Citation Nr: 21000285 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-43 535 DATE: January 5, 2021 REMANDED Service connection for hypertension, to include as secondary to service-connected coronary artery disease (CAD) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1967 to December 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This issue was previously before the Board in August 2018 and September 2019. Service connection for hypertension, to include as secondary to service-connected CAD is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue. Stegall v. West, 11 Vet. App. 268, 271 (1998). Remand is necessary to obtain an addendum VA opinion regarding the Veteran’s claim of service connection for hypertension, to include as secondary to service-connected disabilities. The Veteran was afforded a VA examination in January 2014 to assess whether his hypertension was secondary to his service-connected diabetes mellitus or CAD. The relevant January 2014 VA examination reflects a negative nexus opinion determining that the Veteran’s hypertension was not proximately due to his CAD. However, the examiner failed to address whether the Veteran’s hypertension was aggravated beyond its natural progression by his CAD. As noted above, the Board remanded the hypertension issue in September 2019 to obtain another VA opinion regarding direct service connection and to address whether the hypertension was aggravated by his CAD. The Veteran underwent another VA examination in December 2019. The examiner opined that the currently diagnosed hypertension was less likely than not aggravated beyond its natural progression by the veteran's service-connected disabilities, to include diabetes mellitus type II and CAD. Specifically, CAD did not cause hypertension. No rationale regarding whether the Veteran’s hypertension was aggravated by his CAD was provided as specifically requested by the September 2019 remand. Accordingly, another remand is required to secure an opinion that addresses the Veteran’s contentions regarding secondary service connection. This matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician. The clinician should review the virtual file, including a copy of this Remand. The clinician is to address the following: Whether it is at least as likely as not (50 percent or greater probability) that the current hypertension diagnosis has been aggravated (i.e., worsened beyond the normal progression of that disease) by any service-connected disability, including his service-connected coronary artery disease. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. 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 K. Cruz, 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.