Citation Nr: 21002918 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-58 345 DATE: January 19, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for acid reflux, to include as secondary to service-connected PTSD, is remanded. REASONS FOR REMAND The Veteran had active service from January 1953 to October 1954. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April and August 2016 rating decisions of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). This case has been before the Board before, most recently in June 2019 when at that time the Board denied the claims of service connection for hypertension and acid reflux, both as secondary to service-connected PTSD. The Board also granted a 70 percent rating, but no higher, for PTSD, effective from October 15, 2013 to February 28, 2019. The Veteran appealed the June 2019 Board decision to the United States Court of Appeals for Veterans Claims (Court). Based on a Joint Motion for Partial Remand (Joint Motion) in July 2020, the Court indicated that the Veteran did not appeal that portion of the Board decision granting a 70 percent rating for PTSD effective from October 15, 2013 to February 28, 2019. The Court then remanded that part of the Board’s decision that denied service connection for hypertension and acid reflux, both as secondary to service-connected PTSD, for development in compliance with the Joint Motion. In the July 2020 Joint Motion, the parties determined that in the June 2019 Board decision denying service connection for hypertension and acid reflux, the Board erred in when it relied on an inadequate examination that was performed in March 2019. The parties concluded that in a June 2018 Board remand directive, the Board requested that the examiner provide medical opinions regarding aggravation and employed the "permanent worsening standard.” It was noted that in Ward v. Wilkie, 31 Vet. App. 233(2019), the Court held that the “permanent worsening” standard has no application in cases involving an incremental increase in disability of a non-service-connected condition proximately due to or the result of a service-connected disease or injury. In Ward, the Court explained that "aggravation" is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. Id. A failure of examiners to provide adequate examinations and opinions necessitates remand for new examinations and/or opinions. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, a remand is required to obtain new medical opinions to properly address claimed aggravation of the Veteran’s hypertension and acid reflux by his service-connected PTSD. The matters are REMANDED for the following action: Obtain an addendum VA medical opinion from an appropriate VA examiner. Following a complete review of the electronic claims file, including a copy of this remand, the VA examiner is requested to address the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran's current hypertension and/or acid reflux disabilities have been aggravated (worsened) by his service-connected PTSD disability? Secondary service connection does not require permanent worsening to qualify for service connection based on aggravation by a service-connected disability. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The VA examiner's opinion must be supported by a complete explanatory rationale based on the examiner's medical expertise, the examiner's clinical experience, current medical principles, and citations to the record, as appropriate. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board William J. Jefferson III 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.