Citation Nr: 21005923 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 10-16 143 DATE: February 2, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1974 to July 1977 and, in the Southwest Asia Theater of Operations, from September 1990 to April 1991 and December 1995 to September 1996. He also had additional intervening periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). These matters are before the Board of Veterans’ Appeals on remand from the United States Court of Appeals for Veterans Claims (Court). They were originally before the Board on appeal from February 2009 (hypertension) and April 2013 (left eye and right knee) rating decisions of the Jackson, Mississippi Department of Veterans Affairs (VA) Regional Office/Agency of Original Jurisdiction (RO/AOJ). In September 2010, the Veteran testified at a hearing before a Decision Review Officer (DRO) at the RO in connection with his hypertension claim. In March 2014, a Board hearing was held before the undersigned. A transcript of both hearings is in the record. In September 2014, the Board issued a decision that (in pertinent part) denied service connection for hypertension and disabilities of the right knee and left eye. The Veteran appealed that portion of the decision to the Court. [Notably, the September 2014 Board decision remanded the claims for increased ratings for a low back disorder and gastroesophageal reflux disorder (GERD)/hiatal hernia. Thereafter, Board decisions in April 2015 (low back disorder) and September 2015 (GERD/hernia) denied these claims.] In September 2015, the Court issued a Memorandum Decision that vacated the September 2014 Board decision with respect to the denial of service connection hypertension and disabilities of the right knee and left eye, and remanded the claims for readjudication. In April 2016 and October 2018, the Board remanded the matters to the RO for additional development necessary to ensure compliance with the terms of the September 2015 Memorandum Decision (the October 2018 Board decision also denied the left eye service connection claim). Unfortunately, another remand is required. In correspondence received in October 2018 (but apparently associated with the record visible to the Board subsequent to the October 2018 Board remand), the Veteran’s attorney advanced an argument that the Veteran’s hypertension manifested during his first period of active duty from July 1974 to July 1977 because his blood pressure was 120/80 on May 1977 service separation examination. In support of this assertion, the Veteran’s attorney provided a citation to an internet article (https://www.webmd.com/hypertension-high-blood-pressure/features/new-low-for-high-blood-pressure#1) which states that “[a]nyone with a systolic (top number) reading of 120 or over, or a diastolic (bottom) reading of 80 or over, now has prehypertension.” The October 2018 correspondence from the Veteran’s attorney also advanced the argument that the Veteran’s right knee disorder is secondary to the Veteran’s service-connected low back disorder. Although a December 2015 VA knee examination report includes the opinion that “there is no association between any degenerative changes of the back and any degenerative changes of the knees,” this opinion is conclusory and does not address whether a right knee disorder is aggravated by the Veteran’s service-connected low back disorder. See El-Amin v. Shinseki, 2638 C.F.R. § 136, 140 (2013) (a medical opinion is inadequate when it fails to adequately address the question of aggravation). Notably, the June 2017 knee examination report and opinion does not address secondary service connection. Accordingly, the Board finds that remand for additional development is necessary to obtain adequate opinions addressing the unresolved medical questions raised in connection with the Veteran’s claims. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and/or private mental health treatment the Veteran has received. 2. After the development in paragraph 1 has been completed to the extent possible, please obtain an addendum medical opinion. Based on review of the record (and, if necessary and deemed feasible, interview and examination of the Veteran, and using telehealth techniques if possible), the clinician should respond to the following: Is at least as likely as not (a 50 percent probability or greater) that the Veteran’s hypertension (1) began during his first period of active duty service from July 1974 to July 1977, (2) manifested within one year after discharge from his first period of active duty service (during the year prior to July 1978), or (3) was noted during service with continuity of the same symptomatology since service. In responding to this request, in addition to the Veteran’s credible recollections as to the onset and treatment for hypertension, the examiner should consider and discuss as necessary (1) the STRs during the Veteran’s first period of service from July 1974 to July 1977 and blood pressure readings noted therein, including 120/80 on May 1977 service separation examination and (2) the internet article (https://www.webmd.com/hypertension-high-blood-pressure/features/new-low-for-high-blood-pressure#1) submitted in support of the Veteran’s claim. Detailed rationale is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. After the development in paragraph 1 has been completed to the extent possible, please obtain an addendum medical opinion. Based on review of the record (and, if necessary and deemed feasible, interview and examination of the Veteran, using telehealth techniques if possible), the examiner should provide opinions that respond to the following: a) Please identify each right knee disorder, to include arthritis, since receipt of the Veteran’s July 2012 claim for service connection. b) For each diagnosed right knee disorder, including arthritis, is it at least as likely as not (50 percent probability or greater) that the disorder is proximately due to or the result of the Veteran’s service-connected disabilities, to specifically include lumbosacral strain with degenerative arthritis of the spine? c) Is it at least as likely as not (50 percent probability or greater) that any diagnosed right knee disorder, including arthritis, is aggravated by (an increase in disability) the Veteran’s service-connected disabilities, to specifically include lumbosacral strain with degenerative arthritis of the spine? The clinician is informed that aggravation here is defined as any increase in disability. If the Veteran’s service-connected disabilities, to specifically include lumbosacral strain with degenerative arthritis of the spine, aggravates any right knee disorder, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. Detailed rationale is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kshama Hughes 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.