Citation Nr: 21068254 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 16-32 959 DATE: November 9, 2021 REMANDED Entitlement to service connection for a cardiovascular disability, to include hypertension, is remanded. REASONS FOR REMAND The Veteran had active service from June 2003 to June 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified before a Veterans Law Judge. A copy of the transcript has been associated with the claims file. The Board notes that in January 2021 correspondence, the Board notified the Veteran that the Veterans Law Judge who conducted the hearing is no longer available to participate in the appeal. The Veteran was notified that she had thirty days to request another optional hearing. The Veteran did not respond within the allotted time. Therefore, the Board will proceed accordingly. In June 2020 and July 2021, the Board remanded the appeal for further development. Entitlement to service connection for a cardiovascular disability, to include hypertension, is remanded. The Veteran seeks service connection for a cardiovascular disability. She reports spikes and drops in her blood pressure, which she asserted was related to her service-connected vasovagal syndrome. The Board remanded this matter in July 2021. In that remand, the Board requested additional medical inquiry into the service connection claim on appeal. Specifically, the Board requested that the Veteran be provided with a VA examination by an appropriate VA examiner. In response, the RO obtained a medical opinion from an appropriate clinician in August 2021. However, the RO did not provide the Veteran with a new VA examination. See Stegall v. West, 11 Vet. App. 268 (1998) (the Board errs as a matter of law when it fails to ensure compliance with previous remand directives). Thus, another remand is required. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination for his cardiovascular disability. The examiner must review the claims file. Determine whether it is at least as likely as not that the Veteran has hypertension that is due to, manifested in or related to the Veteran's period of service. The examiner should also determine whether it is at least as likely as not that the Veteran has a cardiovascular disability, including hypertension or hypotension or a related disorder, that is due to or aggravated by the Veteran's service-connected idiopathic vasovagal syncope. In making this determination, the examiner is asked to consider and discuss the Veteran's VA treatment records noting spikes and drops in blood pressure. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: a) Is the cardiovascular disability at least as likely as not related to service? Provide a rationale to support the opinion(s). b) Is the cardiovascular at least as likely as not proximately due to idiopathic vasovagal syndrome? c) Is the cardiovascular disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by idiopathic vasovagal syndrome? A rationale should be provided for all opinions expressed. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.