Citation Nr: 21071676 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 16-48 384 DATE: December 1, 2021 REMANDED Entitlement to service connection for hypertension also claimed as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from July 1970 to March 1976. The Veteran appeals the denial of service connection for hypertension. He claims that his hypertension is due to his exposure to herbicides and/or ionizing radiation during service. Alternatively, he argues it is secondary to his service-connected PTSD and/or the service-connected bladder cancer. When this issue was last before the Board in April 2021, it was determined that further development was needed to include affording the Veteran a VA examination. The Veteran was afforded a VA examination in May 2021. When addressing the question of whether the Veteran's hypertension was aggravated by the service-connected PTSD, the examiner stated, in part: PTSD has an association with hypertension, however, in this Veteran's case, no aggravation beyond natural progression has been demonstrated. Review of CPRS demonstrates variable control, with medication changes as needed for maximization of blood pressure management. Almost half of patients with hypertension will eventually need more than one medication for blood pressure control, per the ALLHAT Trial. While the examiner provided a reasoning in support of his finding of no aggravation, the Board is still unable to determine if there is aggravation based on this rationale alone. To that end, the Board notes that while the VA examiner indicates that the Veteran's hypertension is controlled with medication changes as needed, such does not negate that there can be aggravation by the PTSD. As such, the Board finds that another opinion is needed on this matter for proper adjudication of the claim. The matters are REMANDED for the following action: 1. Obtain a VA opinion to determine the nature and etiology of the Veteran's hypertension. The examiner must be provided access to the Veteran's electronic claims file. If, after review of the claims file, the examiner determines that another VA examination is necessary, such must be scheduled, and the Veteran must be notified. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected PTSD has caused any additional medically discernible functional impairment of the Veteran's hypertension, even if temporary (e.g., a worsening of symptoms beyond the expected baseline level of symptoms). In so doing, the examiner is asked to explain why the fact that even if the Veteran's hypertension "demonstrates variable control, with medication changes as needed for maximization of blood pressure management," it negates a showing of aggravation by the service-connected PTSD. The examiner should discuss whether it is medically discernible that any increases in blood pressure requiring additional medication are attributable to the effects of service-connected PTSD. A complete rationale for any opinion should be provided. The examiner must not rely solely on the absence of a diagnosis or symptom in service as the basis for a negative opinion. It is also noted that the mere passage of time without treatment is not a sufficient basis for finding that no relationship between a current disability and service exists. Any opinion should be reconciled with the service treatment and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. If the lay evidence is rejected, an explanation must be provided. If an opinion cannot be made without resort to speculation, please state so and include an explanation for that conclusion. (continued on the next page) 2. Upon completion of the above, and any additional development deemed appropriate, the AOJ should readjudicate the remanded issue. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response, the appeal must be returned to the Board for appellate review. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S. Willie 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.