Citation Nr: A21020256 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 210831-181717 DATE: December 20, 2021 REMANDED Service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 to August 1990. These matters come to the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO). In the September 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. Service connection for hypertension is remanded. The Veteran contends he has hypertension related to service. The Board finds remand is necessary to correct pre-decisional duty to assist errors. The Veteran was afforded a VA examination in September 2020 during which the examiner offered a negative nexus opinion based, in-part, on the rationale that the Veteran's service treatment records (STRs) only revealed elevated blood pressures twice, in 1979 and 1988. Upon review, however, the Veteran's blood pressure was noted to be 130/80 in February 1987, which remains unaddressed. The Board acknowledges the non-VA provider's opinion in this case but notes that the provider failed to address or reconcile the context of the Veteran's elevated blood pressure readings in the year following service. Thus, remand is necessary for an addendum opinion considering the additional elevated blood pressure reading during service. While the Veteran has contended only that his hypertension was caused by or incurred during service, the Board also finds the record reasonably raises the theory that the Veteran's hypertension, alternatively, is secondary to his service-connected obstructive sleep apnea (OSA). In particular, a non-VA provider opined in September 2013 that untreated sleep apnea may cause or exacerbate other disorders and abnormalities. The provider noted the Veteran developed hypertension and explained that untreated sleep apnea may cause hypertension in a relatively young man. While this opinion is speculative and is not supported by a rationale, the Board finds it has reasonably raised the theory that the Veteran's hypertension is secondary to his service-connected OSA. As this evidence was before the AOJ prior to the January 2021 rating decision on appeal, the AOJ erred in not properly developing this aspect of the claim. Accordingly, the Board finds remand is necessary to obtain an opinion regarding secondary service connection. See Robinson v. Peake, 21 Vet. App. 545, 552-56 (2008). Thus, this claim is remanded to correct pre-decisional duty to assist errors by affording the Veteran an adequate VA examination and opinion which also addresses the reasonably raised theory of secondary service connection. The matters are REMANDED for the following action: 1. Return the entire claims file and this remand to the September 2020 VA examiner, if available, or to another appropriate examiner for review. The necessity of an in-person examination is left to the examiner's discretion. The examiner should render an opinion, including rationale, addressing the following: - Whether it is at least as likely as not the Veteran's hypertension is related to service. In so opining, the examiner is specifically directed to consider the in-service elevated blood pressure readings in 1979 and 1988, previously referenced in the September 2020 VA examination, as well as the February 1987 reading of 130/80. - Whether it is at least as likely as not the Veteran's hypertension is caused or aggravated by his service-connected obstructive sleep apnea. In so opining, the examiner is directed to address and consider the September 2013 non-VA provider's opinion discussing obstructive sleep apnea and hypertension. The VA examiner is cautioned that the term "aggravated," as used in 38 C.F.R. § 3.310(b), does not require that there be "permanent worsening" of the nonservice-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence." See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.