 rating decision. Therefore the issue is no longer before the Board. 1. Entitlement to service connection for hypertension as secondary to service-connected thoracolumbar spine disability is remanded. The Veteran contends that his hypertension is secondary to his thoracolumbar spine disability. He testified at his Board hearing that he takes Celebrex for his service-connected back disability, and it has caused his hypertension. (The Board notes that at his hearing, the Veteran specifically limited his claim to the theory of secondary service connection and that he does not seek direct service connection for hypertension.) The Veteran was afforded a VA examination in March 2019. The examiner opined that the Veteran’s hypertension was most likely not caused by his thoracolumbar disability. It is likely, however, [that] hypertension can be caused by… and aggravated “by Celebrex as it is a commonly known fact that NSAID use can increase blood pressure.” The RO secured a supplemental opinion in April 2020. The opinion determined that the Veteran’s use of Celebrex more likely than not did not aggravate the Veteran’s hypertension and provided a thorough rationale. However, there is no adequate medical opinion of record addressing whether the Veteran’s back disability, including his taking of Celebrex, specifically caused his hypertension, a remand is warranted for a supplemental opinion. 2. Entitlement to service connection for right elbow epicondylitis is remanded. The Veteran credibly testified in his March 2018 Board hearing that he hurt his right elbow during the Half-track accident at Ft. Bragg, North Carolina. In support of his claim, he provided notarized and signed affidavits from three fellow Guardsmen who witnessed the accident. The Veteran was afforded a VA examination in March 2019. The examiner concluded that the Veteran’s right elbow epicondylitis was less likely as not incurred in or caused by the right elbow epicondylitis (tennis elbow) during service. The examiner explained that the condition was originally diagnosed in 2008, and therefore the records fail to show epicondylitis in service. The examiner further explained that regarding the Veteran’s period of ACDUTRA, “the disability was diagnosed in 2008, before the March 2018 hearing, and before the Half-track accident.” The Board finds this opinion inadequate as the examiner seems to misinterpret the record. The Veteran states that his half-track accident was during his time in the military, which ended years before 2008. Once VA affords a veteran a medical examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As the Board finds the examination inadequate, a remand for a supplemental opinion is warranted. 3. Entitlement to service connection for arthritis of the hands is remanded. The Veteran credibly testified in his March 2018 Board hearing that he also hurt his hands during the Half-track accident. He testified that he currently experiences pain, and when driving, he experiences cramping of the hands, which forces him to “switch hands more often than normal.” The Veteran was afforded a VA examination in March 2019. The examiner diagnosed degenerative arthritis of the bilateral hand and provided a negative nexus to service. The examiner explained that “[t]his can be a commonality due to the use of hands during service. This is speculation as hand arthritis was just recently diagnosed, and there are no records to substantiate this during service.” The Board finds this examination inadequate, and as such, a supplemental opinion is warranted. Barr, 21 Vet. App. 311 (2007). Accordingly, the matters are REMANDED for the following action: 1. Provide the Veteran’s claims file to a qualified clinician so that a supplemental opinion may be provided to determine the nature and etiology of hypertension. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. The entire claims file and a copy of this remand must be made available to the clinician to review. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current hypertension is caused by his service-connected thoracolumbar disability and/or medications taken for its treatment, to include Celebrex. The clinician must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above-requested opinions cannot be made without resort to speculation, the clinician must state this and provide a rationale for such a conclusion. 2. Provide the Veteran’s claims file to a qualified clinician so that a supplemental opinion may be provided to determine the nature and etiology of his right elbow disability. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. The entire claims file and a copy of this remand must be made available to the clinician to review. Although an independent review of the claims file is required, the Board calls the examiner’s attention to: a. May 1980 Report of Medical Examination indicating “no heavy bending.” b. March 2012 notarized and signed affidavits from three fellow Guardsmen who witnessed the accident Half-track accident at Ft. Bragg, North Carolina. c. March 2018 hearing testimony, where the Veteran describes the Half-track accident. The clinician is asked to opine as to whether the Veteran’s right elbow disability is at least as likely as not (50 percent or greater probability) began a period of ACDUTRA or INACDUTRA, to include the Half-track accident discussed in his March 2018 hearing. The clinician must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above-requested opinions cannot be made without resort to speculation, the clinician must state this and provide a rationale for such a conclusion. 3. Provide the Veteran’s claims file to a qualified clinician so that a supplemental opinion may be provided to determine the nature and etiology of bilateral hand arthritis. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. The entire claims file and a copy of this remand must be made available to the clinician to review. Although an independent review of the claims file is required, the Board calls the examiner’s attention to: a. May 1980 Report of Medical Examination indicating “no heavy bending.” b. March 2012 notarized and signed affidavits from three fellow Guardsmen who witnessed the accident Half-track accident at Ft. Bragg, North Carolina. c. March 2018 hearing testimony, where the Veteran describes the Half-track accident. The clinician is asked to opine as to: a. Whether the Veteran’s right elbow disability is at least as likely as not (50 percent or greater probability) began a period of ACDUTRA or INACDUTRA, to include the Half-track accident discussed in his March 2018 hearing. b. Whether bilateral hand arthritis was incurred within one year of service. The clinician must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above-requested opinions cannot be made without resort to speculation, the clinician must state this and provide a rationale for such a conclusion. 4. Ensure that the directives specified in this remand have been implemented. If they have not, appropriate corrective action must be undertaken before readjudication. Stegall v. West, 11 Vet. App. 268 (1998). (Continued on the next page)   5. Readjudicate the claims. If any decision is unfavorable to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Stevens, 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.