Citation Nr: 21069195 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 17-50 756 DATE: November 17, 2021 REMANDED The claim of entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from September 1975 to October 1977. This matter comes before the Board of Veterans' Appeals (Board) from a December 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) for further evidentiary development, to include obtaining outstanding Social Security Administration (SSA) records and to provide the Veteran an adequate medical examination to address the nature and etiology of his claimed hypertension condition. In October 2020, the Board again remanded the matter, finding that the AOJ had failed to substantially comply with the Board's prior directives as it did not attempt to obtain SSA records, and as the medical examination was completed without access to those records. See Stegall v. West, 11 Vet. App. 268 (1998). The Board directed the RO to obtain the outstanding SSA records and then to determine whether any relevant information that had not been considered by the July 2020 VA examiner had been received. If so, the AOJ was to request an addendum opinion from a clinician who had reviewed the additional records. The opining clinician was to address the likelihood that the Veteran's hypertension was either proximately caused or aggravated by his service-connected disabilities. The clinician was also to specifically address potential worsening related to medication prescribed to the Veteran to treat other service-connected disabilities and to address previous medical opinions indicating that some medications may cause or worsen hypertension. See November 2015 examination (noting, that "medications to treat rhinitis/sinusitis can...cause hypertension."). Following the October 2020 remand, the RO successfully obtained hundreds of pages of SSA records and requested medical opinions regarding the claimed hypertension condition. The RO then obtained multiple separate medical opinions from two clinicians. Regrettably, the opinions obtained do not adequately address the matter on appeal as directed by the Board; specifically, they fail to address the question of whether any medications taken to treat the Veteran's service-connected conditions could have caused or aggravated the Veteran's hypertension and provide conclusory rationale. One examination request sought an opinion regarding a "heart condition," yet the Veteran is not service connected for such a condition. Further, the extent to which the examiners reviewed and considered the extensive SSA records is unclear from their opinions. As such, the AOJ has not substantially followed the Board's remand instructions and additional remand is required. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2) and 38 C.F.R. § 20.902(c). The claim of entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. The Veteran contends that his hypertension is related to his active service on either a direct or secondary basis. See January 2017 Notice of Disagreement. As discussed above, the medical opinions obtained on remand do not adequately address whether the Veteran's hypertension has been caused or aggravated by his service-connected conditions, to include the medications taken to treat those conditions. The matter is REMANDED for the following action: 1. This appeal has been advanced on the Board's docket. 2. Obtain a medical opinion from a clinician of appropriate expertise as to whether it is at least as likely as not (probability of at least 50 percent) that the Veteran's hypertension is either proximately due to (caused by) or aggravated (worsened beyond normal progression) by his service-connected disabilities, to include as caused or worsened by medications taken to treat or control his service-connected disabilities. In providing these opinions, it is up to the discretion of the opining clinician to determine whether an in-person or tele-health examination is needed to provide the requested opinions. If deemed necessary, the RO shall schedule the indicated examination. 3. The clinician shall be asked to fully review the medical evidence of record, to include a full review of the Veteran's SSA records, and records pertaining to medications prescribed to treat the Veteran's service-connected conditions. The clinician shall then opine as to the following: (a.) What is the nature and type of the Veteran's hypertension (e.g., primary or secondary hypertension)? (b.) Is it at least as likely as not (probability of 50 percent or more) that the Veteran's hypertension is proximately due to (caused by) his service-connected disabilities? Please explain the medical basis for the opinion as informed by the lay and medical evidence in the Veteran's claims file. (c.) Is it at least as likely as not (probability of 50 percent or more) that the Veteran's hypertension was/is aggravated (worsened beyond normal progression) by his service-connected disabilitiesspecifically to include by medications taken to treat those conditions? The clinician's attention is directed to the November 2015 VA examination (noting, that "medications to treat rhinitis/sinusitis can...cause hypertension.") and to the July 2020 VA examination noting the association between Aimbovig and hypertension. The clinician is asked to review the Veteran's SSA records to determine if there is any additional medical evidence to suggest that the Veteran's hypertension was worsened by relevant medications during the period on appeal. Please explain the medical basis for the opinion as informed by the lay and medical evidence in the Veteran's claims file. If any requested opinion cannot be provided without resort to speculation, that should be noted and explained. Again, it is up to the discretion of the opining clinician to determine whether an in-person or tele-health examination is needed to provide the requested opinions. Any indicated tests and assessments must be completed, if deemed necessary. 4. Finally, the RO shall review the record to determine that all directives have been fully and adequately accomplished. If the appeal remains denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, 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.