Citation Nr: 20051376 Decision Date: 08/03/20 Archive Date: 08/03/20 DOCKET NO. 13-28 493 DATE: August 3, 2020 REMANDED Entitlement to service connection for fibrocystic breast disease is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected depression, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1977 to June 1995. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO denied the Veteran’s October 2009 claims of service connection for hypertension and “cystic fibrosis”. In an October 2014 statement, the Veteran clarified that she was claiming service connection for a breast cystic condition. The matter was ultimately appealed to the Board which issued a decision in September 2018 limiting the appeal to a claim of service connection for a cystic breast disorder as noted above. The September 2018 decision remanded the issues of entitlement to service connection for fibrocystic breast disease and hypertension for additional development. The case has now returned to the Board for further appellate review. 1. Entitlement to service connection for fibrocystic breast disease is remanded. Pursuant to the September 2018 Board decision, the Veteran received a VA examination in November 2019 regarding the nature and etiology of her claimed fibrocystic breast disease. The examiner opined that the Veteran did not have a present diagnosis of breast disease. However, in reviewing the Veteran’s medical history, the examiner failed to discuss instances during the period in which this appeal has been pending wherein VA treatment records show abnormal mammograms. Accordingly, the Board finds this examination inadequate for determining entitlement to service connection for fibrocystic breast disease. As such, remand is warranted to obtain a new VA examination. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected depression, is remanded. In a July 2020 appellate brief, the Veteran’s representative asserted that the Veteran’s diagnosed hypertension may be etiologically related to service-connected depression. Pursuant to Robinson v. Peake, 21 Vet. App. 545 (2008), the VA must adjudicate all theories of entitlement reasonably raised by the record. Moreover, alternative theories of entitlement are encompassed within a single claim. See Roebuck v. Nicholson, 20 Vet. App. 307 (2006). In this case, no VA examination has been obtained to address the asserted theory that the Veteran’s hypertension is etiologically related to her service-connected depression. Accordingly, remand is warranted to obtain a new medical opinion. The matters are REMANDED for the following action: 1. Afford the Veteran a VA examination(s) to determine the nature and etiology of any current disorder of the breast, including, but not limited to, fibrocystic breast disease, and hypertension. Any indicated tests or studies should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. (a.) With regards to the Veteran’s claimed breast disorder, if the examiner determines that a breast disorder is currently present or has been present at any time during the pendency of the claim, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s breast disorder, cysts, or residuals thereof that manifested in military service, or were a result of service, including any circumstances therein. In providing this opinion, the examiner should address the Veteran’s contentions regarding her in-service exposure to chemicals, any identified malignancies, history of surgical operations, and any of the Veteran’s other medical symptoms that may be related such as her service-connected scalp cysts, and tumors noted in service. (b.) Regarding the Veteran’s claimed hypertension, the examiner(s) should provide an opinion regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s diagnosed hypertension: a. Manifested in service or within one year thereafter or that is otherwise causally or etiologically related to military service, including any symptomatology therein; b. Is proximately due to service-connected disabilities, to specifically include service-connected depression, as well as any treatment for service-connected disabilities; or c. Was aggravated beyond its natural progression by service-connected disabilities, to specifically include service-connected depression, as well as any treatment for service-connected disabilities. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case and state whether the inability to provide the required opinions is based on a lack of knowledge among the medical community at large. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Gorum, 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.