Citation Nr: 21023450 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-14 123A DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertensive vascular disease (hypertension), to include as secondary to service-connected acquired psychiatric disorder, chemical exposure, and/or agent orange exposure, is remanded. REASONS FOR REMAND The Veteran served active duty from October 1972 through December 1974. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In August 2015 the Veteran submitted a notice of disagreement (NOD) and in February 2017 the ROI issued a statement of the case (SOC). In March 2017, the Veteran perfected his substantive appeal for service connection and requested a video conference before a Veterans Law Judge (VLJ). In August 2019, the Veteran testified at a videoconference hearing before the undersigned VLJ. A transcript of that proceeding is associated with the record. In a February 2020 decision, the Board remanded this issue for additional development. Unfortunately, the Board’s remand instructions have been not been substantially completed and another remand is required before the Board can adjudicate the entitlement to service connection for hypertension. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for hypertension, to include as secondary to service-connected acquired psychiatric disorder, chemical exposure, and/or agent orange exposure, is remanded. The Veteran is seeking service connection for hypertension. Specifically, he contends that his hypertension is secondary to his exposure to paint fumes during service. See August 2015 NOD; April 2013 Correspondence (containing lay assertions and submitted medical literature). Alternatively, the Veteran asserts that his hypertension is secondary to his service-connected acquired psychiatric disorder because as he gets angry and his emotions flare up his blood pressure rises. See August 2019 Board Hearing Tr. Furthermore, the Veteran asserts that he served in the waters around Vietnam. See September 1998 Statement. As noted above, in February 2020, the Board remanded this issue for additional development and requested a new VA opinion. In October 2020, a VA examiner opined that the Veteran’s hypertension is less likely than not due to service because there is no evidence that the Veteran’s hypertension started in service. He also opined that the Veteran’s disability is not caused by or aggravated by his service connected acquired psychiatric disorder based on there being no evidence of a link in medical literature. Here, the examiner fails to provide a rationale for his conclusory statement regarding a lack of a direct nexus. He also does not address the Veteran’s inservice exposure to paint fumes (lead based), to include his submitted medical literature indicating a possible link, or the Veteran’s contention that he served in the waters near Vietnam. Regarding secondary service connection, the examiner also fails to consider the Veteran’s competent assertions regarding a feeling of elevated blood pressure due to emotional flareups. Accordingly, the VA opinion is insufficient for adjudicative purposes and a remand for a new VA opinion is warranted. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: 1. The AOJ should obtain all outstanding VA treatment records and any private treatment records identified by the Veteran. All obtained records should be associated with the evidentiary record. In doing so, the AOJ should attempt to verify the Veteran’s statement that he served in around waters off the coast of Vietnam. 2. After all outstanding treatment records have been associated with the claims file, obtain an addendum opinion from an appropriate physician regarding the Veteran’s hypertension. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran. The VA examiner should address the following: (A) Whether it is at least as likely as not (i.e. a 50 percent probability) that the Veteran’s hypertension began during or is otherwise due to active service, to include as due to exposure to chemical (lead based paint fumes), and/or any verified herbicide exposure. In doing so, the examiner should address the Veteran’s submitted medical literature. See April 2013 Correspondence. (B) Whether it is at least as likely as not (i.e. a 50 percent probability) that the Veteran’s hypertension is (1) proximately due to his service-connected acquired psychiatric disorder, or (2) aggravated beyond its natural progression by his service-connected acquired psychiatric disorder. In doing so the examiner should address the Veteran’s competent lay assertions that he gets angry, his emotions flare up his blood pressure rises. See August 2019 Board Hearing Tr. If the examiner determines that the Veteran’s hypertension was aggravated by his service-connected disability, then the examiner should cite medical records which show the baseline severity of his hypertension prior to aggravation. If the examiner is unable to establish a baseline for the hypertension prior to the aggravation, he or she should state such and explain why a baseline cannot be determined. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). (Continued on the next page)   3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.