Citation Nr: 21000394 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-35 044 DATE: January 5, 2021 REMANDED Entitlement to service connection for hypertension to include as secondary to posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for sleep apnea to include as secondary to PTSD is remanded. Entitlement to service connection for headaches to include as secondary to PTSD is remanded. Entitlement to service connection for a rapid heartbeat disability to include as secondary to PTSD is remanded. Entitlement to service connection for an acquired psychiatric disability separate and apart from the service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to January 1968. This case comes before the Board of Veterans’ Appeals (Board) on appeal of an August 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. This case was previously before the Board in April 2018, when it was remanded for development. 1. Entitlement to service connection for hypertension to include as secondary to posttraumatic stress disorder (PTSD) is remanded. 2. Entitlement to service connection for sleep apnea to include as secondary to PTSD is remanded. 3. Entitlement to service connection for headaches to include as secondary to PTSD remanded. 4. Entitlement to service connection for a rapid heartbeat disability to include as secondary to PTSD is remanded. 5. Entitlement to service connection for an acquired psychiatric disability separate and apart from the service-connected PTSD is remanded. Pursuant to the Board’s April 2018 Remand, the AOJ scheduled examinations to determine the nature and etiology of the claimed disabilities. However, the record reflects that the scheduled examinations were cancelled because the Veteran failed to report. Generally, when a Veteran fails to report for a VA examination in connection with the assignment of an initial claim, the Board must decide the appeal based on the evidence of record. 38 C.F.R. § 3.655. However, the claims file does not contain any evidence that the Veteran was notified of the date, time, and place of his VA examination. Additionally, the Veteran was previously afforded VA examinations. According to the August 2010 VA examination, the Veteran was noted to have hypertension, recurrent episodes of palpitations, sleep apnea, chronic tension headaches which the examiner opined were not likely related to the Veteran’s active military service. The examiner’s rational was that there is no documentation the claimed medical conditions in the Veteran’s service treatment records or civilian records immediately after service. The rationale seems to be primarily based on the lack of the claimed conditions shown in service. However, a claimant may establish service connection for a disability even when the initial documentation of the disability after service- as long as the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d); see also Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007) (an opinion is inadequate where examiner relies solely on absence of in-service treatment). The Board also notes that the Veteran complained of headaches in service in July 1966. Accordingly, the opinion regarding headaches was based on inaccurate facts. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (medical opinion based upon an inaccurate factual premise has no probative value). In addition, as noted in the prior Board remand, the record is contradictory as to what other psychiatric disabilities the Veteran experiences, or has experienced during the appeal period, other than PTSD. As the August 2010 opinion is inadequate and no addendum opinions were provided nor was an explanation as to why one could not be provided based on the evidence of record following the prior Board remand, remand is required for an additional opinion. The matters are REMANDED for the following actions: 1. Forward the claims file to an appropriate clinician(s) to determine the nature and etiology of the Veteran’s claimed hypertension, sleep apnea, rapid heartbeat, headaches and acquired psychiatric disorder other than PTSD. If the examiner(s) determines that an additional in-person examination is required, one should be scheduled, and the record should include clear documentation showing that the Veteran was notified of the date, time and place of the examination. Any necessary tests should be obtained. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. The Veteran should understand that VA’s duty to assist is not always a one-way street. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Rather, the Veteran must cooperate in obtaining the evidence necessary to adjudicate the Veteran’s claim, including attending VA exams. See, e.g., 38 C.F.R. §§ 3.159(c) (requiring claimant to “cooperate fully with VA’s efforts” to obtain both VA and non-VA medical records) and 3.655(b) (setting forth potential consequences when a veteran fails to appear for a scheduled examination). The Veteran should be aware, that a failure to appear at a scheduled examination without good cause will result in a determination based on the record. If the Veteran fails to report for a scheduled VA examination, obtain the requested opinions based on review of the claims file. The entire claims file must be made available to and be reviewed by the examiner. The examiner must provide thorough responses to each of the following: (a) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed hypertension is related to active service; (b) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed hypertension was caused by or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD; (c) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed sleep apnea is related to active service; (d) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed sleep apnea was caused by or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD; (e) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed headache condition is related to active service; (f) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed migraine headache condition was caused by or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD. (g) Clarify whether rapid heartbeat is a separate, chronic disability or whether it is a symptom or manifestation of another chronic disability; (h) if the Veteran’s rapid heartbeat disability is a separate disability, determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s rapid heartbeat disability is related to active service; or (i) whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s rapid heartbeat disability was caused by or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD. (j) Identify/diagnose any acquired psychiatric disorder, other than PTSD, that presently exists or that has existed during the appeal period. (k) For each identified disorder, if such is found, state whether the disorder is distinct and separate from the already service-connected PTSD. Any negative finding should be reconciled with the separate diagnoses present in the claims file. (l) If the answer is YES (distinct and separate), discuss whether it is at least as likely as not (at least 50 percent probability) that any current psychiatric disorder other than PTSD was incurred in service or is otherwise causally or etiologically related to any event in service. (m) Whether it is at least as likely as not that the service-connected PTSD: (1) caused or (2) aggravated any additionally diagnosed psychiatric disorder(s). The examiner is advised that an opinion based solely on the fact the conditions were not shown in service or at separation is NOT a sufficient rationale. The examiner is also asked to consider the service treatment records, including the report of headaches in July 1966, as well as the Veteran’s statements, particularly his reports of continuity of symptoms. The examiner must provide a complete rationale for the opinions expressed. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Williams, 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.