Citation Nr: 20060774 Decision Date: 09/15/20 Archive Date: 09/15/20 DOCKET NO. 08-00 310 DATE: September 15, 2020 REMANDED Entitlement to service connection for hypertension, to include on a secondary basis, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March to December 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from November 2008 (hypertension) and July 2010 (TDIU) rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, these matters were previously before the Board in October 2013, December 2016, June 2018, May 2019, and August 2019, when they were remanded for additional development. 1. Entitlement to service connection for hypertension, to include on a secondary basis, is remanded. As noted above, the Board most recently remanded the matters on appeal in August 2019 to obtain a VA examination to determine the nature and etiology of the Veteran’s hypertension. Specifically, the Board found the May 2015 VA medical opinion to be inadequate in light of the holding in Ward v. Wilkie, 31 Vet. App. 233 (2019) (finding that permanent worsening is not a requirement for secondary service connection of a non-service-connected injury or disease). In this regard, the Board asked the VA examiner to provide an opinion addressing whether it was at least as likely as not that the Veteran’s hypertension (a) began in or was related to his active duty service, (b) was caused by one or more of the Veteran’s service-connected disabilities, to include gastritis and an acquired psychiatric disorder, and (c) underwent any incremental increase in disability, regardless of its permanence, due to the Veteran’s service-connected disabilities. In addition, the Board notified the Veteran that it was his responsibility to report for any examination and to cooperate in the development of the claim. See August 2019 BVA Decision, pages 5-8. Following a review of the evidence of record, the Board notes that the requested VA examinations have not taken place. In this regard, a February 2020 report of general information shows that VA contacted the Veteran to verify his address. The report shows that the Veteran indicated that he was living at a Salvation Army homeless shelter but reported that he would be required to leave within eight days. See February 2020 VA Form 21-0820 Report of General Information. A subsequent report of general information, dated in March 2020, shows that VA attempted to contact the Veteran at the shelter identified in the February 2020 report of general information, without success; however, an examination scheduling request, dated one day thereafter, continues to show that the Veteran was residing at that address. See March 2020 VA Form 21-0820 Report of General Information; March 2020 Examination Request. The Board notes that the March 2020 report of general information and the examination scheduling request are dated approximately five weeks after the date of departure identified by the Veteran in February 2020. An examination scheduling request contention cancellation form, dated in April 2020, shows that the Veteran failed to attend his scheduled examination without providing a reason. See April 2020 Examination Request. No address was listed on the April 2020 examination scheduling request contention cancellation form, and no attempts were made to either reschedule the VA examination or obtain a VA nexus opinion. More recently, in a June 2020 request for change of address, an updated address for the Veteran was provided. See June 2019 VA Form 572 Request for Change of Address/Cancellation of Direct Deposit. Importantly, the Board notes that the Veteran’s claims file includes multiple pieces of returned mail dated prior to the Veteran’s June 2020 request for change of address, to include eight pieces of returned mail dated after the August 2019 Board decision. However, no mail has been returned as undeliverable since the Veteran’s address was updated. Based on the foregoing, it is unclear to the Board whether notice of the scheduled VA examination was mailed to the Veteran’s most recent address. As the Veteran has now provided what appears to be a valid address, the Board finds that a remand is warranted to obtain a new VA addendum opinion for full compliance with the Board’s previous remand instructions. 2. Entitlement to a TDIU is remanded. As the issue on appeal is being remanded, consideration of the Veteran’s claim of entitlement to a TDIU, at this juncture, would be premature. Accordingly, the Board will defer TDIU adjudication. The matters are REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the claims file from the Veteran’s VA treatment facilities, and all private treatment records from the Veteran not already associated with the file. 2. After completion of the above development, obtain an addendum opinion by an appropriately qualified examiner to determine the nature and etiology of the Veteran’s hypertension. It is up to the discretion of the examiner as to whether an in-person examination is necessary. The examiner should provide the following opinions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension began in or is otherwise etiologically related to his service? Please explain why or why not. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was caused by one or more of his service-connected disabilities, to include anxiety disorder, not otherwise specified, with dysthymia and history of alcohol and cannabis abuse and/or gastritis with irritable duodenal bulb? Please explain why or why not. (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension underwent any incremental increase in disability, regardless of it permanence, by one or more of his service-connected disabilities, to include anxiety disorder, not otherwise specified, with dysthymia and history of alcohol and cannabis abuse and/or gastritis with irritable duodenal bulb? Please explain why or why not. The examiner is advised that the term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Additional disability due to flareups of musculoskeletal disabilities, even if it cannot be quantified, or an incremental increase in pain might constitute an increase in disability, or aggravation, for the purposes of secondary service connection. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. 3. Should the Veteran fail to report to the scheduled VA examination, such must be fully documented in the record, to include notice that the Veteran was contacted at his current address of record and properly notified of his scheduled examination. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Justis, Attorney-Advisor 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.