Citation Nr: 21024598 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 17-42 408 DATE: April 23, 2021 REMANDED Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served in the United States Air Force from February 1973 to July 1973. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board virtual hearing in October 2020 before the undersigned, and a copy of the hearing transcript has been obtained and associated with the record. The Veteran seeks service connection for coronary artery disease and hypertension, claimed as secondary to his service-connected posttraumatic stress disorder (PTSD). Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. The Board concludes that the matter must be remanded and regrets the additional delay. A VA medical opinion was prepared in May 2017. Although the examiner concluded that it was less likely than not that the Veteran’s coronary artery disease is due to, or aggravated by, the Veteran’s PTSD, the examiner also noted that it was “far more likely” due to his hypertension. The examiner did not, however, provide an opinion as to whether the Veteran’s hypertension itself was due to, or aggravated by, the Veteran’s PTSD. The Veteran submitted a September 2018 private medical examination. Dr. B. M. opined that it was more likely than not that the Veteran’s coronary artery disease and hypertension were due to, or aggravated by, the Veteran’s PTSD. The Board does not conclude at this time that the September 2018 private examination is sufficient to establish service connection. The examiner’s opinion is conclusory and does not contain a connecting the Veteran’s coronary artery disease and hypertension to the Veteran’s PTSD. An adequate medical opinion must contain clear conclusions with supporting data and a reasoned explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, the medical literature cited and provided do not speak to the specific facts and circumstances of this Veteran’s case, and cannot be awarded probative weight. See Wallin v. West, 11 Vet. App. 509, 514 (1998). The Board does find, however, that the examination and its incorporated literature does sufficiently indicate that there may be a connection between PTSD and hypertension to entitle the Veteran to a VA examination on the issue. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The medical evidence of record being otherwise insufficient to decide the issue, the Board concludes that a remand is necessary to obtain a VA examination concerning whether the Veteran’s hypertension is due to, or has been aggravated by, the Veteran’s PTSD. Because the record reasonably raises the possibility that the Veteran’s coronary artery disease is caused by hypertension, for which service connection may still be established, the Board will therefore remand this claim as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The Veteran’s VA treatment records have been associated with the claims file periodically during the course of this claim. The records obtained indicate that the Veteran receives community care paid by VA, records of which are scanned into the VistA imaging system and have not been reproduced for the record before the Board. Another remand is necessary to obtain all the Veteran’s VA medical records, to include those scanned into the VistA imaging system. The matter is REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records in VA possession and associate with the claims file. Those records scanned into the VistA imaging system should also be associated with the file. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to, proximately due to, or aggravated beyond its natural progression by the Veteran’s service-connected PTSD. The examiner shall address the September 2018 private medical examination by Dr. B.M. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. 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. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner’s lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael D. Wagner, 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.