Citation Nr: 20054794 Decision Date: 08/19/20 Archive Date: 08/19/20 DOCKET NO. 14-18 326 DATE: August 19, 2020 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to April 1970 and February 1979 to March 1981. This matter came before the Board of Veterans Appeals (Board) on appeal from a January 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The case was remanded in January 2018 and February 2020 for additional development, and it now returns for adjudication. Entitlement to service connection for hypertension is remanded. The Veteran contends that his hypertension is related to his active service, and thus service connection is warranted. Specifically, he argues that his hypertension is secondary to his service-connected posttraumatic stress disorder. Unfortunately, the Board finds another remand is necessary to ensure compliance with previous remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). The January 2018 Board remand instructed obtain a VA opinion as to whether the Veteran’s hypertension was caused or aggravated by his service-connected PTSD. The Board referred a Federal Register statement of June 28, 2005, 70 F.R. 37040, which noted that presumption of service connection was warranted for hypertensive vascular disease for prisoners of war (POW). It was reasoned that presumption of service connection was warranted on the basis that several medical studies found veterans with a long-term history of PTSD to have a high risk of developing cardiovascular disease and myocardial infarction, and since POWs have a relatively high rate of PTSD incurrence, they would presumably be at risk of cardiovascular disease to include hypertension. VA has therefore recognized that medical studies have shown that veterans with PTSD have a high risk of cardiovascular disease including hypertension and that a connection exists between PTSD and hypertension. The Board directed that the VA examiner should consider the Federal Register statement and its findings in providing the opinion. The Veteran was provided with a VA examination in May 2018. However, the examiner did not address the article in the Federal Register or whether the Veteran’s hypertension has been aggravated by his service-connected PTSD. Accordingly, the February 2020 Board remand directed the RO to obtain another VA opinion as to whether the Veteran’s hypertension began in-service or within a year of service, or was caused or aggravated by his posttraumatic stress disorder. The Board again specifically directed the examiner to address the Federal Register statement of June 28, 2005, 70 F.R. 37040. In March 2020, the Veteran underwent another VA examination, at which time the examiner provided the requested opinions. Notably, the examiner did not address the Federal Register statement of June 28, 2005, 70 F.R. 37040. Rather, in supporting the opinion regarding service connection secondary to posttraumatic stress disorder, the examiner noted that, “The many articles and various studies which consider a possible relationship present a generalized association between PTSD and hypertension and do not account for the effects of multiple other etiologies of hypertension, thereby decreasing their utility as scientific data.” The Board finds this reference to “many articles and various studies” does not adequately comply with the Board’s instructions to address the Federal Register statement. Consequently, remand is necessary to obtain an opinion which addresses the Federal Register statement. The matters are REMANDED for the following action: 1. Forward the record to an appropriate VA examiner for an opinion pertaining to the etiology of the Veteran’s hypertension. The record and a copy of this Remand must be made available to the examiner. Following a review of the entire record, the examiner should opine as to whether it is at least as least as likely as not that hypertension is (1) proximately due to service-connected PTSD, or (2) aggravated beyond its natural progression by service-connected PTSD. The examiner must address the Federal Register statement of June 28, 2005, 70 F.R. 37040. A rational should accompany all opinions offered. J.B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jonathan M. Estes 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.