Citation Nr: 21067763 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 19-38 227 DATE: November 5, 2021 ORDER The application to reopen the claim of entitlement to service connection for hypertension, secondary to service-connected posttraumatic stress disorder (PTSD), is granted. REMANDED Entitlement to service connection for hypertension, secondary to service-connected PTSD, is remanded. FINDINGS OF FACT 1. In a November 2015 final rating decision, the VA regional office (RO) denied service connection for hypertension. 2. The evidence received since the final November 2015 rating decision regarding service connection for hypertension is not cumulative or redundant and raises a reasonable possibility of substantiating the Veteran's claim. CONCLUSION OF LAW New and material evidence having been submitted, the service connection claim for hypertension is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from June 1969 to March 1971. The Board notes the Veteran requested a live videoconference hearing on his December 2019 substantive appeal. A hearing was scheduled for October 2021, but a subsequent September 2021 correspondence from the Veteran's representative waived the Veteran's request for a hearing. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(a)(2). New and Material Evidence Claim The Veteran's claim of service connection for hypertension was denied in a November 2015 rating decision. The Veteran did not appeal this decision and did not submit any new and material evidence during the appeal period. Therefore, the November 2015 rating decision became final. Once a decision becomes final, VA will only reopen it and decide it on the merits if new and material evidence is submitted. Evidence is considered "new" if it was not previously submitted to agency decision makers. "Material" evidence is existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. "New and material evidence" can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the "credibility of the evidence is to be presumed." Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence received since the time of the RO's December 2015 rating decision include a VA opinion, lay statements, and medical treatment records. This evidence was not before adjudicators when the Veteran's claim was last finally denied, and it is not cumulative or redundant of the evidence of record at the time of the last decision. The new evidence relates to unestablished facts necessary to substantiate the claim of service connection for hypertension and raises a reasonable possibility of substantiating the claim. Accordingly, the claim is reopened. REASONS FOR REMAND Entitlement to service connection for hypertension, secondary to service-connected PTSD, is remanded. Upon review of the record, the Board finds that the claim must be remanded for a VA examination. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. A medical opinion provided by a VA physician from a review of the records was associated the Veteran's claims file in June 2020. The VA physician opined that the Veteran's hypertension was less likely than not proximately due to or aggravated by the Veteran's service-connected PTSD. He explained that the Veteran had renal artery stenosis, which is a well-known cause of hypertension, and that there was insufficient medical evidence with which to establish a nexus between the PTSD and hypertension. Additionally, the Veteran had PTSD long before the hypertension diagnosis and there was insufficient medical evidence that longstanding PTSD can aggravate new onset hypertension from a secondary cause of renal artery stenosis. Though the June 2020 VA physician found the etiology of the Veteran's hypertension to be his renal artery stenosis, he provided a conclusory aggravation opinion, merely stating that there was insufficient medical evidence. In particular, the citation to "insufficient evidence" does not explain whether there are some studies supporting that a mental health condition could cause OR aggravate hypertension but the examiner feels the studies are insufficient; or whether the examiner feels that there are not enough studies supporting the theory for some reason; or whether there are no studies supporting the theory. In any view of the matter, the examiner's rationale is inadequate to provide the Board with sufficient information to make a reasoned decision on the claim. Accordingly, a new examination and etiological opinion is warranted. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file any relevant outstanding treatment records. 2. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran's hypertension. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: (a.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's hypertension was caused or aggravated by the Veteran's service-connected PTSD. AN OPINION AS TO BOTH CAUSATION AND AGGRAVATION IS REQUESTED. The examiner is asked to perform medical research as to the relationship between a stress-related mental health condition and its effect on hypertension and report findings when rendering the requested opinion. (b.) If the examiner finds that the Veteran's hypertension was aggravated by his service-connected PTSD, then he/she should specify the baseline level of disability of the hypertension prior to aggravation due to the service-connected PTSD. Note that aggravation means any incremental increase in disability in the non-service-connected condition (i.e., any additional impairment of earning capacity) resulting from the service-connected condition. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.