Citation Nr: 21069203 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 11-01 212 DATE: November 17, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1986 to October 1989 with subsequent service in the Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2009 rating decision of a Department of Veterans' Affairs (VA) Regional Office (RO). This matter was previously remanded in October 2020 and July 2021 by the Board for additional development. Entitlement to service connection for hypertension is remanded. Pursuant to the prior July 2021 Board remand, another VA etiological opinion was obtained in August 2021. See August 2021 C&P Exam. However, as highlighted by the October 2021 correspondence submitted by the Veteran's attorney in support of the claim, the August 2021 VA examiner did not provide an adequate rationale for the opinion provided and did not specifically determine whether the Veteran's service-connected disabilities aggravated the Veteran's obesity or provide a rationale as requested in the July 2021 Board remand directives. See October 2021 Third Party Correspondence. Specifically, the examiner indicated that obesity is less likely than not due to service-connected conditions but did not opine as to whether it is as likely as not that the service-connected conditions aggravated the Veteran's obesity. The examiner provided a conclusory finding that there is no evidence of aggravation of hypertension due to the service-connected conditions or obesity with no supporting rationale. The Board further notes that a review of the record shows that a 2006 private treatment record initially noted an assessment of hypertension. See September 2009 Medical Treatment Record Non-Government Facility. A November 2007 VA treatment record also noted the Veteran was diagnosed with hypertension in 2006. See April 2008 Medical Treatment Record Government Facility. The examiner indicated that the onset of hypertension was possibly in the 1990s or in 2000 and as such noted the Veteran did not have numbers in the obese range between the 1990s and 2000 in support of the negative etiological opinion. As the onset of hypertension is later in 2006 and treatment records during this time frame noted numbers in the obese range in the 2000s prior to the treatment for and diagnosis for hypertension, the examiner's finding in support of a negative etiological opinion appears misplaced. See January 2003 Medical Treatment Record Government Facility, October 2003 Medical Treatment Record Government Facility, and March 2009 Medical Treatment Record Government Facility. The Board notes that aggravation is defined as "any increase in disability." See Allen v. Brown, 7 Vet. App. 439, 448 (1995) Considering the above, the Board finds that a remand is warranted to obtain an adequate opinion that provides supporting rationale. The matter is REMANDED for the following action: Obtain an addendum medical opinion from an examiner different than the examiners that conducted the August 2021 and November 2020 opinions, if possible, from a medical professional with appropriate expertise regarding the Veteran's claim for hypertension. The examiner should review this remand decision and the Veteran's claims file in its entirety. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. The examiner shall issue an addendum opinion addressing the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any of the Veteran's service-connected disabilities caused her obesity, to include as due to any lack of exercise resulting from service-connected disabilities. (b.) If the answer to (a) is "no," opine as to whether it is at least as likely as not (50% or better probability) that any service-connected disabilities aggravated the Veteran's obesity, to include as due to any lack of exercise resulting from service-connected disabilities. (c.) Opine as to whether it is at least as likely as not (50% or better probability) that obesity (or the aggravation of obesity per question (b)) was a substantial factor in causing the Veteran's hypertension. (d.) Opine as to whether it is at least as likely as not (50% or better probability) that the Veteran would not have hypertension if she were not obese (or but for obesity aggravated by her service-connected disabilities per question (b)). Aggravation is any incremental increase in disability attributable to the service-connected disability, i.e., any additional impairment of earning capacity that is above the degree of disability existing before the increase, regardless of its permanence. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner must consider the February 2019 statement from Dr. M.S. which noted the Veteran's degenerative spinal diseases "affected her status in terms of obesity and general physical fitness." The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Cheng, 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.