Citation Nr: 21071297 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-02 963 DATE: November 30, 2021 REMANDED Entitlement to service connection for hypertension is remanded. INTRODUCTION The Veteran served on active duty in the United States Army from November 1985 to November 1988. This case comes before the Board of Veterans' Appeals (Board) on appeal of a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). When this case was the Board in June 2021, it was remanded for additional development. This matter has since been returned for further appellate review. REASONS FOR REMAND While the Board regrets additional delay, further development is required before the Veteran's claim is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). To be considered adequate, medical examination reports must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In its June 2021 remand, the Board determined an addendum medical opinion was needed to address whether the Veteran's diagnosed hypertension was incurred in service. In September 2021, a VA examiner provided the requested medical opinion. Unfortunately, the examiner's opinion is insufficient for several reasons. First, the examiner found the Veteran's hypertension was not incurred in service because there was no evidence of a diagnosis or treatment of hypertension in-service, noting "transient intermittent evaluations of BP are common and not diagnostic of hypertension." In support of this conclusion the examiner cited to an UpToDate article titled, "Blood pressure measurement in the diagnosis and management of hypertension in adults." The Board reviewed the cited UpToDate article. The article states a diagnosis of hypertension "should not be made until the BP has been measured on at least three visits, spaced over a period of one week or more." As detailed in the previous Board remand, the Veteran's service treatment records contain three evaluated blood pressure readings spaced over a period of one month. The examiner wholly failed to explain how or why these facts lead to the conclusion that the Veteran did not have a diagnosis of hypertension while in-service. Additionally, the examiner stated the Veteran was "normotensive" for years following service and was not diagnosed with hypertension until 2008, almost twenty years after his separation from service. However, the Veteran has stated he was treated for hypertension and high blood pressure during service, and since his separation from service has been told by his doctors that he has high blood pressure. A medical examiner cannot solely rely on the absence of medical records corroborating the continuity of a condition, and moreover, is simply not free to ignore a veteran's statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Moreover, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the Board's remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Based on the foregoing insufficiencies, a remand is required to obtain an adequate medical opinion. Accordingly, this matter is REMANDED for the following action: The RO should obtain another addendum medical opinion from an examiner with sufficient expertise to comment on the etiology of the Veteran's hypertension. All pertinent evidence of record must be made available to and reviewed by the examiner. Another examination of the Veteran should be performed only if deemed necessary by the examiner providing the opinion. The examiner should state an opinion as to whether it is at least as likely as not (i.e., at least 50 percent probable) that the Veteran's hypertension originated in service or is otherwise etiologically related to service. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. The examiner must also address whether the Veteran's elevated blood pressure readings on May 12, 1986, May 19, 1986, and June 11, 1986 meet the diagnostic criteria for hypertension. The examiner must provide a complete rationale for any proffered opinion. If the examiner is unable to provide the required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nestander, Jessica S. 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.