Citation Nr: 21062310 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 14-14 982 DATE: October 6, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for left ventricular hypertrophy is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1972 to February 1976 and in the Air Force Reserve from September 1980 to September 1983. He appeals a September 2010 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in October 2016. A transcript is of record. Thereafter, in February 2018 and March 2020, the Board remanded the Veteran's claims to the AOJ for further development. The claims are back before the Board for further appellate proceedings. 1. Hypertension Following the Board's March 2020 remand to obtain a VA opinion as to whether the Veteran's service-connected acquired psychiatric disorder has caused or aggravated his hypertension, a VA examiner provided negative opinions in August 2020. However, a review of the rationale provided in support of the opinions illustrates that the examiner phrased the rationale in speculative terms. For example, regarding causation, the examiner stated "[w]hile psychiatric conditions such as anxiety may result in transiently elevated blood pressure, this would be during active symptoms." Therefore, given the speculative nature of the opinions, additional VA causation and aggravation opinions are necessary. Furthermore, regarding the aggravation opinion, the examiner reasoned that "[w]hile psychiatric conditions such as anxiety may result in elevated blood pressure, this would be during active symptoms, and would not result in permanent or ongoing blood pressure elevation, or result in permanent aggravation of prior hypertension." In addition, the examiner noted that "pharmacologic elevation of blood pressure would be transitory, and would not be expected to cause a permanent and ongoing elevation of blood pressure, or result in permanent aggravation of prior hypertension." However, the United States Court of Appeals for Veterans Claims has held aggravation under 38 C.F.R. § 3.310(b) does not require there be a "permanent" worsening of the nonservice-connected disability. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). Thus, an additional aggravation opinion is necessary as the March 2020 opinion focuses on permanent aggravation. 2. Left Ventricular Hypertrophy The August 2010 VA examiner found the Veteran's left ventricular hypertrophy is secondary to his hypertension. As the claim of service connection for left ventricular hypertrophy is premised in part on the finding of service connection for hypertension, the issue of left ventricular hypertrophy is inextricably intertwined with that issue. Accordingly, the Board will defer adjudication on the matter. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his hypertension and left ventricular hypertrophy that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's hypertension. The evidentiary record, including a copy of this remand, must be made available to, and be reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran's hypertension was CAUSED by his service-connected psychiatric condition, to include any medication taken for his psychiatric condition? B. Is it at least as likely as not that the Veteran's hypertension was AGGRAVATED by his service-connected psychiatric condition, to include any medication taken for his psychiatric condition? Please note: the United States Court of Appeals for Veterans Claims has held aggravation under 38 C.F.R. § 3.310(b) does not require there be a "permanent" worsening of the nonservice-connected disability. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and her representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Breitbach, 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.