Citation Nr: 21026203 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 17-27 001 DATE: April 30, 2021 REMANDED Entitlement to service connection for hypertension, including as due to service-connected diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Air Force from January 1962 to May 1982, retiring with more than 24 years of active service. Service personnel records show he served in Vietnam from January 1967 to January 1968 and was awarded the Master Aircrew Badge and Combat Crew Badge. This matter comes before the Board of Veterans Appeals (Board) from a June 2013 rating decision of the Waco, Texas Department of Veterans Affairs (VA) Regional Office (RO). This claim was remanded in February 2019 to allow for additional VA examination and opinion concerning aggravation of hypertension by the service-connected diabetes mellitus. The claim is again before the Board. Having reviewed the record evidence, and although the Board is reluctant to contribute to "the hamster-wheel reputation of Veterans law" by remanding this appeal again, additional development is required before the underlying claim can be adjudicated on the merits. Cf. Coburn v. Nicholson, 19 Vet. App. 427, 434 (2006) (Lance, J., dissenting) (finding that repeated remands "perpetuate the hamster-wheel reputation of Veterans law"). In an April 2021 brief, the Veteran’s representative argued that the February 2020 VA medical opinion for hypertension failed to comply with the direction given in the February 2019 remand. In particular, the representative argued the rationale for the negative medical opinion relied on generalized data without reference to the Veteran, his risk factors, or his specific circumstances. In addition, the representative argued that the February 2020 VA examiner failed to identify the cause of the diagnosed hypertension once it was determined it was the not the result of the service-connected diabetes mellitus, any other service-connected conditions, active service, or any in-service incident. Finally, the representative requested additional VA examination, as the February 2020 medical opinion was conducted on medical data and examination in 2016, which may have omitted significant current medical data necessary for arriving at a more informed medical opinion. Upon close review, the Board concedes the inadequacy of the February 2020 examination. The February 2020 VA examination reveals general references to medical texts, statistical pathologies, and lists of secondary causes for hypertension without further explanation or definition as to how this medical literature, statistical information, or secondary causes applies to the Veteran’s particular claim and the specifics of his medical history and circumstances. In addition, the VA examiner opined the claimed hypertension was most likely primary or essential (in other words, idiopathic or “of unknown cause or spontaneous origin” Dorland’s Illustrated Medical Dictionary, 912 (32nd ed. 2012)). The VA examiner offered no rationale for this opinion, however. Finally, because an opinion as to whether the Veteran’s other service-connected disabilities could have aggravated the claimed hypertension, the Board concedes that a current VA examination would yield significant medical evidence to assist the VA examiner in arriving at full and complete medical opinions as to the cause of the claimed hypertension, particularly for the theories of secondary service connection and aggravation, with rationale. VA has a duty to ensure the direction of the previous remand is fulfilled. In addition, VA must provide a medical opinion with sufficient analysis that allows the Board to adjudicate the case. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Moreover, once VA accords the Veteran a VA examination, it has a duty to ensure that examination is adequate. See Barr v. Nicholson, 21 Vet. App. 311 (2007); Stegall v. West, 11 Vet. App. 268 271 (1998). The RO should obtain the Veteran’s updated treatment records. The matters are REMANDED for the following action: 1. Conduct any appropriate development to obtain the Veteran’s updated treatment records. 2. Thereafter, schedule the Veteran for examination to determine the nature and etiology of his hypertension. The claims file and a copy of this REMAND must be provided for review. Based on a review of the claims file and the result of the Veteran’s physical examination, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that hypertension, if diagnosed, is related to active service or any incident of service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a service-connected disability caused or aggravated (permanently worsened) hypertension, if diagnosed. A rationale must be provided for any opinion(s) expressed. If any requested opinion(s) cannot be provided without resorting to speculation, then the clinician should explain why this is so. The clinician is advised that the lack of contemporaneous records documenting complaints of or treatment for hypertension, alone, is insufficient rationale for a medical nexus opinion. The clinician also is advised not to review or rely upon a February 2020 medical nexus opinion in preparing his or her own opinion. 3. Readjudicate the appeal. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bakke, Lila J. 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.