Citation Nr: 21069127 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 16-05 344 DATE: November 17, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for gastro-esophageal reflux disease (GERD) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to deviated septum and/or post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1968 to May 1972. This matter came before the Board of Veterans Appeals (Board) on appeal from October 2012, January 2013, November 2013 and February 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during a July 2019 hearing. The transcript of the hearing is of record. November 2019 and April 2021 Board decisions remanded the issues on appeal for further development. A December 2020 rating decision granted service connection for PTSD. As that constituted a complete grant of the benefit sought on appeal, it is not before the Board. 1. Entitlement to service connection for hypertension 2. Entitlement to service connection for coronary artery disease 3. Entitlement to service connection for GERD 4. Entitlement to service connection for sleep apnea, to include as secondary to deviated septum and/or PTSD In June 2021, the Veteran submitted a statement contending that his claimed disabilities are due to his service-connected PTSD. As the prior VA examinations of record did not address the question of whether PTSD caused or aggravated hypertension, coronary artery disease (CAD), GERD or sleep apnea, remand for new opinions is required. The April 2021 Board decision requested new VA examinations regarding the whether the claimed disabilities were caused or aggravated by the Veteran's service-connected deviated septum. Opinions regarding hypertension, CAD, GERD and sleep apnea were provided in May 2021. In each case, the examiner found that the Veteran's disabilities were not caused or aggravated by his deviated septum but did not properly address whether the Veteran's disabilities were worsened by ongoing nasal obstruction from his deviated septum, basing the opinions either upon a discussion of risk factors (which pertain to causation rather than worsening) or on a conclusory statement that there was no evidence of aggravation. Notably, regarding CAD, the examiner referred to "the remote history of the deviated septum," which suggests that the examiner was incorrectly addressing only the in-service septal deviation rather than ongoing impact of the Veteran's current service-connected disability. The Board acknowledges that the examiner provided an addendum opinion in July 2021 to address the Veteran's lay statements. However, that opinion also provided essentially conclusory findings regarding aggravation and did not properly address the question of whether the Veteran's disabilities were worsened by the service connection deviated septum. As the April 2021 examiner did not properly address the question of aggravation, the opinions are inadequate. See El-Amin v. Shinseki, 26 Vet. App. 136, 14041 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). Upon remand, the examiner should address whether the Veteran's hypertension, CAD, GERD, and sleep apnea were caused or aggravated by the service-connected deviated septum as well as his service-connected PTSD. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination, with a different examiner than the one who performed the April 2021 examination, to determine the etiology of the Veteran's hypertension, coronary artery disease, GERD, and sleep apnea. The examiner should review the file and provide a complete rationale for all opinions expressed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that hypertension, coronary artery disease, GERD and sleep apnea are related to the Veteran's active service, to include whether it was caused or aggravated by the Veteran's service connected PTSD and/or sleep apnea. Regarding the question of aggravation, the opinion should specifically address whether the claimed disability was worsened beyond its natural progression by the Veteran's service connected disabilities. Regarding the deviated septum, this should include not only the in-service surgery but any ongoing symptoms such as nasal obstruction. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Arnold 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.