Citation Nr: 21004990 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 13-20 601 DATE: January 28, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Air Force from April 1969 to June 1972. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in August 2017. A copy of the hearing transcript is of record. The Board issued a decision in February 2018 which denied entitlement to service connection for hypertension. The Veteran appealed the denial to the Court of Appeals for Veterans Claims (the Court). A Joint Motion for Remand (JMR) was filed in November 2018. In December 2018, the Court issued an Order returning the case to the Board for action consistent with the JMR. In August 2019, the Board remanded this matter to provide a VA medical examination and opinion. Although the Board regrets further delay, remand is again warranted to ensure that all due process requirements are met. Entitlement to service connection for hypertension is remanded. The Veteran contends that he suffers from hypertension, which is either directly related to active duty service, or secondary to a service-connected disability. Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). Causation and aggravation are independent concepts and should have separate findings and rationales. Atencio v. O’Rourke, 30 Vet. App. 74 (2018). An opinion to the effect that one disability “is not caused by or a result of” another disability does not answer the question of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). In February 2020, the Veteran was provided with a VA hypertension examination. The VA examiner found that the Veteran did have a current diagnosis of hypertension. In July 2020, the VA examiner provided addendum opinions that the Veteran’s hypertension was not directly related to service or secondary to a service-connected disability. Specifically, in a July 7, 2020 addendum opinion, the VA examiner opined that the Veteran’s hypertension was not directly related to service because there was no treatment for this condition during service or afterwards until 2000, many years after separation in 1972. Regarding causation, the examiner also found that the hypertension was not proximately due to or the result of any of the Veteran’s service-connected conditions. Regarding aggravation, the VA examiner found that the current severity of the Veteran’s hypertension was greater than the baseline level of severity, but that it was not aggravated by his service-connected conditions. To support this conclusion, the examiner stated that people develop hypertension later in life for no apparent reason. Although this opinion is probative of causation, it does not address whether the Veteran’s service-connected disabilities aggravated his hypertension after service. Later in July, the VA examiner was asked to provide a valid rationale as to why the Veteran’s hypertension, which is greater than the baseline established by the examiner, was not aggravated beyond its normal progression by service-connected disabilities. In a July 23, 2020 addendum opinion, the VA examiner stated that there was no known aggravation of the Veteran’s hypertension during service. The VA examiner also stated that the Veteran’s service-connected conditions are not known to cause hypertension, and that even without his service-connected conditions, the Veteran would still have developed hypertension. Again, the Board finds that, although this opinion is probative of causation, it does not address whether the Veteran’s service-connected disabilities aggravated his hypertension after service. While the July 2020 VA addendum opinions and rationales address causation, the opinions are inadequate to determine whether the Veteran’s hypertension was aggravated by his service-connected disabilities. The Board finds that a new VA medical opinion is necessary to determine whether the Veteran’s hypertension was aggravated by his service-connected disabilities. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to his service-connected disabilities, proximately due to his service-connected disabilities, or aggravated beyond its natural progression by his service-connected disabilities, including medication for these disabilities. (a.) The VA examiner must provide separate findings and rationales relating to causation and aggravation. (b.) The examiner is reminded that aggravation can occur after service. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Casey 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.