Citation Nr: 21026623 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-32 317A DATE: May 3, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities is remanded. Entitlement to service connection for a respiratory disorder is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1982 to October 2002. These matters come before the Board of Veterans' Appeals (Board) from July 2013 and July 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the Veteran's claims in September 2020 in order to obtain addendum medical opinions. For reasons detailed at length below, the Board does not find that substantial compliance has been achieved relative to its remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities is remanded. Upon review of the February 2021 VA addendum medical opinion addressing secondary service connection, the Board finds the VA examiner's reasoning/rationale to be inadequate, as well contradictory, for purposes of deciding the Veteran's claim in stating that erectile dysfunction (E.D.) does cause hypertension, but erectile dysfunction can be secondary to hypertension, but again does not cause hypertension. Given the contradictory nature of the aforesaid statement, the Board finds that an addendum medical opinion must be sought to clarify as whether it is at least as likely as not that the Veteran's currently diagnosed hypertension condition is proximately due to and/or aggravated beyond its natural progression by his service-connected E.D. disability; when medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. See Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). 2. Entitlement to service connection for a respiratory disorder is remanded. Upon review of the February 2021 VA medical opinion, the Board finds that the VA examiner did not address the May 2003 VA examination report, of which suggested a mild bronchospastic component, as directed by the Board in the September 2020 remand. The February 2021 VA medical examiner also did not explain why the findings in the May 2003 VA examination report were not dispositive on the issue of nexus, and therefore the Board does not find that its September 2020 remand directives were substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, an addendum medical opinion must be sought on remand addressing the May 2003 VA examination report relative to the Veteran's claim for service connection for a respiratory condition. The matters are REMANDED for the following action: 1. Associate with the Veteran's claims file any outstanding VA treatment records since October 2020 VA treatment records. 2. Obtain addendum medical opinions from the February 2021 VA examiner for the claims on appeal (or another appropriate clinician if unavailable). Upon review of the record, to include this remand, the VA examiner is requested to opine as to all of the following: For the claimed for hypertension condition... a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension is proximately due to his service-connected erectile dysfunction (E.D.), to include any medications prescribed for his E.D.? b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension is aggravated by his E.D. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. For the claimed for respiratory condition... c. Is it at least as likely as not (50 percent probability or greater) that the Veteran has a currently diagnosed respiratory condition that had its onset during service, or is otherwise directly related to an event, injury or disease during service, to include, but not limited to, exposure to aircraft fuel toxins? The VA examiner must specifically address the May 2003 VA examination report which suggested that the Veteran was suffering from a mild bronchospastic component at the time. If the findings from the May 2003 VA examination report are not found to be dispositive on the issue of service connection, the VA examiner should explain that reasoning/rationale in detail. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.