Citation Nr: 21075820 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 09-46 998 DATE: December 21, 2021 REMANDED Entitlement to service connection for cardiovascular disease, to include hypertension, is remanded. Entitlement to service connection for diabetes mellitus type II (diabetes) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1962 to March 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2010, the Veteran testified at a Board videoconference hearing before a Veterans Law Judge (VLJ) who is no longer employed by the Board. In February 2016, the Veteran testified at another Board videoconference hearing before the undersigned VLJ. In a May 2017 decision, the Board, in relevant part, denied the Veteran's service connection claims for cardiovascular disease and diabetes. The Veteran timely appealed the May 2017 Board decision to the United States Court of Appeals for Veterans Claims (Court). In an April 2018 Order, pursuant to a Joint Motion for Remand (JMR) filed by the parties, the Court, in relevant part, vacated and remanded the Board decision as to his service connection claims for cardiovascular disease and diabetes. In November 2018, October 2020, March 2021, and most recently in July 2021, the Board remanded the appeal for further development. The Board regrets additional delay, but unfortunately another remand is required. Pursuant to the Board's July 2021 remand directives, addendum opinions were obtained in September 2021. The Board asked the examiner to opine on whether it is at least likely as not (50 percent or greater probability) that diagnosed hypertension and diagnosed diabetes had their onset in service or were otherwise related to service, to include as a result of documented "tired blood" therein. In addressing this question, the Board specifically directed the examiner to: please discuss and assume as true: (1) the Veteran's reports that symptoms including frequent urination, dizziness, and fatigue began during service and (2) that he was treated for high blood pressure shortly after separation from service. Please provide a discussion of whether a nexus relationship between the Veteran's hypertension and diabetes and service is "medically consistent" with the above-mentioned reports and the documented chief complaint of "tired blood" as representative of fatigue. See August 1964 STR; see also February 2021 Appellate Brief noting "tired blood" means fatigue. The Board also reminded the examiner that they should not rely on unremarkable STRs or any other medical evidence that contradicts with assuming as true the above-mentioned reports in providing a negative opinion. If any of the above instructions are not adhered to, the opinion will be rendered inadequate. Despite these directives, the examiner relied on unremarkable STRs, lack of continuity of ongoing treatment in post-service treatment records that support his claims, provided a limited rationale, and did not assume as true (1) the Veteran's reports that symptoms including frequent urination, dizziness, and fatigue began during service and (2) that he was treated for high blood pressure shortly after separation from service or provide a discussion of whether a nexus relationship between the Veteran's hypertension and diabetes and service is "medically consistent" with the above-mentioned reports and a documented chief complaint of "tired blood," as specifically requested by the Board. Thus, for these reasons, another addendum opinion from a different examiner is needed on remand to ensure substantial compliance with the Board's July 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Obtain an addendum opinion from a VA examiner other than the June 2020, October 2020, May 2021, and September 2021 VA examiners, preferably a physician, to determine the nature and etiology of the Veteran's hypertension and diabetes disabilities. The claims file, to include a copy of this remand, must be made available to the examiner for review, and the examination report must reflect that such a review was accomplished. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. (a) For diagnosed hypertension (see June 2020 VA examination report), please opine whether it is at least likely as not (50 percent or greater probability) that such disability had its onset during service or is otherwise related to service, to include as a result of documented "tired blood" therein. (b) For diagnosed diabetes (see June 2020 VA examination report), please opine whether it is at least likely as not (50 percent or greater probability) that such disability had its onset during service or is otherwise related to service, to include as a result of documented "tired blood" therein. In addressing these questions, please discuss and assume as true: (1) the Veteran's reports that symptoms including frequent urination, dizziness, and fatigue began during service and (2) that he was treated for high blood pressure shortly after separation from service. Please provide a discussion of whether a nexus relationship between the Veteran's hypertension and diabetes and service is "medically consistent" with the above-mentioned reports and the documented chief complaint of "tired blood" as representative of fatigue. See August 1964 STR; see also February 2021 Appellate Brief noting "tired blood" means fatigue. The examiner is reminded that they should not rely on unremarkable STRs or any other medical evidence that contradicts with assuming as true the above-mentioned reports in providing a negative opinion. If ANY of the above instructions are not adhered to, the opinion will be rendered inadequate and another opinion will be sought. A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resorting to speculation, the examiner must so state and then provide a rationale for this conclusion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.