Citation Nr: 21063008 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 07-38 080A DATE: October 12, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active service from January 1975 to June 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2011, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran's electronic claims folder. In January 2013, the Board denied the Veteran's claim. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In a July 2014 Memorandum Decision, the Court vacated the Board's denial and remanded the matter to the Board for further adjudication. The Board remanded the matter for additional development and again denied the matter in January 2020. The Veteran again appealed the denial to the Court. In January 2021, pursuant to Joint Motion for Remand (JMR), the Court vacated the Board's January 2020 denial and remanded the matter to the Board for further development. Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. The Veteran contends that he is entitled to service connection for hypertension because that it is secondary to his service-connected PTSD or medication used to treat his service-connected disabilities. See June 2008 VA Form 21-4138, Board Hearing Transcript, p. 11. In May 2021, the Board remanded the matter to obtain an addendum opinion regarding the etiology of the Veteran's hypertension. Specifically, the Board requested that a clinician address whether the Veteran's hypertension was aggravated by his service-connected posttraumatic stress disorder (PTSD) or medication to treat it. Previous medical opinions used an inaccurate legal standard to address the issue of aggravation. In that regard, the medical opinions addressed whether there was a permanent aggravation of the Veteran's hypertension rather than merely an aggravation beyond the hypertension's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019)("any incremental increase in disability and additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence.") In a June 2021 medical opinion, the clinician provided an opinion which continued to restate an inaccurate legal standard. At the onset, the clinician took issue with the remand and said it was unclear as to why the matter was returned for an addendum opinion. The clinician opined that, "[T]he Veteran's [hypertension] is less likely than not permanently aggravated beyond its natural progression by PTSD or the medications used to treat such." The clinician further stated that medication "can cause a temporary but not a chronic/permanent elevation in blood pressure," and that "the VBA rating is for chronic/permanent and not for a temporary disability." It is clear that the June 2021 clinician did not comply with the Board's remand directives and therefore, the Board finds that a remand is necessary to obtain an addendum opinion which is based on an accurate legal standard. The matters are REMANDED for the following action: Obtain an addendum medical opinion from a suitable clinician who has not previously examined the Veteran as to the etiology of the Veteran's hypertension. If it is determined that another examination is needed, schedule the Veteran for such an examination. The Veteran's electronic claims folder, including a copy of this remand, must be provided to the clinician. The clinician is requested to provide an opinion as to the following: Whether it is at least as likely as not (50 percent probably or greater) that the Veteran's hypertension was aggravated by his service-connected PTSD or medication (bupropion, hydroxyzine, sertraline, prazosin, aripiprazole, and trazodone) to treat it. The clinician is requested to specifically address the findings of the October 2008 examiner who found "[i]t is as likely as not that the patient's post-traumatic stress disorder has caused transient elevations in blood pressure that would be considered aggravation but in my opinion it is not as likely as not that this caused permanent blood pressure changes for this patient." If necessary, the examiner must reconcile his or her findings with that the October 2008 report. A complete rationale, with citation to appropriate medical principles, is requested. This matter is being returned because the previous clinicians used an inaccurate legal standard in their opinions. The Board previously denied the matter based on the previous opinions, but the Court vacated the Board's denials and returned the matter to the Board for further medical opinion clarification. The clinician's attention is directed to the following legal standard regarding the aggravation element of secondary service-connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019)("any incremental increase in disability and additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence."). If the examiner determines that an opinion cannot be made without resort to mere speculation, then it should be clear in the examiner's remarks whether it cannot be determined from current medical knowledge that a specific in-service injury or disease can possibly cause the claimed disorder, or whether the actual cause is due to multiple potential causes. In other words, simply stating that an opinion cannot be made without resort to mere speculation is not acceptable without a detailed explanation as to why this is so. See Jones v. Shinseki, 23 Vet. App. 382 (2010) Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Baskerville 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.