Citation Nr: 21075219 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 13-28 493 DATE: December 17, 2021 ORDER Entitlement to service connection for a right breast cystic disability is granted. REMANDED Entitlement to service connection for hypertension is remanded. FINDING OF FACT The Veteran's right breast cystic disability is related to service. CONCLUSION OF LAW The criteria for service connection for right breast cystic disability have been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1977 to June 1995. In an October 2014 statement made via telephone, the Veteran clarified that she was claiming service connection for a right breast cystic condition as opposed to cystic fibrosis; therefore, the Board will consider the former condition. In March 2015, the Veteran withdrew her request for a Board hearing included on the August 2013 VA Form 9 Appeal to the Board. As a result, no Board hearing will be scheduled. In September 2018, the Board remanded the claims for service connection for fibrocystic breast disease and hypertension for VA treatment records and VA examinations. In August 2020, the Board again remanded the claims for service connection fibrocystic breast disease and hypertension because the November 2019 VA breast examination was found by the Board to be inadequate and for a VA examination to consider whether hypertension was secondary to service-connected depression. The Board finds further development is necessary for the claim of service connection for hypertension which will be discussed in detail below. 1. Entitlement to service connection for a right breast cystic disability. The Veteran contends she was diagnosed and treated for a right breast cystic disability in service. Service treatment records document that mammograms in May and June 1995 found cysts in the right breast. An August 1999 VA treatment record documents she has a history of abnormal breasts with fibrocystic breasts disease though the August 1999 mammogram was noted to be within normal limits. After service, the Veteran continued to undergo mammograms and ultrasounds of the breasts with periodic abnormalities. The Veteran underwent a VA examination in November 2019, but the August 2020 Board decision found this examination to be inadequate; therefore, its findings are not probative. The Veteran also underwent a VA examination in July 2021. The examiner provided a negative nexus. The Board finds this examination is inadequate because the examiner failed to consider the Veteran's contentions, namely ongoing breast symptoms, and a previous diagnosis of fibrocystic breast disease. During the July 2021 VA examination, the Veteran reported her current symptoms as multiple cysts, tenderness, and occasional discharge. She noted her condition interferes with contact. The Board finds the Veteran's report of current symptoms is competent and credible. The Board finds the Veteran has continued to have symptoms associated with a right breast cystic disability since cysts related to that disability were found in service. Therefore, service connection for a right breast cystic disability is warranted. REASONS FOR REMAND 1. Entitlement to service connection for hypertension is remanded. The Board regrets that further development is necessary to decide the claim for service connection for hypertension. Pursuant to the August 2020 Board decision, the Veteran received a VA examination in July 2021 regarding the nature and etiology of her claimed hypertension. The examiner opined that hypertension could not be caused and/or aggravated by service-connected disabilities in part due to the fact that the hypertension diagnosis preceded the diagnosis for the service-connected disabilities. A service-connected disability can occur after a non-service-connected disability and cause the latter to be aggravated beyond its natural progression. The examiner also failed to discuss the Veteran's contention that depression is common in people with uncontrolled hypertension and may interfere with blood pressure control. See July 2020 Appellate Brief. Accordingly, the Board finds this examination inadequate for determining entitlement to service connection for hypertension. As such, remand is warranted to obtain a new VA examination. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file VA treatment records from December 2020. 2. Once updated VA records are obtained, send the Veteran's claim file for an addendum opinion with an examiner other than the July 2021 VA examiner. If the examiner finds an in-person examination is necessary, one should be scheduled. 3. Regarding the Veteran's claimed hypertension, the examiner(s) should provide an opinion regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed hypertension: a. Manifested in service or within one year thereafter or that is otherwise causally or etiologically related to military service, including any symptomatology therein; b. Is proximately due to service-connected disabilities, to specifically include service-connected depression, as well as any treatment for service-connected disabilities; or c. Was aggravated beyond its natural progression by service-connected disabilities, to specifically include service-connected depression, as well as any treatment for service-connected disabilities. The examiner cannot use the fact that hypertension was diagnosed prior to service-connected disabilities as a rationale for denying aggravation of hypertension by service-connected disabilities. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case and state whether the inability to provide the required opinions is based on a lack of knowledge among the medical community at large. The examiner must address the Veteran's medical records and contentions specifically that depression may put patients at higher risk for heart disease, stroke, and death, and that depression is common in patients with uncontrolled hypertension and may interfere with blood pressure control. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. McDaniels, 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.