Citation Nr: 21066713 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 17-42 408 DATE: November 2, 2021 REMANDED Entitlement to service connection for coronary artery disease secondary to service-connected post-traumatic stress disorder (PTSD) is remanded. Entitlement to service connection for hypertension secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served in the United States Air Force from February 1973 to July 1973. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board virtual hearing in October 2020 before the undersigned, and a copy of the hearing transcript has been obtained and associated with the record. This matter was remanded by the Board in April 2021. Unfortunately, another remand is required before this matter can be adjudicated. 1. Entitlement to service connection for coronary artery disease secondary to service-connected PTSD is remanded. 2. Entitlement to service connection for hypertension secondary to service-connected PTSD is remanded The Veteran claims that he is entitled to service connection for coronary artery disease secondary to his service-connected PTSD. In the April 2021 remand, the RO was directed to obtain all outstanding VA and private treatment records, including any records from private providers scanned into the VistA system. Although the RO obtained additional VA treatment records, it does not appear that records from the VistA system have been obtained and associated with the claims file. Additionally, the RO was directed to obtain an addendum opinion addressing whether the Veteran's hypertension is at least as likely as not related to, proximately due to, or aggravated beyond its natural progression by the Veteran's service-connected PTSD. The examiner was also directed to address the private opinion of Dr. B.M. which was submitted by the Veteran and has been associated with the claims file. See September 2018 letter from Dr. B.M. The RO received an addendum opinion in July 2021 which did not address the opinion of Dr. B.M. The examiner also opined that the Veteran's hypertension was not "substantially aggr[a]vated," by his service-connected PTSD, which was not consistent with the directive in the April 2021 Board remand. Thus, a remand is required to obtain a new addendum opinion which complies with the Board's remand directives. The matters are REMANDED for the following actions: 1. Make as many attempts as necessary to obtain the Veteran's records scanned into the VistA image system. If the RO is unsuccessful in obtaining the records and has concluded that the records sought do not exist or that further efforts to obtain those records would be futile, a record should be made in the claims file detailing the RO's efforts to obtain the records. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not related to, proximately due to, or aggravated beyond its natural progression by his service-connected PTSD. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical (Continued on the next page) professional who has the knowledge and training needed to render such an opinion. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Boal, 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.