Citation Nr: 21002987 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-31 731 DATE: January 19, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected unspecified anxiety disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to April 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). This issue was previously before the Board in August 2015 when it was remanded for further development, and in February 2019 when it was denied. The Veteran appealed the denial to the Court of Appeals for Veterans Claims (Court). In May 2020, the Court granted a Joint Motion for Remand, and remanded the issued to the Board. Entitlement to service connection for hypertension, to include as secondary to service-connected unspecified anxiety disorder, is remanded. Remand is required for an addendum VA medical opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 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 a secondary service connection claim, a medical opinion that a disorder is not the result of an already service-connected disability does not address the issue of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran underwent a VA examination in April 2018 where the examiner provided a negative nexus opinion. On a direct basis, the examiner opined that the one episode of elevated blood pressure in service in June 1969 is not sufficient to make a diagnosis of hypertension. The examiner explained that the Veteran was not diagnosed until June 1996, despite numerous hospitalizations for psychiatric reasons. Further, the examiner noted documentation of blood pressure of 108/90 in May 1979, and 130/60 in May 1989. This rationale is inadequate because the examiner failed to provide a well-reasoned opinion regarding whether the current hypertension is due to active service, as opposed to whether the Veteran was diagnosed in service. Further, the examiner erred when stating that the Veteran was not diagnosed until June 1996, when actually the Veteran was first diagnosed with essential hypertension in January 1996. On a secondary basis, the examiner again noted that the Veteran was not diagnosed until June 1996. Further, the examiner explained that in January 1996 the Veteran was diagnosed with essential hypertension, which means hypertension is not caused by some other pathologic processes or disease. The examiner stated that this diagnosis does not correlate with the onset of psychiatric symptoms first documented in September 1970 as a mild anxiety reaction to marital problems. However, the examiner failed to provide any other rationale for the opinion that the hypertension does not correlate with the onset of his psychiatric symptoms. Regarding aggravation, the examiner did state that they could not determine a baseline of severity of aggravation at the time of the examination because the Veteran’s blood pressure was within normal limits, even with not taking medication; however, this does not actually address whether the hypertension was aggravated by the service-connected unspecified anxiety disorder. Accordingly, remand is required for an addendum VA medical opinion. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the hypertension from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the hypertension had onset in, or is otherwise related to, active service. (b) The examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the hypertension is caused by the service-connected unspecified anxiety disorder. (c) The examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the hypertension is aggravated by the service-connected unspecified anxiety disorder. (d) The examiner must address the following: 1) the June 1969 service treatment records indicating blood pressure of 142/100; 2) the January 1996 VA treatment records indicating a diagnosis of essential hypertension; and 3) the April 2018 VA examination. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rogos 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.