Citation Nr: 21026362
Decision Date: 04/30/21	Archive Date: 04/30/21

DOCKET NO. 17-22 087
DATE: April 30, 2021

REMANDED

Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, herbicide exposure, and/or depressive disorder is remanded.

REASONS FOR REMAND

Entitlement to service connection for hypertension.

The Veteran asserts entitlement to service connection for hypertension as secondary to his psychiatric disability. See April 12, 2021 Appellant Brief.

In October 2020, a VA examiner opined that it is less likely than not that the Veteran’s hypertension was proximately due to, the result of, or aggravated by his psychiatric disability. The October 2020 examiner noted that depression itself would not elevate blood pressure but did acknowledge that an anxiety component would act much like pain, and temporarily elevate blood pressure. The examiner concluded that this would not result in worsening of hypertension (as it does not act on the primary mechanism of hypertension, which is resistance in the peripheral vascular system).

Recent caselaw dictates that secondary service connection does not require “permanent” worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental. Ward v. Wilkie, 31 Vet. App. 233 (2019). Hence, an addendum is necessary for an opinion addressing the question of any aggravation, even if not beyond the natural course of the claimed disability. 

Further, this opinion should address whether the service-connected diabetes caused or aggravated hypertension.

This matter is REMANDED for the following action:

1. Update VA treatment records.

2. Thereafter, obtain an additional addendum to the October 2020 examination to address hypertension. After reviewing the claims folder, the examiner is specifically instructed to provide the following information:

(a) Is it at least as likely as not that the Veteran’s hypertension began in or is related to his time in the service, to include presumed herbicide exposure? 

(b) Is it at least as likely as not that the Veteran’s hypertension was caused by psychiatric disability and/or diabetes? 

(c) Is it at least as likely as not that the Veteran’s hypertension underwent any incremental increase in disability, regardless of its permanence, due to the service-connected psychiatric disability and/or diabetes? 

The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.

 

It should be noted that the Veteran, is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology such as anxiety.

 

 

Nathaniel J. Doan

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	A.D. Jackson, 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.