Citation Nr: 21001342 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 16-28 191 DATE: January 7, 2021 REMANDED Entitlement to service connection for heart disease is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1985 to October 1985 and from August 1986 to December 1991. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in March 2019. A transcript of the hearing is associated with the Veteran’s claims folder. This case was previously before the Board in June 2019, on which occasion the claims were remanded. 1. Entitlement to service connection for heart disease is remanded. 2. Entitlement to service connection for hypertension is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the Board's June 2019 decision, claims of service connection for heart disease and hypertension were remanded for new VA medical opinions. The RO was directed to request a medical opinion regarding whether it is at least as likely as not that the Veteran’s heart disease and hypertension are due to his service-connected migraine syndrome. In doing so, the Board specifically directed the examiner to include a discussion of the medical articles submitted by the Veteran. In December 2019 a new VA medical opinion was proffered, wherein a VA medical provider opined that the Veteran’s heart disease and hypertension are less likely than not proximately due to or the result of his service-connected migraine syndrome. However, the examiner did not address the medical articles submitted by the Veteran as directed by the Board in the June 2019 decision. A remand by the Board confers on the claimant, as a matter of law, a right to compliance with the remand orders. See Stegall v. West, 11 Vet. App. 268, 271 (1998). As the December 2019 examiner failed to address the medical articles submitted by the Veteran in rendering an opinion, the Board finds that there has not been substantial compliance with the Board's previous remand directives. Additionally, the Board notes that there is evidence that the Veteran’s heart disease and hypertension may have manifested during his period of active duty service. In this regard, the Veteran was diagnosed with cardiomegaly while on active duty. (12/19/1991, STR, p. 54). Regarding hypertension, the Board notes that the Veteran had diastolic blood pressure readings in excess of 90mm on several occasions. (12/19/1991, STR, p. 68, 71, 77, 100, 119). While the Board was unable to find an in-service diagnosis of hypertension, these elevated blood pressure readings are sufficient to trigger VA’s duty to assist in requesting a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In light of the aforementioned, the Board finds that the claims must be remanded for further medical development. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from November 2020 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s heart disease. The examiner must opine on whether heart disease is at least as likely as not: (a.) related to an in-service diagnosis of cardiomegaly, (12/19/1991, STR, p. 54); (b.) proximately due to service-connected migraine syndrome; and (c.) aggravated beyond its natural progression by service-connected migraine syndrome. The examiner must provide a full explanation for all opinions provided. A full explanation – must – include discussion of the medical articles submitted by the Veteran and Dr. D’s 2015 opinion, and whether the VA physician agrees or disagrees and the reasons why. (3/24/2011, Web Documents, p. 1); (3/2/2018, Medical Treatment Record, p. 1). 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s hypertension. The examiner must opine on whether hypertension is at least as likely as not: (a.) related to in-service elevated blood pressure readings, (12/19/1991, STR, p. 68, 71, 77, 100, 119); (b.) proximately due to service-connected migraine syndrome; and (c.) aggravated beyond its natural progression by service-connected migraine syndrome. (d.) The examiner must provide a full explanation for all opinions provided. A full explanation – must – include discussion of the medical articles submitted by the Veteran and Dr. D’s 2015 opinion, and whether the VA physician agrees or disagrees and the reasons why. (3/24/2011, Web Documents, p. 1); (3/2/2018, Medical Treatment Record, p. 1). Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.