Citation Nr: 21012844 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 05-10 497A DATE: March 5, 2021 REMANDED Entitlement to service connection for hypertension, claimed as a residual of a motor vehicle accident (MVA), to include as secondary to multiple sclerosis, is remanded. REASONS FOR REMAND The Veteran had active service from May 1961 to November 1982. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a September 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in October 2014 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In March 2015, February 2016, and February 2020, the Board remanded this claim for additional development. Entitlement to service connection for hypertension. The Veteran seeks entitlement to service connection for hypertension. This issue was remanded in February 2020 to obtain a VA medical opinion regarding whether the Veteran’s hypertension is proximately due to or aggravated by his service-connected multiple sclerosis. A VA medical opinion was obtained in September 2020. The VA examiner opined that it was less likely than not that the Veteran’s hypertension was due to or aggravated by his multiple sclerosis. The examiner stated that hypertension and multiple sclerosis are two separate, unrelated conditions and that for most adults, there is no identifiable cause of hypertension. The examiner then stated that some people have high blood pressure caused by an underlying condition, and listed several conditions, including obstructive sleep apnea, kidney problems, thyroid problems, etc., citing to a medical article from Mayo Clinic. The Veteran’s representative submitted a statement in February 2021, arguing that the September 2020 VA medical opinion merely described multiple sclerosis and hypertension as two separate, unrelated conditions without analysis of comorbidities or secondary issues. The Veteran’s representative stated that while relatively few large-scale studies have looked into the prevalence of cardiovascular conditions in people with demyelinating diseases, many do suggest that cardiovascular conditions are either as prevalent or more prevalent in people with multiple sclerosis than healthy people. The representative stated that this is true for many reasons, one of which is that multiple sclerosis patients typically are less physically active. The representative also noted that medical literature findings report that multiple sclerosis patients were about 48 percent more likely to have hypertension compared to control groups. The Board finds an addendum opinion is necessary that addresses the argument presented by the Veteran’s representative in February 2021, to include the reported medical literature findings. While this case is in remand status, the Veteran and/or his representative are also free to obtain a medical opinion in support of this appeal, if so desired. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Obtain an addendum opinion for the Veteran’s hypertension. Based on a full review of the record, to include the Veteran's lay statements regarding the incurrence and symptomatology of his hypertension, please answer the following: Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's currently diagnosed hypertension is proximately due to or aggravated (beyond a natural progression) by his service-connected multiple sclerosis? *The examiner is asked to specifically consider and discuss the February 2021 argument from the Veteran’s representative that while relatively few large-scale studies have looked into the prevalence of cardiovascular conditions in people with demyelinating diseases, many do suggest that cardiovascular conditions are either as prevalent or more prevalent in people with multiple sclerosis than healthy people; that this is true for many reasons, one of which is that multiple sclerosis patients typically are less physically active; and that medical literature findings report that multiple sclerosis patients were about 48 percent more likely to have hypertension compared to control groups. (continued on next page) A detailed explanation (rationale) is requested for all opinions provided, citing supporting clinical data and/or medical literature, as appropriate. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.