Citation Nr: 21023986 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-18 181 DATE: April 21, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to July 1979. In a September 2018 decision, the Board of Veterans’ Appeals (Board) reopened and denied a claim for entitlement to service connection for spondylosis of the lumbar spine and remanded the claims for service connection for hypertension and hepatitis C to the Department of Veterans Affairs (VA) Regional Office (RO) for additional development. In July 2020, the Board again remanded the claims for entitlement to service connection for hypertension and hepatitis C for additional development. During the pendency of this appeal, entitlement to service connection for hepatitis C was granted by a November 2020 rating decision, thereby constituting a full grant of the benefits sought on appeal and thus, this issue is no longer in appellate status before the Board. Although the Board regrets additional delay, remand is again necessary to ensure the Veteran all due process. Entitlement to service connection for hypertension is remanded. The Veteran asserts that his hypertension is related to his active service or, in the alternative, is secondary to his service-connected dislocation of costo-sternal joint of 3rd and 4th ribs with costochondritis. Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) (2019); Allen v. Brown, 7 Vet. App. 439 (1995). In a July 2019 VA opinion, a VA examiner concluded that hypertension was less likely than not proximately due to or the result of Veteran’s service-connected condition, explaining the two conditions are not medically related. The VA examiner also found hypertension was a separate entity entirely from the service-connected dislocation of costo-sternal joint of 3rd and 4th ribs with costochondritis and unrelated to it. He noted that the medical literature did not support a medical relationship and that it was possible that acute elevation with pain at costochondral region was present but only acute and that no chronic elevation from the service condition was plausible. The examiner also opined that hypertension was not at least as likely as not aggravated beyond its natural progression by the service-connected condition. However, the rationale provided for this finding was the same as the rationale provided for the opinion regarding causation. The Board finds that the July 2019 opinion regarding secondary service connection is not adequate as it did not provide a separate rationale for both causation and aggravation. Causation and aggravation are independent concepts and should have separate findings and rationales. Atencio v. O’Rourke, 30 Vet. App. 74 (2018). As such, a new opinion is necessary to provide separate findings and rationales relating to causation and aggravation. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not proximately due to his service-connected dislocation of costo-sternal joint of 3rd and 4th ribs with costochondritis, or was aggravated beyond its natural progression by his service-connected dislocation of costo-sternal joint of 3rd and 4th ribs with costochondritis. (a.) The VA examiner must provide separate findings and rationales relating to causation and aggravation. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Saira Spicknall, 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.