Citation Nr: 21007631 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-45 056 DATE: February 10, 2021 REMANDED The claim of entitlement to service connection for hypertension is remanded. The claim of entitlement to service connection for degenerative arthritis of the back is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1972 to December 1984.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO).  In January 2019, the Veteran testified in a hearing before the Board. A transcript of the hearing has been included in the electronic claims file and has been reviewed. In May 2019, the Board remanded the claims on appeal for additional development. Another remand is warranted for medical inquiry. The Veteran underwent VA examination of his claim regarding back disability in August 2018. However, the examiner did not provide a medical opinion regarding whether service related to the disorder. The record contains an opinion commenting on the claim, found in an August 2016 addendum report to an August 2014 examination report. But a substantial amount of evidence – including private medical evidence, evidence from the Social Security Administration (SSA), and lay assertions during the Board hearing – has been included in the record since the opinion. An addendum opinion should be sought from the examiner who conducted the August 2018 examination. Pursuant to the May 2019 remand, the Veteran underwent VA examination into his hypertension claim in December 2019. The report and opinion are responsive to the Board’s inquiries. Nevertheless, an addendum opinion addressing one aspect of the opinion should be issued. In the December 2019 report, the examiner indicated that substance abuse may explain why the Veteran had elevated blood pressure readings during service. However, there is no evidence in the service personnel records or in the service treatment records indicating that the Veteran abused drugs during service. As such, the opinion must be reexamined. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Return the case to the examiner who conducted the August 2018 VA examination of the Veteran’s back (or to a suitable substitute) for issuance of an addendum medical opinion. After reviewing the claims file, the examiner should answer the following question: Is it at least as likely as not (i.e., probability of 50 percent or more) that a lower back disorder had its onset during service, or is related to a disease, event, or injury during service? The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Return the case to the examiner who conducted the December 2019 VA examination addressing hypertension (or to a suitable substitute) for issuance of an addendum medical opinion. After reviewing the claims file, the examiner should answer the following question: Is it at least as likely as not (i.e., probability of 50 percent or more) that hypertension had its onset during service, or is related to a disease, event, or injury during service? In answering this question, note that the record does not substantiate that the Veteran used illegal drugs during service, such as when he had elevated blood pressure readings during service. As such, the examiner must revisit and reexamine the premise of the opinion noted in the December 2019 report. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee, 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.