Citation Nr: 21023547 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 15-03 221 DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertension (HTN) is remanded. Entitlement to service connection for anemia is remanded. REASONS FOR REMAND The Veteran had active duty service with U.S. Army from February 1973 to February 1977. The Veteran had additional service in the Army Reserve. This case comes before the Board of Veteran’s Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a September 2016 Board Hearing. The record contains a transcript of the hearing. The Veterans Law Judge who conducted the hearing is unavailable to participate in a decision in this matter. Via July 2020 Correspondence, VA notified the Veteran of his right to have another Board hearing. The Veteran has not opted for an additional hearing, so the Board may proceed to the merits without another hearing. A January 2018 Board decision reopened the previously denied claim of hypertension and remanded the underlying claim on the merits for adjudication. While the Board regrets the additional delay, further remand is required with regard to the claims of service connection for anemia and HTN, to secure compliance with VA’s duty to assist the Veteran in substantiating his claims. Hypertension In September 2020, the Board remanded this matter to obtain a secondary service connection medical opinion. In January 2020, a secondary medical opinion was obtained. The Board notes that the medical opinion is adequate for adjudication. However, the record does not have an adequate medical opinion addressing direct service connection. The August 2019, November 2019, and February 2020 VA examiners provided a negative nexus opinion. The examiners based their opinions on no diagnosis during service. Neither examiners addressed the Veteran’s lay assertions. The Board finds that the nexus opinions provided in the examinations are inadequate because they were merely based on the absence of medical records and thus fail to provide sufficient medical reasons for the opinions. To rectify these deficiencies, a VA examination and opinion must be obtained. Anemia In September 2020, the Board remanded this matter to clarify whether the Veteran had a diagnosis of anemia. The medical evidence was contradictory. Given the diagnosis of aplastic anemia in the September 2019 VA examination, opinions addressing that diagnosis were required. In October 2020, a VA medical addendum opinion was obtained. The examiner explained that anemia was a condition that occurred when the body stopped producing enough new blood cells. He indicated that normally, red blood cells, white blood cells and platelet levels stay within certain ranges. In aplastic anemia, all three of these blood cell levels were low. However, according to the lab results on the August 1, 2019 examination, white blood cells and platelet counts were within normal limits. Therefore, he concluded that the Veteran did not meet the criteria for a diagnosis of anemia. The examiner noted that there was no record that the Veteran ever received any sort of treatment for anemia. The Board notes that the previous September 2020 remand only asked the VA examiner to address the 2019 diagnosis. However, during the pendency of this appeal, private treatment records demonstrated that the Veteran was diagnosed with anemia. Specifically, May and September 2011 private treatment notes documented that the Veteran had anemia. The private examiner noted that the cause of the Veteran’s anemia was unclear. Given this diagnosis is during the pendency of the appeal and proximate to the appeal period, a medical opinion addressing this diagnosis is required (to include, if necessary, an explanation of why that diagnosis was incorrect or merely referred to history and not the current appeal period). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Schedule the Veteran for a VA hypertension examination; the claims folder must be reviewed in conjunction with the examination. The examiner must opine as to whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s hypertension is caused or aggravated by service. The examiner must address the Veteran’s lay assertions. A full and complete rationale is required for all opinions expressed. 3. Obtain an addendum medical opinion from the VA examiner that provided the October 2020 addendum opinion, or a suitable substitute. A new examination is only required if deemed necessary by the examiner. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner is asked to address the May and September 2011 private treatment notes documenting a diagnosis of anemia. If the examiner determines that no diagnosis is warranted at any time under consideration, such must be clearly stated and the difference of opinion with prior diagnosticians should be discussed. The examiner must opine as to whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s anemia was caused or aggravated by service. 4. Thereafter, readjudicate the remanded issues. If any benefit sought remains denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. JESSICA SEAY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Baxter 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.