Citation Nr: 21071926
Decision Date: 12/01/21	Archive Date: 12/01/21

DOCKET NO. 19-08 794A
DATE: December 1, 2021

REMANDED

Entitlement to a compensable rating for hypertension is remanded.

REASONS FOR REMAND

The Veteran had active military service from October 1973 to December 1993.

This matter comes before the Board of Veteran's Appeals (Board) on appeal from January 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

This case was previously before the Board. In a September 2019 decision, the Board denied entitlement to a compensable rating. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In February 2021, the Court granted a Joint Motion for remand (JMR), vacating and remanding the issue. In May 2021, the Board remanded the issue to afford the Veteran a VA examination and obtain a medical opinion.

Subsequently, in July 2021, the Veteran had a VA hypertension examination, and a medical opinion was provided. The examiner was instructed to address whether the Veteran had a history of diastolic pressure that was predominantly 100mm or more, including consideration and discussion of whether taking continuous mediation for hypertension since approximately 1987 constitutes "a history of diastolic pressure predominantly 100 or more."  The examiner was also directed to consider and discuss whether pre-2011 blood pressure readings showing a diastolic pressure of 100mm or greater demonstrate "a history of diastolic pressure predominantly 100 or more," including treatment records dated on March 31, 2003; January 8, 2004; April 30, 2004; May 9, 2005; May 11, 2005; November 21, 2006; July 16, 2007; October 5, 2007; and October 15, 2010.

Based upon a thorough review, the Board finds the July 2021 VA medical opinion to be inadequate for adjudication. The examiner appears to have focused on whether service connection for hypertension was warranted, and did not adequately address the remand directives.  The examiner noted the pre-2011 blood pressure readings and stated that if the Veteran was not on medication for his blood pressure, his readings would be "much higher than noted."  The examiner did not, however, discuss the blood pressure readings, nor did she opine on whether the readings and/or the blood pressure medication constituted "a history of diastolic pressure predominantly 100 or more."

In light of the above, a remand for an addendum opinion is warranted to ensure compliance with the May 2021 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

The matter is REMANDED for the following action:

Send the claims file to an appropriate VA examiner and ask the examiner to review the record and prepare a medical opinion on the nature and severity of the service-connected hypertension.  

Based on the review of the record, the examiner is requested to note the current severity and manifestations of the hypertension, including whether the Veteran has a history of diastolic pressure of 100mm or more.

The examiner must consider and discuss whether the Veteran's history of taking continuous medication for hypertension since approximately 1987 constitutes "a history of diastolic pressure predominantly 100 or more."

The examiner must also consider and discuss whether the pre-2011 blood pressure readings showing diastolic pressure of 100mm or greater (treatment records dated March 31, 2003; January 8, 2004; April 30, 2004; May 9, 2005; May 11, 2005; November 21, 2006; July 16, 2007; October 5, 2007; and October 15, 2010) constitute demonstrate "a history of diastolic pressure predominantly 100 or more."

The rationale for all opinions expressed must be provided. Another VA examination of the Veteran should only be conducted if deemed necessary by the VA examiner that provided the requested medical opinions.

 

 

N. NELSON

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Ivan Franklin

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.