Citation Nr: 21074241 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 19-00 595A DATE: December 14, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1972 to September 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board denied service connection for the issues adjudicated herein, in a March 2020 decision. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court) which, in February 2021, issued an order that granted a Joint Motion for Partial Remand (JMPR) that vacated the Board's decision and remanded the matter for action consistent with the JMPR. In June 2021, the Board remanded this matter to the RO for additional development consistent with the findings of the JMPR. Regrettably, the Board finds an additional remand is required for the reasons set forth below. 1. Hypertension is remanded. The Veteran asserts his hypertension is secondary to his service-connected scoliosis, dorsal spine, and lumbosacral strain. Pursuant to the Board's June 2021 remand, in September 2021, a VA examination and opinion were obtained. The VA examiner stated that the current literature does not indicate a direct or indirect causal relationship between orthopedic or bone conditions and the development of hypertension. The examiner continued on to state that the literature does indicate that acute pain can cause transitory elevations of blood pressure without evidence of a permanent change in the condition. Therefore, it is less likely than not that the Veteran's hypertension was aggravated beyond its natural progression by his service-connected disabilities. In June 2019, the United States Court of Appeals for Veterans Claims (the Court) issued a decision in Ward v. Wilkie, 31 Vet. App. 233 (2019), which held that secondary service connection is warranted for any incremental increase in disability and any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions, regardless of its permanence. As the September 2021 VA opinion does not comply with the holding in Ward, the opinion is inadequate for rating purposes. Therefore, a remand is required for an addendum opinion concerning this determinative issue of causation. The matters are REMANDED for the following action: 1. Obtain an opinion from a different examiner than the one who conducted the September 2021 examination and opinion concerning the nature and etiology of the Veteran's diagnosed hypertension. A complete rationale for all opinions offered must be provided. The examiner is asked to provide an opinion on the following, with a full rationale: (a.) Whether the Veteran's hypertension is at least as likely as not (a 50 percent or greater probability) related to his active service, to include whether it was diagnosed within one year of separation from service. (b.) Whether it is at least as likely as not that the hypertension was caused by ANY of the Veteran's currently service-connected orthopedic/ musculoskeletal disorders, to include the pain caused by these conditions, yes or no? (c.) Whether it is at least as likely as not that the Veteran's hypertension was aggravated (incremental increase in disability, regardless of its permanence), due to: 1. ANY service-connected orthopedic/ musculoskeletal disabilities, to include the pain caused by these conditions, yes or no? 2. ANY medicine(s) taken for pain/symptom management for his service-connected orthopedic/ musculoskeletal disabilities, yes or no? The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. 2. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, 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.