Citation Nr: 21073270 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 16-53 595A DATE: December 8, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected pericarditis, is remanded. REASONS FOR REMAND The Veteran had active military service from February 1983 to February 1986. This case comes before the Board of Veterans' Appeals (Board) on appeal of an October 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The issue on appeal was previously before the Board in September 2019 and June 2021, at which times it was remanded for additional development. This case has been returned to the Board for further appellate action. Service Connection Hypertension The Board regrets additionally delay, but finds that another remand is warranted to ensure that the Board has a complete record upon which to decide the Veteran's claim. The Veteran asserts that his hypertension is the result of his active service or, alternatively, secondary to his service-connected pericarditis. The Board initially notes that in December 2020, the Veteran was granted service connection for pericarditis with an effective date of August 27, 2013. In June 2021, the Board remanded the issue on appeal and specifically instructed a VA examiner to provide an opinion in regard to whether it was at least as likely as not that the Veteran's hypertension was due to, caused by, or aggravated by his service-connected pericarditis. In July 2021, a VA examiner opined that the Veteran's hypertension, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The VA examiner reasoned that the Veteran's diagnosis of pericarditis was rendered in error. Additionally, the VA examiner found that there was insufficient evidence to support a current diagnosis of pericarditis, and no new and material evidence to demonstrate otherwise. Ultimately, the VA examiner opined that any claim secondary to the Veteran's pericarditis, including hypertension, was invalid. In an August 2021 addendum opinion, the July 2021 VA examiner, again opined that the Veteran did not have a current diagnosis of pericarditis. Thus, the VA examiner found that the Veteran's hypertension was not at least as likely as not aggravated beyond its natural progression by his pericarditis. The Board finds that the July and August 2021 VA addendum opinions are inadequate for adjudication purposes as they completely failed to address the Board's June 2021 remand instructions. In this regard, the VA examiner completely failed to make any finding in regard to an association between the Veteran's service-connected pericarditis and his hypertension. The Board emphasizes that the sufficiency of the record is a legal determination reserved for the Board, and an insufficient basis on which to premise a medical opinion. Additionally, the Board notes that the ultimate determination of whether a disability meets VA's criteria for service connection is also RESERVED for the BOARD, rather than to the individual medical examiner. See 38 U.S.C. § 7104(a) (2018) (emphasis added). Based on the foregoing, the Board finds that a remand is warranted to obtain an addendum opinion that complies with the June 2021 remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). This matter is REMANDED for the following action: 1. Forward the claims file, to include a copy of the herein remand, to a VA examiner with the appropriate expertise, who has not yet provided an opinion in this case, for an addendum medical opinion. After reviewing the claims folder, to include a copy of the herein remand, the examiner must provide an opinion on the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is due to or caused by his service-connected pericarditis? (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected pericarditis aggravated his hypertension? The term "at least as likely as not" does not mean with the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The Board notes that the Veteran's diagnosis of pericarditis is not at issue in this case. As such, the VA examiner should not provide an opinion as to the validity of that diagnosis itself. The Board also notes that the Veteran is competent to report the observable symptoms of his hypertension. If there is a medical basis to support any doubt of the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that opinion. A complete and detailed rationale must be provided for all opinions provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that they have exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Ensure that the opinions provided comport with this remand, and undertake any other development necessary. 3. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for a response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, 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.