Citation Nr: 21004137 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 03-17 945 DATE: January 26, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1974 to August 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The Veteran was scheduled to appear in a virtual hearing before the Board in December 2020. Notice of the hearing was sent to both the Veteran and his representative. However, the Veteran did not appear and has not submitted evidence of good cause for his absence. Thus, the Board considers the hearing request to have been withdrawn. This matter has an extensive procedural history dating back to 2007. Most recently, in October 2019, the Board remanded this matter for an addendum VA medical opinion. The agency of original jurisdiction (AOJ) obtained a medical opinion in February 2020. Regrettably, a further remand is required to afford the Veteran appropriate notice of the qualifications of the VA medical opinion provider. In January 2021, the Veteran’s representative challenged the qualifications of the February 2020 VA medical opinion provider. Applicable law holds that once a veteran challenges the competency of a medical examiner, just as in typical litigation, the side presenting the expert must satisfy its burden of persuasion as to the expert’s qualifications. Francway v. Wilkie, 940 F.3d 1304, 1308 (Fed. Cir. 2019). Review of the February 2020 medical opinion shows that it was completed by a clinician with the initials “R.R.” However, no further explanation of R.R.’s qualifications, title, experience, or specialized training has been provided. Therefore, the matter must be remanded for VA to satisfy the burden of persuasion as to the opinion provider’s qualifications. If R.R.’s qualifications are unavailable, the AOJ is asked to obtain a new medical opinion from a qualified examiner, and ensure that a copy of the examiner’s qualifications is included with the report. Additionally, the Board notes that the most recent valid power of attorney reflects that the Veteran selected the American Legion as his representative. See VA Form 21-22, June 2019. However, in July 2019, the Veteran submitted a request on an improper form to appoint Veterans of Foreign Wars of the United States as his power of attorney. No further clarification was received from the Veteran, and the American Legion has continued to act on the Veteran’s behalf in the pending appeal. On remand, the Veteran is invited to submit an updated power of attorney to ensure that his choice of representative is consistent with his intent. The matter is REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorders on appeal. 2. Please obtain a copy of the professional qualifications of the February 2020 medical opinion provider (R.R.), such as a curriculum vitae, listing of education, previous work experience, areas of specialized training or competence, etc. and associate it with the claims file. If, and only if, the professional qualifications of R.R. cannot be associated with the record, the AOJ is asked to obtain a new medical opinion from a suitably qualified clinician regarding the etiology of the Veteran’s hypertension. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran’s hypertension had its onset during or is causally related to active duty service? (b) Is it at least as likely as not that the Veteran’s hypertension is proximately due to, a result of, or aggravated by, a service-connected disorder, to include posttraumatic stress disorder (PTSD)? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: • The 2015 VA study indicating a possible connection between heart disease and psychiatric disorders, as described at the following link: https://pubmed.ncbi.nlm.nih.gov/25713943/ • The article authored by Harold Cohen, Ph.D, which states that studies have shown that people with PTSD are at increased risk for hypertension, submitted by the Veteran in June 2019 • The Veteran’s lay contentions that his hypertension is proximately due to, a result of, or aggravated by, his service-connected PTSD The clinician is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. 3. Provide the Veteran with an opportunity to submit an updated power of attorney, to include a VA Form 21-22 or VA Form 21-22a. Document all development with respect to this directive in the claims file. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.