Citation Nr: 21015451 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-22 175 DATE: March 17, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a chronic low back condition is remanded. Entitlement to service connection for left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1972 to December 1981. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from August 2008 and March 2011 rating decisions of the Department of Veterans’ Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. This appeal was most recently before the Board in October 2020, at which time it was remanded in its entirety for additional evidentiary development. Specifically, the appeal was remanded for clarifying addendum opinions for the disabilities on appeal. As outlined below, the addendum opinions are not adequate for rating purposes and thus, remand is required to obtain clarifying opinions. See Stegall v. West, 11 Vet. Appl 268, 271 (1998) (holding when a remand is issued, the Veteran is entitled, as a matter of law, the right to compliance with the remanded order). Hypertension In the October 2020 remand, the Board instructed the examiner to consider the Veteran’s report of self-treatment for hypertension after his period of service and clarify whether such remedies could be used to control blood pressure. In the January 2021 addendum opinion, the examiner opined that the Veteran’s hypertension was not related to his period of service, to include the documented in-service instance of hypertension. In so finding, the examiner based the negative nexus on the fact that the single episode of elevated blood pressure during service was associated with a medical emergency and hypertension was not formerly diagnosed until over 20 years post-service. Notably, the examiner failed to consider the Veteran’s lay statements, to include his reports of post-service self-treatment. As the January 2021 addendum opinion is not responsive to the October 2020 remand, another remand is required. Low Back and Knee Conditions Similarly, in the October 2020 Board remand, the Board sought clarification regarding the Veteran’s claimed orthopedic disabilities. Specifically, the Board acknowledged the Veteran’s lay statements regarding stepping in a pothole while unloading a tent during service and instructed the examiner accept as true the Veteran’s statements regarding stepping into a pothole when rendering the opinion. The January 2021 VA addendum opinion is not responsive to the October 2020 remand instructions. The examiner provided a negative nexus, reasoning that despite the Veteran’s claims, there was no evidence of onset in or chronicity of the claimed disabilities since service. The examiner did not discuss the Veteran’s claimed in-service event of stepping in a pothole while unloading a tent and whether or not this event contributed to his current disabilities. As such, the Board finds that remand is required to obtain an another opinion regarding the Veteran’s claimed orthopedic disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any current left knee or low back disability. The examiner should elicit a detailed medical history from the Veteran, to include his claimed injury along with any symptomatology and treatment since service. For each diagnosis noted, the examiner should determine if it is at least as likely as not that any current left knee or low back disability is related to an in-service injury, event, or disease, including twisting his knee and back after stepping into a pothole. For purposes of this examination, the examiner should accept as true the Veteran’s contentions of twisting his knee and back after stepping into a pothole even though not documented. However, the examiner should also accept that the credible lay evidence reflects that the Veteran did not experience recurrent back pain or a “trick” or locked knee at service separation. The examiner should specifically consider a 2007 x-ray examination of the left knee interpreted as reflecting findings consistent with prior left knee trauma and discuss whether there is any medical reason to accept or reject the Veteran’s contentions that any current left knee or low back disability is related to the in-service injury, including the Veteran’s recollections that his physician told him that his left knee injury in service twisted his left knee ligaments. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his hypertension. The examiner should elicit a detailed history from the Veteran, to include the onset of his symptoms and the various treatments he used, particularly upon discharge from service until he was first diagnosed. Upon review of the record and examination of the Veteran, the examiner should opine as to whether the Veteran manifested hypertension in service, to include an explanation as to whether the March 1979 diagnosis of hypertension was correct or a misdiagnosis. The examiner should specifically consider the Veteran’s report of self-treatment for hypertension with remedies and over-the-counter medicine since service and clarify the type of self-treatment(s) the Veteran undertook, identify whether such remedies could be obtained over-the-counter or require a prescription, and opine as to whether such treatment(s) would have controlled blood pressure readings to the extent shown in the record prior to the formal diagnosis many years after service. If the examiner finds that the Veteran did not manifest hypertension either during service or within one year of discharge, the examiner should determine whether it is at least as likely as not that the Veteran’s hypertension is otherwise etiologically related to service. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Orie, 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.