Citation Nr: 21077573 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 15-04 850 DATE: December 30, 2021 REMANDED The appeal regarding entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service from March 1966 to December 1969. He died in March 2019. His surviving spouse has been substituted in this appeal. This matter comes before the Board of Veterans' Appeals (Board) from a January 2012 rating decision by the Agency of Original Jurisdiction (AOJ). The Board remanded the instant issue in May 2018, May 2021, and October 2021 to obtain opinions regarding the etiology of the Veteran's hypertension. In October 2021, the Board noted that an opinion was obtained in August 2021, and that the examiner addressed a general relationship to service. The Board pointed out, however, that the examiner did not provide an opinion regarding whether hypertension was related to conceded in-service asbestos exposure as directed by previous Board remands. The Board also noted that the examiner's rationale regarding the question of a relationship between the claimed hypertension and the Veteran's service-connected asbestosis considered only causation. The Board directed that an opinion regarding whether the Veteran's hypertension had been aggravated by his service-connected asbestosis be obtained. In October 2021, a VA physician indicated that she had reviewed the records and the previous medical opinion. She stated the following: It is less likely as not that the veteran [sic] HTN is or was related to his asbestos exposure. rationale: see previous medical opinion by Dr Gugucheva. Review of medical literature, the etiology and risk factors for htn includes multiple etiologies and risk, but Asbestos exposure is not known to be one of them. To the extent that this physician pointed to the rationale provided in August 2021, the Board again notes that the August 2021 opinion did not address a relationship to asbestos exposure. As such, the rationale offered to support that opinion does not consider the question of a relationship to asbestos exposure during service. Moreover, her remaining rationale does not adequately address the medical principles underlying her conclusion. Considering the deficiencies discussed above, the Board concludes that remand is necessary to obtain additional opinions. The matters are REMANDED for the following action: 1. Request an opinion from a qualified clinician regarding the etiology of the Veteran's hypertension. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The clinician's report must include a notation that this record review took place. After the record review, the reviewing clinician should provide an opinion regarding whether it is at least as likely as not that the Veteran's hypertension was incurred in, or is otherwise related to active service, to include conceded exposure to asbestos therein. The examiner should also provide an opinion with respect to whether it is at least as likely as not that the Veteran's hypertension was caused or aggravated by the Veteran's service-connected asbestosis. The complete rationale for all opinions must be set forth, to include a complete discussion of the facts and medical principles underlying the clinician's conclusions. If the examiner is unable to offer any of the requested opinions, it is essential that he offer a rationale for the conclusion that an opinion cannot be provided without resort to speculation, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (Continued on the next page) 2. Then, readjudicate the claim. If the decision remains adverse to the appellant, she and her representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.