Citation Nr: 21065246 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 14-24 151A DATE: October 25, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a cervical spine disability, to include as due to service-connected disability, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disability, prior to April 8, 2020, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1976 to June 1980, and from June 1994 to February 2000. These matters come before the Board of Veterans' Appeals (Board) on appeal of an August 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in May 2018 and March 2020. In April 2021, the case returned to the Board. The Board found the Veteran's lumbar spine rating reduction to be improper and the Board restored the Veteran's rating. In addition, the Board denied an increased rating for the Veteran's lumbar spine disability. Moreover, the Board remanded the Veteran's claims for entitlement to service connection for hypertension and a cervical spine disability for additional VA examinations because the Board found the Veteran's previous examinations to be inadequate. Lastly, the Board remanded the Veteran's claim for TDIU because it was intertwined with the claims remaining on appeal. 1. Entitlement to service connection for hypertension is remanded. The Board notes that an addendum opinion was obtained for this issue in September 2021. Following the examination, the examiner found that the Veteran's disability was less likely as not due to his military service. The examiner opined that the Veteran's "STRs revealed several isolated elevated BP readings that do not represent pre-hypertension or hypertension. Per available post service medical records, the Veteran was diagnosed with hypertension in 2011, eleven years after separation from last period of AD." The examiner then simply stated that "a nexus is not established." The Board finds this medical opinion inadequate because the examiner did not provide any explanation as to why the Veteran's high blood pressure readings while on active duty did not demonstrate the onset of the Veteran's present disability. Moreover, the Board finds this opinion is inadequate because the examiner did not provide a thorough and well-reasoned analysis and instead relied on the absence of treatment records to support their negative nexus opinion. Thus, for the above stated reasons, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran's disability. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). 2. Entitlement to service connection for a cervical spine disability, to include as due to service-connected disability, is remanded. The Board notes that an addendum opinion was obtained for this issue in September 2021. Following the examination, the examiner found that the Veteran's disability was less likely as not due to his military service. The examiner stated that the Veteran's STRs revealed a complaint of neck pain on July 17, 1997, after a fall. The examiner stated that there is no additional documented complaints or treatment of neck pain during any period of active duty service. The examiner stated that post-service medical records show the next documented complaint of neck pain to be in 2009, over 10 years after separation from service. The examiner then opined that "without documented continuity of care, in that approximately 10-year interim, a new injury or disease process cannot be excluded as the etiology of the current neck condition. A nexus is not established." The Board finds this opinion is inadequate because the examiner did not provide a thorough and well-reasoned analysis and instead relied on the absence of treatment records to support their negative nexus opinion. Thus, for the above stated reasons, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran's disability. See Barr, supra. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disability, prior to April 8, 2020, is remanded. The Veteran's claim for TDIU is intertwined with the issues currently on appeal. Harris v. Derwinski, 1 Vet. App. 180 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together). Therefore, further consideration of the claim for TDIU must be deferred. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from July 17, 2021, to the present. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran's hypertension. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension had its onset in service or is caused by or related at least in part to his active service? The examiner's opinion should provide a thorough analysis as to whether the high blood pressure readings recorded on active duty demonstrate the onset of the Veteran's present disability. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran's cervical spine disorder. The electronic claims file must be reviewed by the examiner. All indicated testing and studies must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Is it at least as likely as not (50 percent or greater probability) that the Veteran's cervical spine disability had its onset in service or is caused by or related at least in part to his active service? The examiner's opinion should specifically address the Veteran's in-service injury in 1997 and whether this injury is related to the Veteran's present disability. The VA examiner should also address the Veteran's reports of suffering from neck symptoms since his service. (B). Is it at least as likely as not (50 percent or greater probability) that the Veteran's cervical spine disability was caused or aggravated by his service-connected lumbar spine disability? In providing the requested opinions, the examiner cannot rely exclusively on the absence of relevant treatment in the Veteran's medical history. The VA examiners should provide a complete rationale for all opinions offered. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Rescan, 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.