Citation Nr: A21020049 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 200521-113969 DATE: December 15, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a kidney condition is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1987 to May 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2020 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Veteran filed a notice of disagreement selecting direct review of the evidence considered by the RO. The Veteran continues to seek service connection for hypertension and for a kidney condition, which he claims are secondary to his service-connected PTSD with depression. Unfortunately, remand is required in order to provide the Veteran with adequate VA medical opinions. Regarding service connection for hypertension, in April 2020 a clinician was asked to discuss whether the Veteran's hypertension is aggravated by his PTSD with depression. The clinician responded that "[t]he Veteran has multiple medical conditions that could have aggravated his hypertension. It would be speculation to attempt to assign causation to any specific one. Substance abuse, cigarette smoking and lifestyle are all identified aggravators of hypertension." Unfortunately, such an opinion fails to adequately answer the question relevant for the service-connection inquirythat is, whether PTSD with depression aggravated hypertension. Service connection would be warranted even if the service-connected disability was one aggravating factor among others; entitlement does not depend on evidence showing that the service-connected disability was the "specific," "one" aggravating factor. See 38 C.F.R. § 3.310(a). Furthermore, the opinion is also inadequate because, as held by the U.S. Court of Appeals for Veterans claims, where a VA examiner states that he or she cannot provide an opinion without speculating, he or she must explain whether the basis for the inability to provide an opinion without speculating reflects a limitation in the medical community at large or is based on the examiner's own lack of expertise, insufficient information, or unprocured testing. Regarding the claim for service connection for a kidney condition, an April 2020 VA opinion stated that "[i]t is at least as likely as not that the Veteran's kidney condition could been aggravated by the hypertension when the hypertension was poorly controlled. The Veteran's hypertension at this time is controlled with medications." This opinion failed to adequately address whether the Veteran's hypertension was "poorly controlled" at any point during the appeal period; if it was, then service connection may be warranted. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that entitlement to service connection benefits may arise at any time during an appeal period). Given this evidence of a connection to hypertension, the claim of service connection for hypertension and the claim for service connection for a kidney condition are intertwined and should be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Smith v. Gober, 236 F.3d 1370, 1373 (Fed. Cir. 2001). These failures to have provided adequate VA opinions existed at the time of the April 2020 rating decision on appeal, and thus remand is appropriate to cure the pre-decisional duty to assist errors. 38 C.F.R. § 20.802(a); see 38 U.S.C. § 5103A, 38 C.F.R. § 3.159(c)(4). Accordingly, the matter is REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's hypertension. The clinician must opine whether the Veteran's hypertension at least as likely as not is aggravated (worsened beyond the natural course of the disease) by service-connected PTSD with depression. If the examiner is unable to provide the requested opinion without resorting to speculation, the examiner should state whether the inability is due to insufficient testing by the examiner and/or his or her lack of expertise, or due to a limitation of the medical community at large. 2. Obtain an addendum opinion regarding the etiology of the Veteran's kidney condition. The clinician must opine whether it is at least as likely as not that the Veteran's hypertension at any time since approximately 2018 has been "poorly controlled" and thereby, per the etiological relationship asserted in the April 2020 VA opinion, aggravated the Veteran's kidney condition. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.