Citation Nr: 21077327 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 19-33 436 DATE: December 29, 2021 REMANDED Entitlement to accrued benefits based on a pending claim for service connection for hypertension is remanded. Entitlement to accrued benefits based on a pending claim for service connection for a cerebral vascular accident (stroke or CVA) is remanded. INTRODUCTION The Veteran served on active duty from January 1967 to January 1971. He died in July 2021; the Appellant is his surviving spouse and has been substituted as the claimant in these matters. In December 2021, the Appellant attended a hearing before the undersigned Veterans Law Judge. REASONS FOR REMAND In July 2015, the Veteran initiated a claim for entitlement to service connection for hypertension and a stroke. He asserted these disabilities were either caused by his exposure to herbicides in service, or alternatively may have been consequentially related to his service-connected diabetes mellitus. With respect to his hypertension, the Veteran also intimated this disability may have been incurred in service. A review of his outpatient treatment records shows the Veteran was diagnosed with both hypertension and strokes prior to his death. Additionally, the Board notes the Veteran's exposure to herbicides was conceded in the November 2015 rating decision on appeal. Turning to the Veteran's service treatment records (STRs), the Board notes the Veteran was assessed as having elevated blood pressure in the course of his October 1970 separation examination. Further, the Veteran provided a disability benefits questionnaire, which was completed by his private clinician in June 2015. In this report, the clinician indicated the Veteran's hypertension and stroke were consequences of his diabetes; however, the clinician provided no explanation for how or why he came to this conclusion. The Veteran then underwent a VA examination in September 2015 to assess his diabetes mellitus. Following that examination, the RO obtained an addendum medical opinion in October 2015 addressing the Veteran's hypertension and CVA. A VA examiner who had not previously examined the Veteran concluded his hypertension and CVA were less likely than not caused or aggravated by his diabetes. The examiner provided little explanation for her conclusions, and also wholly failed to acknowledge or discuss the June 2015 conclusions of the Veteran's private physician. Similarly, the RO obtained a medical opinion from a VA examiner in January 2018, which addressed whether the Veteran's hypertension was incurred in service. The physician relied on serial readings taken after the Veteran was noted to have elevated BP on separation. He concluded the Veteran did not satisfy the criteria for a diagnosis of hypertension in service, but did not explain why his elevated blood pressure during his separation examination could not have represented the onset of the condition in service. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). To date, the RO has not obtained an opinion addressing the Veteran's assertion that his herbicide exposure may have caused his hypertension or stroke. Based on the foregoing insufficiencies, the Board finds a remand is necessary in order to obtain competent medical opinions addressing all theories of entitlement. Accordingly, this case is REMANDED for the following actions: Obtain a medical opinion addressing the above-noted claims from a Cardiovascular Disease specialist. Following a review of the relevant records and lay statements, the physician is asked to state an opinion with respect to whether the Veteran's hypertension or cerebral vascular accidents (strokes) at least as likely as not (a 50 percent probability or greater): a) originated during his period of active service or was otherwise etiologically related to his active service, to include as a result of his conceded exposure to herbicides therein; b) was caused by his service-connected diabetes mellitus, type II; or c) was worsened to any degree by his service-connected diabetes mellitus, type II. The examiner must consider and discuss the Veteran's competent lay statements regarding the nature of his service and manifestations experienced. The examiner is also asked to consider and expressly discuss the June 2015 examination completed by the Veteran's private physician, which indicated the Veteran's hypertension and stroke were consequentially related to his diabetes. Additionally, the examiner is asked to consider and discuss the Veteran's October 1970 separation examination, which revealed elevated blood pressure readings. In this regard, though the Veteran may not have met the clinical criteria for a confirmed diagnosis of hypertension at that time, the examiner is asked whether these findings may have nonetheless represented the onset of the condition. The examiner must provide a complete rationale for all proffered opinions. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.