Citation Nr: 20056793 Decision Date: 08/27/20 Archive Date: 08/27/20 DOCKET NO. 15-31 495 DATE: August 27, 2020 ORDER Entitlement for service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from May 1966 to March 1970. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a travel board hearing before the undersigned Veterans Law Judge (VLJ) in March 2019. The hearing transcript is of record. The Board remanded the claim in August 2019 for further development by the RO. The case has been returned to the Board for further appellate action. Unfortunately, another remand is warranted in this case. The RO failed to notify the Veteran that it was unable to obtain certain VA treatment records. 38 U.S.C.§ 5103A(b)(2); 38 C.F.R. § 3.159(e). The missing records date from approximately 1980, when the Veteran was diagnosed with hypertension, through approximately 1999, when the records on file begin. Remand is required in order to assist the Veteran in obtaining these treatment records. Furthermore, the November 2019 VA examination is inadequate. The opinion provides a baseline of severity as of 1999, the year the VA treatment records begin. However, this does not take into account the period of nearly 20 years from his diagnosis in 1980 to the year records begin in 1999. Moreover, the rationale is conclusory. The opinion states that there is no evidence that PTSD has aggravated the Veteran’s hypertension, as his blood pressure readings have remained stable for many years without a change in his medications or dosages. However, this rationale does not take into consideration the Veteran’s lay statements that the daily symptoms he experiences as a result of PTSD, such as hypervigilance, nightmares, flashbacks, numbness, anxiety, guilt and rage, impact his blood pressure. See September 2015 Form 9. The case must be returned for an addendum opinion. Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that once VA undertakes an examination, it must provide an adequate one). The matter is REMANDED for the following action: 1. Obtain outstanding VA treatment records. The outstanding records are from Michigan VA facilities and date from approximately 1980 through approximately 1999. If complete VA treatment records cannot be located or are otherwise unavailable, the Veteran should be notified, and a formal finding of unavailability must be included in the claims file. All efforts to obtain the records must be documented. 2. Also obtain updated VA treatment records, from June 2020 onward. 3. After all development has been completed, obtain an addendum opinion from the VA examiner who performed the November 2019 examination or an appropriate medical professional if the examiner is unavailable. The claims file, as updated, must be made available to and reviewed by the examiner. The examiner is asked to opine on whether it is at least as likely as not (a 50 percent or greater probability) that hypertension is attributable to service. The examiner is also asked to provide an opinion as to the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension is caused by his PTSD; and b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension has been aggravated by his PTSD? The Board notes that a permanent worsening or permanent increase in severity of the claimed condition is not required to demonstrate “aggravation.” A complete rationale must be provided for any opinion offered. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and indicate what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Minaya, 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.