Citation Nr: 20051590 Decision Date: 08/04/20 Archive Date: 08/04/20 DOCKET NO. 16-53 610 DATE: August 4, 2020 REMANDED Entitlement to service connection for hypertension, including as secondary to posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for residual injury to hands and arms, claimed as severe hands and arms lacerations, including as secondary to PTSD, is remanded. REASONS FOR REMAND The Veteran had active military service from June 1967 to March 1971. He is a recipient of the Combat Infantry Badge. These matters were previously before the Board of Veterans’ Appeal (Board) in December 2018 and remanded to obtain outstanding Department of Veterans Affairs (VA) treatment records and because the matters are inextricably intertwined with the Veteran’s psychiatric claim that was also being remanded. In an interim April 2020 rating decision service connection was granted for PTSD with alcohol and cannabis substance abuse. That represented a full grant of the benefit sought on appeal and the claim for an acquired psychiatric disability, to include PTSD, is no longer before the Board for appellate consideration. The Veteran claims entitlement to service connection for hypertension and residual injury to hands and arms as secondary to his service-connected PTSD with alcohol and cannabis substance abuse. The Veteran has not been afforded a VA examination to obtain a nexus opinion that addresses the matters of secondary service connection raised by these issues. The requirement to secure a VA examination is a low bar, and this evidence triggers VA's duty to assist. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4). The Board finds that a remand, in this instance, is necessary for VA to fulfill its duty to assist and afford the Veteran examinations for his hypertension and residual injury to hands and arms. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician to assess the etiology of his hypertension and residual injury to hands and arms. After reviewing the record and examining and interviewing the Veteran, the examiner should provide opinions as to the following: a) Is it at least as least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was incurred in or otherwise related to his military service, or caused or aggravated by his service-connected PTSD? Aggravation must be addressed. b) Is it at least as least as likely as not (50 percent probability or greater) that the Veteran’s residual injury to hands and arms was incurred in or otherwise related to his military service, or caused or aggravated by his service-connected PTSD? Aggravation must be addressed. “Aggravation” in this context is defined as a permanent worsening of the disability beyond that due to the natural disease process. Temporary or intermittent flare-ups of a preexisting disease are not sufficient to be considered aggravation unless the underlying condition, as contrasted with the symptoms, has worsened. A rationale for all opinions expressed must be provided. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Young, 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.