Citation Nr: 21004001 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 19-00 776 DATE: January 25, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a bilateral foot disorder, to include as secondary to lumbosacral strain, sciatic nerve radiculopathy or neuritis of the bilateral lower extremities, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1994 to August 1996. These matters are before the Board of Veterans Appeals (Board) on appeal from an October 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran originally requested a Board hearing in his December 2018 VA Form 9. In a May 2020 letter, the Board notified the Veteran that his hearing was scheduled for July 27, 2020. In a July 14, 2020 letter from his representative, the Veteran waived his right to a Board hearing, thus the Board finds that there is no hearing request pending at this time. In the October 2016 rating decision, the RO noted that the Veteran submitted his June 5, 2015 intent to file within a year of the RO’s March 2015 denial. Therefore, the previous decision was not final, and the RO considered the claim submitted a request for reconsideration of the prior decision. In the December 2018 Board appeal submitted by the Veteran’s representative, hypertension and a bilateral foot claims are listed as issues on appeal from the November 2018 Statement of the Case (SOC). See December 2018 VA Form 9. REASONS FOR REMAND Regarding his hypertension claim, the Veteran contends that his current hypertension was incurred in service, or alternatively that his hypertension is secondary to his service-connected disabilities. The Veteran underwent VA examinations in March 2015 and February 2018; neither of those examiners address any secondary theories of entitlement. The Veteran and his representative submitted a November 2020 opinion from a private physician, Dr. J.M.D., opined that the Veteran has “PTSD based on major depressive disorder with multiple co-existing symptoms. He also has documented hypertension which requires continuous medication and a permanent follow-up in a medical office. It is therefore my opinion that his hypertension is secondary to the PTSD and the alcohol,” and that it was “likely as not hypertension in the gentlemen is secondary to the PTSD or alcohol abuse.” Dr. J.M.D. referenced two articles in support of his opinion, Associations Between Mental Disorders and Subsequent Onset of Hypertension, and Hypertension in Relation to Posttraumatic Stress Disorder and Depression in the U.S. National Comorbidity Survey, along with descriptions of the articles. Notably, the articles referenced were not included with the opinion. Moreover, the Board reflects that although Dr. J.M.D. indicated that these articles supported his opinion, he provided no rationale based on the facts or evidence in the case for the conclusion he reached. In this regard, his opinion is conclusory. See Guerrieri v. Brown, 4 Vet. App. 467 (1993) (the probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998) (the failure of the physician to provide a basis for his/her opinion affects the weight or credibility of the evidence). The Board therefore finds that this opinion is not sufficiently probative to warrant a grant at this time, although the Board does note that Dr. J.M.D.’s opinion does meet the low threshold for obtaining a secondary medical opinion in this case. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Accordingly, the case is remanded at this time in order for an addendum opinion to be obtained. Regarding the bilateral foot claim, the Veteran asserts that his feet were first treated while he was in service in November 1994 for a laceration of his heel. Additionally, he has reported that he was required to march with boots and with a pack while he was in service. The Board reflects that the Veteran was diagnosed with plantar fasciitis in an October 2016 VA treatment record. Although the Veteran underwent a VA examination in August 2016 in which he was not diagnosed with plantar fasciitis—and the VA examiner at that time opined that the right heel laceration scar was not related to military service—as the Veteran has a current disability of his feet and there is evidence of a potential in-service injury or event, the Board finds that a remand is necessary in order to obtain an opinion as to whether the Veteran’s plantar fasciitis is related to military service, and to also address the secondary theory of entitlement raised by the representative in this case. See Id.; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On remand, the Board also finds that any outstanding VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain any and all VA treatment records and associate those documents with the claims file. 2. Arrange for the claims file to be sent to an appropriate examiner for an addendum opinion respecting whether the Veteran’s hypertension is related to service or his service-connected disabilities. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner in conjunction with the examination. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After reviewing the record, the examiner should state whether the Veteran’s hypertension at least as likely as not (50 percent or greater probability) began in service or within one year of discharge therefrom, or is otherwise the result of military service. Specifically, the examiner should consider any noted blood pressure readings in service, or within one year after discharge therefrom. The examiner should address whether any readings or notations of borderline hypertension during service, or within one year of discharge therefrom, are initial manifestations of the Veteran’s current hypertension. Next, if the examiner determines that the Veteran’s hypertension is not directly related to service, the examiner should also opine whether any hypertension at least as likely as not was either (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected disabilities including his psychiatric disability, sleep apnea, lumbosacral strain and sciatic nerve radiculopathy/neuritis of the left and right lower extremities, either singularly or in the aggregate. In so addressing, the examiner should specifically discuss Dr. J.M.D.’s November 2020 medical opinion and the two articles noted therein. The examiner must provide an individual opinion and rationale for each of the above requested (a) and (b) opinions. In addressing the above, the examiner should address any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 3. Arrange for the claims file to be sent to an appropriate examiner for an addendum opinion respecting whether the Veteran’s bilateral foot disorders, to include a right heel laceration scar and/or plantar fasciitis, are related to service or his service-connected disabilities. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner in conjunction with the examination. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After reviewing the record, the examiner should state whether the Veteran’s bilateral foot disorders, to include a right heel laceration scar and/or plantar fasciitis, at least as likely as not (50 percent or greater probability) began in service or are otherwise the result of military service, to include marching/physical activity while wearing boots in service. Next, if the examiner determines that the Veteran’s bilateral foot disorders are not directly related to service, the examiner should also opine whether any bilateral foot disorders at least as likely as not was either (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected lumbar spine disability with associated neurological disabilities of the bilateral lower extremities. The examiner must provide an individual opinion and rationale for each of the above requested (a) and (b) opinions. In addressing the above, the examiner should address any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.J. Smith, 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.