Citation Nr: 21065858 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 09-40 753 DATE: October 27, 2021 REMANDED The claim for service connection for hypertension is remanded. The claim for service connection for coronary artery disease (CAD) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1978 to November 1993. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2008 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). In May 2011, the Board denied the claims considered herein. A subsequent November 2011 Joint Motion for Remand was granted by the United States Court of Appeals for Veterans Claims (Court). In June 2012, the case was remanded by the Board. In an October 2017 decision, the Board denied service connection for hypertension and coronary artery disease. The Veteran appealed to the Court. Pursuant to an April 2019 Memorandum Decision, the Court vacated the October 2017 decision to the extent that it denied service connection for hypertension on a secondary basis and for coronary artery disease. The Board remanded these issues in October 2019 to obtain relevant medical records and provide the Veteran an adequate VA examination. In October 2020, the Board denied service connection for hypertension and coronary artery disease. The Veteran appealed to the Court and a subsequent June 2021 Joint Motion for Remand was granted. The Court indicated that the Board did not address the Veteran's attorney's arguments regarding evidence of a possible connection between headaches and hypertension. 1. The claim for service connection for hypertension is remanded. In a January 2020 addendum opinion, the examiner provided a negative nexus opinion for the Veteran's hypertension as secondary to his service-connected vascular headaches. The examiner noted in part that "[t]here is no evidence in the 2007/2008 records (when the patient was diagnosed with HTN) that the patient had any complaints of vascular headaches." This statement is factually inconsistent with the medical evidence of record as it is clear from the Veteran's c-file that he underwent a C&P Examination in April 2008 for vascular headaches where he reported headaches three times per week with severe pain and photophobia with nausea. At that examination, the Veteran's blood pressure was reported as 164/100. As a result, the January 2020 addendum opinion is inadequate, and a remand for a new examination and opinion is required. The Veteran's representative, in an August 2021 filing, sought to call into question the credibility of the January 2020 addendum opinion because only an opinion, and not a full examination, was completed. Based on a review of the examination request form, the examiner was instructed to provide a medical opinion only, despite the Board's remand instructions requesting an examination. Given that a new opinion is required, the Board will specifically order a new VA examination be completed at that time. 2. The claim for service connection for CAD is remanded. Finally, because a decision on the remanded issue of hypertension could significantly impact a decision on the issue of service connection for CAD, the issues are inextricably intertwined and a remand of this claim is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to address the etiology of his hypertension. The examiner should answer the following questions: a) Is it at least as likely as not (50 percent or greater) that the Veteran's hypertension was caused by his service-connected vascular headaches? In so addressing, the examiner should specifically address the fact that the Veteran's hypertension and coronary artery disease (CAD) were diagnosed at approximately the same time. Additionally, in April 2008, the Veteran underwent a C&P Examination for his vascular headaches at which headaches where he reported to occur approximately three times per week with severe pain and photophobia with nausea. See 4/11/2008 VA Examination. b) Is it at least as likely as not that the Veteran's hypertension was aggravated (made worse) by his service-connected vascular headaches? The Board reflects that the analysis for aggravation of the disability must focus on whether there was an increase in the hypertension as a result of the Veteran's service-connected vascular headaches and should not be the same rationale provided for a causation opinion in a) above. In providing the requested opinions, the examiner is directed to consider and address: (a.) 4/11/2008 VA Examination for Vascular Headaches showing a BP reading of 164/100. (b.) 12/18/2009 VA Examination where the examiner listed the Veteran's migraine headaches as "hypertensive related disease." (c.) 9/10/2020 Third Party Correspondence citing medical literature regarding physical stress of a headache causing high blood pressure. (d.) 8/11/2021 Remand BVA or CAVC (p.7-8), explaining why it was felt previous medical opinions were inadequate. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jennifer M. Narvaez, 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.