Citation Nr: 21075533 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-01 828 DATE: December 20, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1970 to December 1971. This matter was previously before the Board in September 2019, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. The RO most recently readjudicated the appeal in a July 2020 supplemental statement of the case. The Veteran contends that he suffers from hypertension that is related to his military service, or in the alternative, to a service connected disability. The Board previously remanded the appeal to obtain a VA opinion addressing whether the Veteran's hypertension had been caused or aggravated by his service-connected acquired psychiatric disability. In December 2019, a VA examiner opined that hypertension was not at least aggravated beyond its natural progression by his service-connected acquired psychiatric disability. The examiner opined that, even though he could not establish a baseline of severity, the Veteran's current hypertension was not at least aggravated beyond its natural progression by his service-connected acquired psychiatric disability. The examiner's rationale consisted of a general statement regarding the unavailability of objective evidence of record to support such aggravation. However, the September 2020 remand specifically directed the examiner to consider and address the Federal Register statement of June 28, 2005, 70 F.R. 37040, which notes that presumption of service connection was warranted for hypertensive vascular disease in certain scenarios based on studies showing a connection between hypertension and acquired psychiatric disorders. Therefore, the Board finds that the December 2019 opinion is not adequate to adjudicate the claim. See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators..."). In an October 2021 brief, the Veteran's representative submitted links to several studies they argue are pertinent to the claim. These include: "Increased risk of hypertension in patients with major depressive disorder: a population-based study" available at https://pubmed.ncbi.nlm.nih.gov/22850255/; "Depression increases the risk for uncontrolled hypertension" available at https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3716493/; and "Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study" available at https://pubmed.ncbi.nlm.nih.gov/19196807/. Moreover, in the aforementioned October 2021 brief, the Veteran's representative raised an additional theory of entitlement, asserting that the Veteran developed hypertension as a result of his service-connected tinnitus. The Court has an interest in conservation of judicial resources and in avoiding piecemeal litigation. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) ("Court will [not] review BVA decisions in a piecemeal fashion"); Fugere v. Derwinski, 1 Vet. App. 103, 105 (1990) ("[a]dvancing different arguments at successive stages of the appellate process does not serve the interests of the parties or the Court"). Nonetheless, given the Court's holding in El Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013) (holding that when multiple theories of entitlement are at issue, the Board must ensure that the medical opinions of record directly address all theories reasonably raised by the record), the Board will consider this theory of entitlement at this time. Therefore, the Board finds that another remand is required to obtain adequate etiology opinions. See 38U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate)/ While the appeal is in remand status, any outstanding VA and private treatment records should also be obtained and associated with the record on appeal. See 38 U.S.C. § 5103A(b). The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records pertinent to this claim. If possible, the Veteran and/or his representative should submit any new pertinent evidence himself. 2. Forward the claims file to a qualified VA examiner/s for an addendum opinion. The claims file, including a copy of this remand, should be made available to the examiner, who should indicate a review of the file in the examination report. Examination of the Veteran is not required unless the examiner/s determines that one is necessary to provide a reliable opinion. If an examination is required, all indicated tests and studies should be completed. Then, the examiner/s should opine as to the following, with full supporting rationales: 3. Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension was either caused or aggravated by his service-connected acquired psychiatric disorder? Please explain why or why not and address the studies advanced by the Veteran's representative that were outlined herein. 4. Is it at least as likely as not (a probability of 50 percent or greater) that hypertension was caused and/or aggravated by a service-connected tinnitus? Please explain why or why not. 5. The examiner should provide a complete rationale for any opinions offered. If the examiner/s is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Woehlke 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.