Citation Nr: 21023259 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-63 105 DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from April 1985 to July 1993 and from February 2003 to August 2003. This matter comes before the Board of Veterans Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2020 when it was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. In April 2019, the Board remanded other issues. To the extent issues were remanded for further development, the issues will be addressed in a future Board decision, if in order, once that development is completed. Pursuant to the August 2020 Board remand, the Veteran received a VA examination in January 2021. The examination found that the Veteran’s hypertension was not due to service, providing a rationale that obesity, sleep apnea, and a smoking history were significant risk factors. However, it is unclear from the rationale if the Veteran’s obesity and sleep apnea were issues when the Veteran first exhibited elevated blood pressure readings during active duty service. Additionally, the examiner did not address evidence favorable to the Veteran such as multiple instances of high blood pressure in his April 1985 service treatment records. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, remand for an addendum opinion is warranted. The matter is REMANDED for the following action: Obtain an addendum opinion to determine the nature and etiology of the Veteran’s hypertension. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. After examining the Veteran—if deemed necessary by the examiner—and considering his pertinent medical history and lay statements regarding his reported symptoms, the examiner should opine as to: Whether it is at least as likely as not (a 50 percent probability or greater) that his hypertension was incurred in, aggravated by, or etiologically related to his military service. The examiner should specifically address the multiple instances of elevated blood pressure noted in the Veteran’s service treatment records. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. B. G. LeMoine Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Javed, 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.