Citation Nr: 21015980 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-10 700 DATE: March 18, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and/or due to a chronic undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to February 1994, October 2001 to May 2002, and February 2003 to January 2004 with service in Southwest Asia. The agency of original jurisdiction (AOJ) granted entitlement to service connection for respiratory conditions and an ear condition in a May 2020 rating decision. The claims were granted in full, and therefore the appeals are no longer before the Board of Veterans’ Appeals (Board). Unfortunately, the Board finds the matter on appeal requires an additional remand prior to adjudication. In September 2018, the Board remanded the appeal in order to obtain a VA examination to determine the nature and etiology of the Veteran’s hypertension. The Veteran was provided with a VA examination in August 2019. The examiner determined the Veteran’s hypertension manifested in 1997, which followed the first period of active service, but preceded the Veteran’s last two periods of active service. Although the examiner provided a detailed rationale to support the negative nexus opinion, the examiner failed to adhere to the remand directives and provide an opinion as to whether the Veteran’s pre-existing hypertension was clearly and unmistakably not aggravated by active duty. Stegall v. West, 11 Vet. App. 268, 271 (1998). The examiner also found the Veteran’s hypertension was not caused or aggravated by the Veteran’s service-connected PTSD. The examiner explained how although there are medical and lay articles explaining an association between PTSD and hypertension, there has been no “clinical consensus” that concludes PTSD causes hypertension. The examiner explained their position thoroughly, but did not abide by the remand directives which required the use of the standard of “at least as likely as not.” Using the higher standard of “clinical consensus” was incorrect, and therefore an addendum opinion with the correct standard is necessary. Id. The Board notes that in the February 2021 Written Brief Presentation, the Veteran’s representative specifically challenged the competency of the VA examiner who administered the August 2019 VA hypertension examination. In light of this statement, and VA’s duty to assist the Veteran in the development of his appeal, the Board must remand these matters to obtain further information regarding the qualifications of the individual who administered examination pertinent to the issue on appeal. See Francway v. Wilkie, 930 F.3d 1377, 1380 (Fed. Cir. 2019). Accordingly, on remand, to the extent possible, a copy of the curriculum vitae for the August 2019 VA examiner as well as any and all known qualifications should be obtained, associated with the record, and provided to the Veteran and his representative for review. The matters are REMANDED for the following action: 1. Appropriate action must be taken to respond to the requests from the representative for copies of the curriculum vitae and other credentialing documents for the VA examiner who conducted the August 2019 hypertension examination. After obtaining this credentialing documentation, associate it with the record and provide the Veteran and his representative a copy thereof. If the requested curriculum vitae and other credentialing documentation is not obtainable, the Veteran and his representative should be notified, and the reasons for such should be documented in the record. 2. Request an addendum opinion with a qualified medical professional to determine the nature and etiology of the hypertension. The claims file to include a copy of this REMAND should be made available to the examiner. Obtain curriculum vitae and other credentialing documents for the VA examiner who provides the addendum opinion. The examiner is asked to address the following: (a.) Provide an opinion as to whether the Veteran’s hypertension at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active duty period between May 1981 to February 1994; (b.) Provide an opinion as to whether hypertension was clearly and unmistakably NOT aggravated beyond its natural progression by the Veteran’s active service periods of October 2001 to May 2002 and February 2003 to January 2004. (c.) Provide an opinion as to whether hypertension was at least as likely as not (50 percent or greater probability) caused or aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected PTSD. In answering all questions, please articulate the reasoning underpinning the conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support the opinion, and (2) explain how that evidence justifies the opinion. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.