Citation Nr: 21067179 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-08 390 DATE: November 3, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to January 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In an October 2019 decision, the Board denied entitlement to service connection for hypertension, inter alia. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (CAVC). CAVC granted a Joint Motion for Remand (JMR) in August 2020 that vacated and remanded the October 2019 decision denying service connection for hypertension. The Court found the Board did not discuss entitlement to service connection based on the Persian Gulf presumptions under 38 C.F.R. § 1117 and 38 C.F.R. § 3.317. Thereafter, per the JMR, in April 2021, the Board remanded this issue in order to provide the Veteran with an additional VA examination and obtain an etiological opinion regarding the nature of the Veteran's hypertension. The requested development has been partially completed; however, the Board regrets the additional delay but finds an additional remand is necessary. Entitlement to service connection for hypertension is remanded. In this post-remand case, the Veteran seeks service connection for hypertension. Per the Board's April 2021 remand directives, the Veteran was afforded a Gulf War VA examination to determine the nature and etiology of his hypertension in June 2021. A nexus opinion regarding presumptive service connection was provided. However, the Board finds a remand is necessary in order to obtain a more complete nexus opinion regarding direct service connection. Two previous etiological opinions were obtained in January 2016 and August 2019. The Board finds these etiological opinions to be inadequate. The first examiner did not consider whether the Veteran's December 1992 elevated blood pressure readings constituted the early onset of the disability. The second examiner appropriately focused on whether the Veteran's hypertension was an undiagnosed illness but did not adequately consider the Veteran's multiple in-service blood pressure readings in the context of entitlement to service connection on a direct basis. Thus, given the lack of adequate opinions regarding direct service connection, the Board finds further remand is necessary. The matters are REMANDED for the following action: Obtain an addendum opinion from a new appropriate VA examiner regarding the nature and etiology of the Veteran's hypertension. After a complete review of the file, the VA examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension had its onset during his active-duty service. In this regard, the examiner should specifically address the multiple elevated readings obtained from the Veteran within two months of his discharge from service. If the examiner does not believe that these readings represented the early onset of the Veteran's hypertension, he or she should provide a rationale for this conclusion. The examiner should also be informed that the lack of an in-service diagnosis of hypertension or a post-service diagnosis until 10 years after service is not, by itself, an adequate basis for a negative opinion. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. DeBoer, 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.