Citation Nr: 21013009 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 16-11 107 DATE: March 8, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active service from July 1990 to July 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in October 2018 and January 2020 for further development. With regard to the increased rating claim for posttraumatic stress disorder (PTSD), the issue was decided by the Board in January 2020, and the decision was effectuated by the RO in a July 2020 rating decision; thus, this issue is no longer before the Board. The Board further notes that the Veteran has appealed the Board’s October 2018 denial of entitlement to service connection for sleep apnea to the United States Court of Appeals for Veterans Claims (CAVC). This issue was remanded by the Board in August 2020 pursuant to the January 2020 memorandum decision by CAVC. However, this issue has not yet been certified to the Board, and VACOLS indicates that it is not yet activated for the Board to take action. Thus, it is unclear if the AOJ is taking any further action or development. Therefore, the Board will not take jurisdiction over the issue at this juncture, but it will be the subject of a subsequent Board decision, if otherwise in order. Entitlement to service connection for hypertension, to include as secondary to service-connected disability, is remanded. The Board sincerely regrets the additional delay of this issue, but further evidentiary development is necessary before the Veteran’s claim for service connection for hypertension can be adjudicated on the merits. In its January 2020, the Board remanded the matter in order to obtain an opinion that adequately addresses whether the Veteran’s hypertension is due to, or aggravated by his service-connected disabilities, including his PTSD and the chronic pain associated with his service-connected ankle and foot disabilities, as was requested in the prior remand. In addition, the examiner was to provide an opinion regarding the theory of whether the Veteran’s obesity constitutes an intermediate step for secondary service connection, as suggested in the July 2019 VA examination. See Marcelino v. Shulkin, 29 Vet. App. 155 (2018) (obesity itself is not subject to service connection); VAOPGCPREC 1-2017 (Jan. 6, 2017) (obesity can be an “intermediate step” between a current disability and a service-connected disability under certain circumstances). In September 2020, opinions were obtained pursuant to the January 2020 Board remand. The Board finds that the opinions provided did not adequately address secondary service connection. The examiner provided conclusory statements regarding causation and aggravation, and did not provide an analysis that clearly and coherently connects the data or medical evidence with the conclusions reached. See Stefl v. Nicholson, 21 Vet. App. at 120, 124 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Lastly, the examiner appeared to apply the incorrect legal standard regarding aggravation. Aggravation pursuant to 38 C.F.R. § 3.310 does not require a permanent worsening of the underlying condition by the service-connected disability. Ward v. Wilkie, 31 Vet. App. 233 (2019). As such, the Board finds that a new medical opinion should be obtained prior to adjudication of the Veteran’s claim. The matters are REMANDED for the following action: Send the claims file to a VA medical professional with the appropriate expertise as relates to the Veteran’s hypertension claim. (a) The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension was caused by chronic pain associated with his service-connected ankle and foot disabilities. (b) The examiner should opine as to whether it is at least as likely as not that the Veteran’s hypertension is/was aggravated by chronic pain associated with his service-connected ankle and foot disabilities. (c) The examiner should opine as to whether it is at least as likely as not that the Veteran’s hypertension is/was caused by his service-connected major depressive disorder and PTSD. (d) The examiner should opine as to whether it is at least as likely as not that the Veteran’s hypertension is/was aggravated by his service-connected major depressive disorder and PTSD. The examiner must address both causation and aggravation for the opinions to be deemed adequate. The examiner should be aware that Ward v. Wilkie, 31 Vet. App. 233 (2019) held that a “permanent worsening” of a nonservice-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). (e) The examiner should opine whether it is at least as likely as not that (i) the Veteran’s service-connected ankle and foot disabilities caused lack of physical exercise and for him to become obese; (ii) such obesity was a substantial factor in causing his hypertension; and (iii) the current hypertension would not have occurred but for obesity caused by the service-connected ankle and foot disabilities. The examiner should provide a detailed and medically-supported rationale for all opinions given. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.