Citation Nr: 21025720 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-01 927 DATE: April 28, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected generalized anxiety disorder with major depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 2008 to June 2008. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Board remanded the issues of service connection for hypertension and an acquired psychiatric disorder to obtain VA medical examinations. After further development, the RO granted service connection for generalized anxiety disorder with major depressive disorder (hereafter, psychiatric or anxiety disorder) in a February 2020 Rating Decision but continued the denial of service connection for hypertension in April 2020. In July 2020, the Board again remanded the issue of service connection for hypertension, finding the VA opinion inadequate. The Board directed the RO to obtain an addendum opinion as to whether it was at least as likely as not that the Veteran’s service-connected anxiety disorder caused or aggravated the Veteran’s hypertension. In August 2020, the RO obtained an addendum opinion concerning the Veteran’s hypertension, however, the opinion again fails to provide an adequate opinion regarding the question of aggravation. As such, and although sincerely regrettable, additional remand is required for full compliance with the Board’s previous remand instructions. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). 1. Entitlement to service connection for hypertension is remanded. The Veteran contends that he had high blood pressure during his service, and that he had hypertension within a year of his discharge from active duty. Alternatively, he contends that his hypertension is secondarily related to his service-connected anxiety disorder. He specifically contends that he began having “problems in the military with elevated blood pressure and symptoms of anxiety/panic attacks.” See May 2013 Agent Correspondence; January 2015 Form 9; May 2020 Notice of Disagreement. The Veteran further contends that the most recent VA medical opinion is inadequate as the examiner misstated evidence and failed to review relevant private medical records. See October 2020 Form 9 and Correspondence. The matter is REMANDED for the following action: 1) Obtain an addendum medical opinion from a qualified clinician regarding the nature and etiology of the Veteran’s hypertension. a) The clinician shall opine as to whether it is at least as likely as not that the Veteran’s hypertension had its onset in service or within one year of separation from service, or is otherwise related to service. This opinion should specifically address the significance, if any, of the elevated blood pressure readings during and within one year following discharge from active service. b) The clinician shall also opine as to whether the Veteran’s service-connected psychiatric condition caused or aggravated the Veteran’s hypertension. In providing this opinion, the examiner is asked to consider the February 2019 Mental Disorders disability benefits questionnaire statement that, “Heart palpitations, hypertension, and migraines” can be physical symptoms of anxiety and even depression, and that “physical symptoms such as these can also exacerbate mental health issues, and vice versa.” Please explain and/or reconcile this statement with the current opinion provided. 2) Following completion of the above, the Agency of Original Jurisdiction (AOJ) should review the record, ensure adequacy of the updated medical opinion, and readjudicate the claim on appeal. If the claim remains denied, the AOJ should issue an appropriate supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. S. Sorathia Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hart, 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.