Citation Nr: 21073076 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 14-09 203 DATE: December 7, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1973 to May 1993. The matter is on appeal from an April 2010 rating decision. The Board previously remanded this matter in February 2018, January 2020, December 2020 and June 2021 As the Board noted in its prior remand, the Veteran testified at a hearing before a Veterans Law Judge (VLJ) in April 2017. A transcript of the hearing has been associated with the record. However, the VLJ who conducted the hearing is no longer available to reach a final decision in the matter. The Veteran was informed of his right to a new hearing with a different VLJ in a March 2021 letter. The Veteran did not respond. As such, the Board will consider his claims based on the evidence of record. Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded. The Board is unable to make an informed decision on the issue of service connection for hypertension because January 2020 and August 2021 VA examination opinions are inadequate. The same VA examiner gave both opinions and opined that the Veteran's diabetes did not cause or aggravate his hypertension because the Veteran's 1995 laboratory results did not indicate this is the case. The Board's June 2021 remand directives specifically directed the examiner to "cite to laboratory results of record that are more recent than 1995." The January 2020 August 2021 opinions did not comply with this directive. Stegall v. West, 11 Vet. App. 268, 271 (1998). Furthermore, the examiner's rationale for aggravation from Parkinson's disease is inadequate as the VA examiner did not provide an opinion, stating it was beyond her expertise. The Agency of Original Jurisdiction (AOJ) did not then obtain an adequate opinion from a medical provider who does possess the requisite expertise. Where a medical professional admits that he or she lacks the expertise necessary to provide the opinion requested by the Board, the opinion itself creates the appearance of irregularity in the process resulting in the selection of that medical professional that prevents the presumption of competence from attaching. Wise v. Shinseki 26 Vet. App. 517 (2014). Accordingly here, because the designated VA examiner admitted to the lack of expertise necessary to answer the questions raised, on remand a new VA medical opinion(s) must be obtained from a qualified medical provider. As a final matter, the Board observes that the prior remand requested the Veteran to complete a VA Form 21-4142 for all diabetes treatment records, to include laboratory test results from Dr. Lang from 2006 to the present. Upon remand, the RO sent a letter to the Veteran in June 2021 asking that he complete the VA Form 21-4142 to authorize VA to obtain the records. He did not respond. Upon remand, he is encouraged to do so as it may be in his interest to have those records considered. The matters are REMANDED for the following action: After undertaking any preliminary action needed, forward the claims file and copies of all pertinent records to an appropriate VA examiner(s) qualified to provide a medical opinion regarding hypertension, to include its relationship to Parkinson's disease. If the examiner(s) determines that an opinion cannot be provided without an examination, one should be scheduled. After reviewing the claims file, the examiner is asked to answer the following questions: (a.) Was the hypertension condition at least as likely as not caused by (i.e., proximately due to) a different medical condition? (b.) Is the hypertension condition at least as likely as not aggravated (i.e., worsened beyond its natural progression) by a different medical condition? In answering these questions, the examiner should particularly address the following: i. If it is determined that the condition was either caused or aggravated by a different medical condition, the examiner is asked to identify the primary medical condition, especially the service-connected diabetes mellitus, type II, or Parkinson's disease. ii. Do laboratory results support that the Veteran's diabetes does not aggravate his hypertension? If so, explain this and cite to laboratory results more recent than 1995, preferable several over the last two decades. (Continued on the next page) iii. If medical literature does not support that Parkinson's disease aggravates hypertension, expressly state this and discuss why it does not. iv. Has the Veteran's hypertension followed a normal course of progression indicative that it is not aggravated/worsened by his diabetes and/or Parkinson's disease? Corey Bosely Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.