Citation Nr: 21002554 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 10-35 451 DATE: January 14, 2021 REMANDED Entitlement to service connection for hypertension, on a direct basis or as secondary to a psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1978 to June 1985, and from June 1988 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matter for further development in August 2015, August 2018, and September 2020. The Veteran, through his representative, has recently raised the issue of whether his hypertension may be secondary to a psychiatric disorder, including depression. See November 2020 Correspondence. Service connection for a psychiatric disorder has not been established, but is pending before the Board, as discussed in more detail below. In its September 2020 decision, the Board bifurcated the issue of entitlement to service connection for hypertension as secondary to service-connected plantar fasciitis, and denied it on the merits. At that time, the Board was not aware of a reasonably raised issue as to whether it may be secondary to depression or any other disability apart from the service-connected plantar fasciitis. Thus, in the “Order” section of the decision, the Board phrased the denial broadly as a denial of service connection for hypertension on a secondary basis. However, that does not foreclose consideration of entitlement to service connection for hypertension as secondary to depression or other disabilities, to the extent the record reasonably raises the issue. Significantly, a separate appeal that includes a claim for service connection for depression was recently docketed at the Board. The Veteran has requested a Board hearing via videoconference with respect to that appeal, which has not yet been scheduled. See April 2020 VA Form 9. Thus, the Board may not address that appeal at this time. As the claim for hypertension on a direct basis is being remanded for additional development, the agency of original jurisdiction (AOJ) will have an opportunity to adjudicate the issue of service connection for hypertension as secondary to depression after the Board has addressed the claim for that disability. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in January 2015. A transcript of the hearing is of record. The Board sent a letter to the Veteran in September 2020 which states that he had elected an in-person Travel Board hearing with a VLJ, and which notified him of his option to select a virtual tele-hearing instead, in light of the continued impacts of the COVID-19 pandemic and consequent delay in scheduling in-person hearings. The Veteran has not responded to that letter. Review of the record shows that he does not have a pending hearing request with respect to this appeal. As stated, he testified at a hearing before the undersigned in January 2015. The transcript of that hearing will be considered in any decision on this appeal. The Board notes that he does have a pending request for a Board hearing via videoconference with respect to a different appeal, which has yet to be scheduled. Service connection for hypertension is remanded. In its September 2020 remand, the Board instructed that a VA medical opinion be obtained on the issue of whether the Veteran’s hypertension may be linked to in-service high blood pressure readings. Such an opinion was provided in October 2020. However, the Board finds that it does not fully comply with its remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). More specifically, while the opinion discusses the Veteran’s high blood pressure readings during service, it does not reflect consideration of his elevated blood pressure readings in the first few years following separation from service, as instructed in the Board’s remand. Accordingly, the examiner who provided the October 2020 opinion should be asked to provide a supplemental opinion addressing the Veteran’s high blood pressure readings in the first few years following separation from service. If that examiner is not available, or an opinion cannot be obtained from the examiner within a reasonable time frame, the opinion may be provided by another medical professional. As discussed above in the introductory section, the Veteran has recently raised a theory that his hypertension may be secondary to a psychiatric disorder, including depression. See 38 C.F.R. § 3.310 (providing for service connection on a secondary basis). His appeal regarding service connection for depression has recently been certified to the Board under a separate docket number, with a pending hearing request. If the AOJ continues to deny service connection for hypertension on a direct basis following the above development, it should defer transferring the matter back to the Board until the Board has addressed the claim for depression. Then, once the Board has adjudicated the claim for depression or, if it determines that a remand is warranted, after the AOJ has readjudicated that claim on remand, the AOJ should adjudicate the claim for hypertension as secondary to depression. The matters are REMANDED for the following action: 1. Request the examiner who rendered the October 2020 VA medical opinion to provide a supplemental opinion, as specified below. If that examiner is not available, or cannot provide the opinion within a reasonable time frame, a different medical professional may provide the opinion. The examiner is asked to review the Veteran’s blood pressure readings in the first few years following his separation from service, and state whether that alters the conclusion reached in the October 2020 medical opinion. In this regard, following the Veteran’s June 1991 separation from service, a February 1992 VA examination report reflects a blood pressure reading of 120/80. An October 1992 VA treatment record reflects a reading of 155/37, which was elevated. An August 1994 record reflects a reading of 130/86. A month later, in September 1994, the reading was 130/90, again showing elevated blood pressure. The records thereafter continue to reflect both elevated and normal blood pressure readings. For example, on December 12, 1995, the Veteran’s blood pressure was 150/100. But on December 28, 1995, it was 130/80. The examiner should address this pattern of alternating normal and elevated blood pressure readings in the first few years following the Veteran’s service separation in light of the occasionally elevated in-service blood pressure readings, in terms of whether they support a link between the Veteran’s hypertension (first formally diagnosed in September 1997) and his period of service. The examiner must provide a complete explanation in support of the conclusion reached. 2. Service connection for hypertension as secondary to depression: If the AOJ continues to deny service connection for hypertension on a direct basis, it should not transfer the matter back to the Board at this time. Rather, after the Board has adjudicated the service connection claim for depression (now pending at the Board), or after the AOJ has readjudicated that claim on remand by the Board, as the case may be, it should adjudicate the issue of service connection for hypertension as secondary to depression. If service connection continues to be denied, it should then transfer the claim back to the Board. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.