Citation Nr: 21071626 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-50 794 DATE: December 1, 2021 REMANDED Entitlement to service connection for hypertension, including as secondary to adjustment disorder with anxiety (claimed as PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from May 1969 to January 1972. This matter came before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Previously, the Veteran applied for entitlement to service connection for hypertension in February 2010. This claim was denied in the June 2010 rating decision. The Veteran did appeal this claim, and the Board affirmed the denial in its June 2011 decision. The Veteran did not appeal the Board's decision and it became final. The Veteran filed the claim of entitlement to service connection for hypertension again in December 2014. In May 2015 rating decision, the RO did not reopen the claim and found that no new and material evidence was received. The Veteran timely appalled the matter to the Board in September 2017 and asserted that he was diagnosed with hypertension, which he believes is secondary to his service-connected adjustment disorder with anxiety (claimed as PTSD). In the March 2019 decision, the Board reopened and remanded the matter to obtain a medical opinion on the nature and etiology of the Veteran's diagnosed hypertension, after finding that new and material was evidence received. Hence, the Veteran was scheduled for an in-person examination and a medical opinion was obtained in November 2019. However, the Board finds the opinion inadequate for deciding the issue on appeal. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Regrettably, the Board finds that further remand is necessary in this matter. Entitlement to service connection for hypertension, including as secondary to adjustment disorder with anxiety (claimed as PTSD) is remanded. The Veteran asserts that that his diagnosed hypertension is directly related to his active service, including his in-service exposure to herbicide agents and/or secondary to the service-connected adjustment disorder with anxiety (claimed as PTSD). In the December 2014 statement and October 2010 Form 9, Appeal to the Board, the Veteran asserted that his hypertension is related to exposure to herbicide agents during his service in Vietnam. In the September 2017 Form 9, Appeal to the Board, the Veteran asserted that his hypertension is due to his service-connected psychiatric disorder. The Board remanded the matter in March 2019 to obtain a medical opinion regarding etiology of hypertension and whether it is directly related to the Veteran's active service or secondary to the service-connected adjustment disorder with anxiety. Pursuant to the Board's remand, the RO afforded the Veteran a VA examination in November 2019, during which the examiner noted the diagnosis of hypertension with date of onset in 1982. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As a rationale, the examiner stated that he was unable to locate any records related to hypertension in the service. Regarding secondary service connection, the examiner opined that the Veteran's hypertension is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected disability. As a rationale, the examiner stated that the claimed condition of hypertension is unrelated to the PTSD and the medical evidence does not link PTSD and Hypertension. The examiner also opined that the Veteran's hypertension is less likely than not (less than 50 percent probability) aggravated beyond its natural progression by a service-connected disability. As a rationale, the examiner stated that the medical records do not give evidence for the PTSD aggravating the Veteran's hypertension. The Board finds the November 2019 VA medical opinion inadequate because the examiner provided very conclusory rationale without an explanation. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Also, the examiner based the negative direct nexus opinion solely on lack of cotemporaneous treatment records and stated that he was unable to locate any records related to hypertension in the service. Whereas the Board finds that the lack of contemporaneous records does not preclude granting of service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim). As noted in the Board's 2011 decision, the Veteran's exposure to herbicide agents during his service in republic of Vietnam is conceded. Hypertension is not one of the conditions or diseases that are presumptively associated with exposure to herbicide agens under the VA regulations. See 38 C.F.R. § 3.309(e). However, VA must still consider whether the Veteran's disability is causally linked to service on a direct basis, to include exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). In this regard, the Board notes that the examiner did not provide an opinion whether the Veteran's hypertension has relationship with in-service exposure to herbicide agents. Consequently, the Board finds that a remand is warranted to obtain a new VA medical opinion on the nature and etiology of the Veteran's diagnosed hypertension, including as secondary to the service-connected psychiatric disorder. The matter is REMANDED for the following action: 1. Obtain a medical opinion on the nature and etiology of the Veteran's diagnosed hypertension. Further in-person examination of the Veteran is left to the discretion of the clinician providing the medical opinion. If the clinician deems such examination is necessary, then an examination should be scheduled. 2. After reviewing the claims file and copy of this remand, the examiner should address the following: (a) Provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed hypertension had its onset during his period of active service, or within one year after the service, or related to an in-service injury, event, or disease, to include in-service exposure to herbicide agents. The examiner is advised to address if there is a possibility of delayed onset of hypertension due to in-service exposure to herbicide agents. (b) Provide an opinion as to whether the Veteran's hypertension is at least as likely as not (i) proximately due to or (ii) aggravated beyond its natural progression by the service-connected disabilities, including adjustment disorder with anxiety. The examiner should consider the Veteran's lay statements. A complete and separate rationale for the opinions rendered must be provided. The examiner is advised to support the conclusion with analysis that the Board can consider for deciding the issue on appeal. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tariq, Nadeem, 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.