Citation Nr: 20056543 Decision Date: 08/26/20 Archive Date: 08/26/20 DOCKET NO. 14-21 783 DATE: August 26, 2020 REMANDED Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2002 to April 2002. He also had additional service in the Reserves. This matter is before the Board of Veterans’ Appeals (Board) on appeal from July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2016, the Veteran testified, sitting in Waco, Texas, before the undersigned via a Travel Board hearing. A transcript of the hearing has been associated with the virtual file and reviewed. This case was most recently before the Board in September 2019, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998).   Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disability, is remanded. A September 2019 Board decision remanded the claim of service connection for hypertension and deferred consideration as the matter was inextricably intertwined with the claim of service connection for the psychiatric issue that was also on appeal. The Board directed the Agency of Original Jurisdiction (AOJ) to schedule the Veteran for a VA examination regarding the etiology of the psychiatric condition. And, if the Veteran’s psychiatric condition was found to be related to service, then the AOJ was directed to schedule the Veteran for a VA examination to determine the etiology of any diagnosed hypertension. The VA examiner was to provide opinions as to whether the Veteran’s hypertension is related to service, to include an opinion as to whether hypertension is caused by or aggravated by his psychiatric condition. 09/26/2019, BVA Decision. A March 2020 rating decision granted service connection for posttraumatic stress disorder (PTSD) and major depressive disorder with psychotic features on the basis of a February 2020 VA examination, which opined that the Veteran’s psychiatric conditions were at least as likely as not related ot his active service. 03/13/2020, Rating Decision; see also 03/10/2020, C&P Exam (positive nexus opinion for psychiatric disabilities). Several issues arose in the attempts by the AOJ to afford the Veteran a VA examination regarding his hypertension condition. Initially, the Veteran was unable to attend any examinations due to the distance between his home and the medical facility. 11/18/2019, VA 21-0820; 12/03/2019, VA 21-0820. In December 2019, the Veteran also affirmatively made requests to be scheduled for a VA examination regarding his hypertension. 12/18/2019, Correspondence. Subsequently, the AOJ erroneously did not include hypertension in the exam requests. 01/23/2020, Exam Request; 03/18/2020, Exam Request. Additionally, in March 2020, the AOJ indicated that the VA examination for hypertension could not be conducted until May 2020 or later due to issues involving Covid-19 (novel coronavirus pandemic). 03/18/2020, VA Exam Worksheet. The Veteran reported that he received an informal examination over the telephone and was notified that an in-person examination was not necessary. 03/18/2020, VA 21-0820; 03/19/2020, Correspondence. For this reason, the Veteran refused to schedule another VA examination, as he was previously informed that the examination was not necessary. 03/26/2020, Exam Request. The Veteran requested a decision on his appeal based on the informal examination that was purportedly conducted, in addition to the evidence currently in the claims file. 03/19/2020, Correspondence. It appears to the Board that the AOJ provided the Veteran conflicting information in the process of scheduling a VA examination for his hypertension condition. Moreover, evidence of an informal examination regarding hypertension does not appear to have been associated with the claims file. Additionally, it is unclear to the Board as to whether a sufficient examination was conducted, informal or formal, as the record suggests that the AOJ was unable to get an echocardiogram until the end of May 2020 due to Covid-19. Upon review of the record as noted above, the Board finds that a medical opinion is necessary to determine the nature and etiology of the Veteran’s hypertension. This matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records, to include any evidence of an informal VA examination regarding the Veteran’s hypertension. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After completing directive # 1, obtain a medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s hypertension. An in-person examination is not required unless deemed necessary by the clinician.   The clinician is to review the virtual file, including a copy of this Remand, and become familiar with the Veteran’s pertinent medical history. The clinician is to address the following: (a.) Whether it is at least as likely as not that a current hypertension condition is related to the Veteran’s period of active service. (b.) Whether it is at least as likely as not that the current hypertension condition was caused by a service-connected disability, to include PTSD and major depressive disorder with psychotic features. (c.) Whether it is at least as likely as not that the current hypertension condition has been aggravated (i.e., worsened beyond the normal progression of that disease) by a service-connected disability, to include PTSD and major depressive disorder with psychotic features. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. (Continued on the next page)   If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han 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.