Citation Nr: 21026358 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 13-16 881 DATE: April 30, 2021 REMANDED Entitlement to service connection for hypertension secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1972 to February 1984. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2017, the Veteran testified during a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In a letter dated March 8, 2021, the Veteran was notified that the Veterans Law Judge who conducted the September 2017 Board hearing was no longer at the Board. The Veteran did not respond with a request for another optional Board hearing within 30 days of the letter. The claim is now returned before the Board. This matter was previously remanded in May 2020. Entitlement to service connection for hypertension secondary to a service-connected disability is remanded. Per the May 2020 remand, the Board instructed that an addendum opinion be obtained to determine whether the Veteran’s hypertension was caused or aggravated by any medication used to treat a service-connected disability. The Board requested that in rendering the opinion, the examiner should address a February 2012 VA treatment record from the Veteran’s rheumatologist advising the Veteran to use the anti-inflammatory, etodolac, sparingly as it could “potentially” affect his blood pressure, as well as the March 2018 VA examiner’s opinion that the Veteran had not taken any medications from 2012 to the present that could cause elevated blood pressure, and specifically determine whether the use of etodolac contributed to the causation or aggravation of hypertension. The requested opinion was obtained in September 2020 and the examiner opined that the Veteran’s hypertension was less than likely caused or aggravated by the Veteran’s service-connected disability. The examiner explained that the use of ketorolac does not cause hypertension. Citing to an October 2012 article, “Minimizing the Adverse Effects of Ketorolac,” she stated that the medical literature does not support this claim. She further stated that as with most NSAIDS, side effects include worsening renal failure, which in turn can contribute to elevated blood pressures. The examiner stated that the Veteran did not sustain any renal failure due to the use of ketorolac, nor was there any worsening of his blood pressure. He was well-controlled on a single agent. There was no evidence of any end organ damage due to elevated or worsening blood pressures. Therefore, she concluded it was less than likely that the claimed hypertension was aggravated. However, the Board finds the opinion insufficient as the examiner did not discuss whether the use of etodolac contributed to the causation or aggravation of hypertension as requested, but instead addressed ketorolac. Accordingly, the Board finds an addendum opinion should be obtained upon remand. Updated treatment records should be obtained as well. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disability. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. Send the claims file to the September 2020 VA examiner, if available, to obtain an addendum medical opinion regarding whether the Veteran’s hypertension is secondary to his service-connected muscle pain syndrome, probable fibrositis. If a new examination is required in order to respond to the request, such should be scheduled. Following review of the claims file, the examiner should provide an opinion as to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that any current disability of the Veteran’s hypertension was caused by any medication used to treat a service-connected disability (muscle pain syndrome, probable fibrositis), to include etodolac? Please explain why or why not, to include addressing the February 2012 VA treatment record where the Veteran was advised by his rheumatologist to use the anti-inflammatory, etodolac, sparingly as it could “potentially” affect his blood pressure, as well as the Veteran’s contention that he has a long history of taking muscle relaxers and various pain medications that have increased his blood pressure and caused or aggravated hypertension. (b.) If not caused by any medication used to treat a service-connected disability (muscle pain syndrome, probable fibrositis), is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension is worsened beyond natural progression (aggravated) by any medication used to treat a service-connected disability (muscle pain syndrome, probable fibrositis), to include etodolac? Please explain why or why not, to include addressing the February 2012 VA treatment record where the Veteran was advised by his rheumatologist to use the anti-inflammatory, etodolac, sparingly as it could “potentially” affect his blood pressure, as well as the Veteran’s contention that he has a long history of taking muscle relaxers and various pain medications that have increased his blood pressure and caused or aggravated hypertension. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Medina, 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.