Citation Nr: 21000987 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-33 088 DATE: January 6, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1964 to August 1966. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Board remanded the appeal. To ensure that the VA has met its duty to assist, an additional remand is necessary. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for hypertension is remanded. The Veteran contends that he was exposed to lead paint in service causing hypertension. See NOD (September 2013). A March 2019 Board remand noted that hypertension had been associated with lead exposure. See Toxic Substances Portal-Lead, Agency for Toxic Substances & Disease Registry, https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=93&tid=22 (last updated Aug. 24, 2016). In addressing the question of the etiology of the Veteran’s hypertension and whether there is a link between hypertension and exposure to lead and/or asbestos, a November 2019 VA medical opinion reflects that: “His service treatment records do not show elevated blood pressure during his service, nor within a year of discharge. They found he had high blood pressure in 2011 when he had heart problems. There is a lack of nexus between the veteran’s hypertension and any in-service lead exposure or service on a submarine.” The issue of entitlement to service connection for hypertension is remanded for an additional medical opinion. The November 2019 medical opinion is inadequate because it relies solely on the absence of documented diagnosis and/or treatment in service or within the first post service year. It does not explain in any meaningful way why the currently shown disability is not at least as likely as not caused by or the result of the reported in-service exposure to lead or asbestos even if of delayed onset. Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25. “[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s hypertension. The claims file and a copy of this REMAND should be reviewed. The examiner must opine whether the Veteran’s hypertension is at least as likely as not related to an in-service injury, event, or disease, to include any in-service lead or asbestos exposure while serving aboard a submarine. The opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A negative medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints/findings. A negative medical opinion may not be predicated solely on the absence of supporting medical literature. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (holding that a medical opinion stating only that there is nothing in the medical literature supporting an association between a disability and a Veteran's military service is inadequate). C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C.E., 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.