Citation Nr: 20054060 Decision Date: 08/14/20 Archive Date: 08/14/20 DOCKET NO. 11-18 463 DATE: August 14, 2020 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from April 1966 to April 1968. This appeal comes before the Board of Veterans’ Appeals (Board) from a January 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in March 2019, it was remanded for additional development. Specifically, the RO was instructed to obtain a medical opinion regarding the Veteran’s claimed hypertension disability which specifically addressed the NAS Veterans and Agent Orange Update 11 (2018) study. The RO obtained the required opinion. As such, the Board finds that the AOJ substantially complied with the directives in the March 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Remand Although the Board sincerely regrets further delay, after a review of the evidence of record, the Board finds that further development is necessary prior to adjudicating this claim. The Veteran contends that his claimed hypertension disability is etiologically related to his active duty service, to include as secondary to his already service-connected conditions. In January 2016, the Veteran submitted a disability benefits questionnaire (DBQ) for his hypertension disability which was completed by a private physician. In this DBQ, the private physician noted that the Veteran had an anxiety disorder “which creates a hypertension loop when any of them become exacerbated.” However, the physician does not define what he means by a “hypertension loop.” Additionally, the physician does not provide an etiological opinion, nor does he indicate whether this “hypertension loop” is caused by the Veteran’s anxiety disorder or aggravates the Veteran’s hypertension beyond the course of its natural progression. The Board notes that in a June 2016 rating decision the RO granted service connection to the Veteran for an unspecified anxiety disorder. The Board further notes that the Veteran’s VA examinations, when addressing secondary service connection, only address the Veteran’s hypertension as secondary to his service-connected coronary artery disease, diabetes mellitus, and renal insufficiency. However, given the January 2016 private physician’s DBQ and the potential link between the Veteran’s anxiety disorder and his hypertension, the Board finds it prudent to obtain an additional medical opinion in order to determine whether the Veteran’s hypertension is secondary to—or aggravated by—his service-connected anxiety disorder; to include as due to the medications taken and treatment thereof. The matters are REMANDED for the following action: Obtain an addendum medical opinion from an examiner with sufficient expertise to comment on the etiology of the Veteran’s hypertension. The examiner should review the file, including this remand. A new VA examination is not necessary unless the VA examiner providing the opinion determines one is needed. The examiner should be instructed to please provide the following opinion: Whether the diagnosed hypertension disability is at least as likely as not (a 50 percent probability or greater) etiologically related to, secondary to, or aggravated by, the Veteran’s service-connected anxiety disorder to include the medications taken for, and treatment thereof. If aggravation is found, the examiner should describe the baseline manifestation of the Veteran’s hypertension prior to aggravation and the increased manifestations that are proximately due to the service-connected anxiety disorder. 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. (Continued on the next page) Further, the examiner must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community at large. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Gresham 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.