Citation Nr: 21068537 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-58 708A DATE: November 10, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a kidney disability is remanded. REASONS FOR REMAND The Veteran had active duty service from June 1974 to June 1977, with additional periods of inactive duty training (IDT) in 1977 and 1978. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Board reopened previously denied claims of service connection for bilateral hearing loss, otitis media of the left ear, cholera, tuberculosis, hypertension, dysentery, a kidney disability, hematuria, and an acquired psychiatric disorder, and remanded the claims for further development. In a June 2020 decision, the Board denied service for bilateral hearing loss, otitis media of the left ear, cholera, tuberculosis, dysentery, hematuria, an acquired psychiatric disorder, hypertension, and a kidney disability. The Veteran appealed the Board's June 2020 decision to the United States Court of Appeals for Veterans Claims (Court). In April 2021, the Court issued a memorandum decision, vacating the Board's denial of service connection for hypertension and a kidney disability. The Court affirmed the Board's denial of service connection for bilateral hearing loss, otitis media of the left ear, cholera, tuberculosis, dysentery, hematuria, and an acquired psychiatric disorder. Accordingly, only the issues of entitlement to service connection for hypertension and a kidney disability remain on appeal. 1. Entitlement to service connection for hypertension is remanded. 2. Entitlement to service connection for a kidney disability is remanded. When VA undertakes the effort to provide an examination, the examination must be adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Inadequate medical examinations include examinations that provide unsupported conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Barr, 21 Vet. App. at 311. It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Nieves-Rodriguez, 22 Vet. App. at 304. VA must consider all lay and medical evidence of record. 38 U.S.C. §§ 1154(a), 5107; 38 C.F.R. § 3.303. The Veteran underwent a VA examination in December 2019, wherein the examiner confirmed a diagnosis of hypertension. In a January 2020 medical opinion, the examiner opined that the Veteran's hypertension is less likely than not related to his active duty service, as his service treatment records were silent for diagnosis or treatment of hypertension and he was not diagnosed with hypertension until the 1990s, years after his separation from active duty service. The Veteran also underwent a VA examination for his kidney disability claim in December 2019, with the same examiner who conducted the hypertension examination. The examiner confirmed a diagnosis of renal impairment. In a January 2020 medical opinion, she opined that the Veteran's renal impairment is less likely than not related to his active duty service, as his service treatment records do not show diagnosis of, or treatment for, a kidney problem during active duty service. The January 2020 medical opinions inadequate because the examiner did not provide a sufficient rationale for her negative etiology opinions. See Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a remand is needed to obtain adequate medical opinions as to the etiology of the Veteran's hypertension and kidney disability. The matters are REMANDED for the following action: Obtain addendum medical opinions from the VA examiner who conducted the December 2019 hypertension and kidney disability examinations or, if she is unavailable then another similarly qualified examiner may respond instead. The entire claims folder, including a copy of this remand, must be made available for review by the examiner, and such review should be noted in the examination report. A new VA examination is only necessary if deemed so by the examiner. After a review of the evidence, the examiner is asked to respond to the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension manifested itself to a compensable degree within one year of his separation from active duty service? (b.) If not, is it at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension is related to his active duty service, to include his claimed exposure to herbicide agents? (c.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's renal impairment is related to his active duty service, to include his claimed exposure to herbicide agents? The examiner must provide a comprehensive rationale for each proffered opinion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any 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. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Pratt 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.