Citation Nr: 20060376 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 17-49 703 DATE: September 14, 2020 REMANDED Service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1968. This case returns to the Board of Veterans’ Appeals (Board) after a remand to the agency of original jurisdiction (AOJ) in October 2019. Because the AOJ failed to substantially comply with the Board’s instructions, another remand is necessary. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board remanded for an adequate medical opinion on whether the Veteran’s hypertension is secondary to his service-connected diabetes mellitus. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (VA medical opinions on secondary service connection must sufficiently address both proximate causation and aggravation). To that end, the Board specifically instructed the VA examiner to consider November 2011 treatment records showing recent diagnoses for both diabetes and hypertension. In December 2019, a VA contractor opined that the Veteran’s hypertension was less likely than not proximately due to diabetes because “the presence of hypertension predated … the onset of diabetes by more than 30 years,” noting that the Veteran previously “report[ed] that he developed hypertension during the 1970s.” This assumption is apparently based on an earlier VA examination report from March 2013, which indicates that the onset of symptoms was in the 1970s. The December 2019 opinion does not reflect consideration of the November 2011 treatment records identified in the Board’s remand. For VA purposes, hypertension means that diastolic blood pressure is predominantly 90mm. or greater, and a diagnosis must be confirmed by readings taken two or more times on at least three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). As the Board’s prior remand suggests, medical records show diagnoses for hypertension and diabetes in November 2011, after the Veteran was hospitalized for a stroke. This appears to be the earliest documentation of a hypertension diagnosis in the record. It is also consistent with the Veteran’s account of “becoming aware of hypertension” while being treated for a stroke at Grady Memorial in Atlanta, Georgia. See December 2019 examination report. The Board acknowledges that there is conflicting information in the record regarding the onset of the Veteran’s hypertension. However, competent medical evidence suggests that he was initially diagnosed with both hypertension and diabetes in or around 2011. The December 2019 examiner did not take this evidence into consideration, as the Board instructed. Instead, the 2019 examiner assumed, based on a prior examiner’s note, that the Veteran’s hypertension preceded his diabetes diagnosis by several decades. Consequently, the Board finds the December 2019 opinion to be inadequate. See e.g. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (VA medical opinions must be based on correct factual premises). An addendum opinion on secondary service connection is warranted. At a minimum, this opinion must address the November 2011 treatment records described above. The matter is therefore REMANDED for the following action: 1. Obtain an addendum opinion on the etiology of the Veteran’s hypertension. The examiner must address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is proximately due to his service-connected diabetes mellitus type II? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is aggravated beyond its natural clinical course by his service-connected diabetes mellitus type II? The opinion must reflect consideration of the Veteran’s hospital records from November 2011, as well as any other relevant medical or lay evidence. 2. Review the medical opinion above to ensure substantial compliance with the Board’s directives. Take any necessary corrective action. 3. Readjudicate the claim on appeal. If it remains denied, issue a supplemental statement of the case and allow the Veteran and his representative the opportunity to respond. Then return to the Board for further appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, 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.