Citation Nr: 21064335
Decision Date: 10/19/21	Archive Date: 10/19/21

DOCKET NO. 16-05 336
DATE: October 19, 2021

REMANDED

The appeal regarding entitlement to service connection for hypertension is remanded.

REASONS FOR REMAND

The Veteran had active service from March 1976 to March 1979.

This matter comes before the Board of Veterans' Appeals (Board) from an April 2012 rating decision by the Agency of Original Jurisdiction (AOJ).

The Board remanded the instant claim in September 2018 to afford the Veteran an additional examination.  It indicated that the examiner should provide an opinion regarding whether the Veteran's hypertension was related to service.  It additionally directed that the examiner should provide an opinion regarding whether hypertension was caused or aggravated by any service-connected knee disability.

In June 2019, a VA examiner concluded that the Veteran's hypertension was not related to service or to his knee disability.  Regarding secondary service connection, she provided the following rationale: 

A medical record review was performed, however medical records were silent for any documentation to reflect a connection of the claimant hypertension and knee disability.  Literature review was performed and there is no peer reviewed medical evidence to support a connection between or having hypertension resultant of a knee condition.

The examiner did not address the question of whether the Veteran's hypertension has been aggravated by his now service-connected knee disabilities.  Moreover, the rationale offered for her conclusion does not adequately explain the medical principles underlying her opinions.  The Board therefore concludes that an additional examination is necessary to determine the nature and etiology of the Veteran's claimed hypertension.  

The matter is REMANDED for the following action:

1.  Schedule the Veteran for an examination to determine the nature and etiology of his hypertension.  

The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner.  The examination report must include a notation that this record review took place.

After the record review and examination of the Veteran, the examiner should provide an opinion regarding whether it is at least as likely as not hypertension was incurred in, or is otherwise related to active service.  

The examiner should also provide an opinion regarding whether it is at least as likely as not that hypertension was caused or aggravated (worsened beyond normal progression) by the Veteran's service-connected bilateral knee disability.    

In rendering these opinions, the examiner 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 examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection.  The examiner 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.

The 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 examiner must provide a complete explanation for why an opinion cannot be rendered.  In so doing, the examiner 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.

2.  Then, readjudicate the Veteran's claim.  If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto.

 

 

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Barone, 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.