Citation Nr: 21027086
Decision Date: 05/04/21	Archive Date: 05/04/21

DOCKET NO. 17-30 862
DATE: May 4, 2021

REMANDED

Entitlement to service connection for hypertension is remanded.

REASONS FOR REMAND

The Veteran had active duty service in the United States Air Force from April 1984 to July 1984, and from September 1990 to October 1990.  The Veteran retired from the Tennessee Air National Guard in 2014, following a thirty-year career.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee.

The Veteran testified before the Board at a February 2020 videoconference hearing.  A transcript has been associated with the claims file.

This matter was previously remanded by the Board for additional development in May 2020.  Following remand, in November 2020 rating decisions, the RO granted entitlement to service connection for major depressive disorder, obstructive sleep apnea and degenerative disc disease of the lumbar spine.  As such, these issues are no longer in appellate status.

The Board notes that a medical history and physical report from February 2013 indicates that the Veteran's hypertension is "partially due to hyperaldosteronism and complicated by OSA [obstructive sleep apnea]."  As the Veteran was granted entitlement to service connection for obstructive sleep apnea in a November 2020 rating decision, there is an open medical question as to whether the Veteran's hypertension was aggravated beyond its natural progression by his obstructive sleep apnea, which was diagnosed in 2002.  See November 2020 Sleep Apnea Disability Benefits Questionnaire.  The Veteran's November 2020 C&P examination report indicates that the Veteran's hypertension is a risk factor for sleep apnea; however, it is not clear whether the relationship between the Veteran's sleep apnea and hypertension is bidirectional.  

On remand, an examination and opinion addressing the nature and etiology of the Veteran's hypertension should be obtained.

The matters are REMANDED for the following action:

1. Schedule the Veteran for examination to assess the nature and etiology of his hypertension.

The contents of the entire electronic claims file must be made available to, and reviewed by the examiner.  The examiner should take a history from the Veteran as to the progression of his hypertension disability.

The examiner is asked to respond to the following questions.  A complete rationale, supported by medical reasoning, must accompany all opinions provided.

(a.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's hypertension had onset in, or is otherwise related to any periods of active service?

(b.)  Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's hypertension is proximately due to or caused by his service-connected obstructive sleep apnea and/or major depressive disorder?

(c.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's hypertension has been aggravated beyond its natural progression by service-connected obstructive sleep apnea and/or major depressive disorder?

The examiner is asked to comment specifically on the February 2013 medical history and physical report, which records that the Veteran's hypertension is "partially due to hyperaldosteronism and complicated by OSA [obstructive sleep apnea]."

2. Thereafter, and after any additional development deemed necessary, readjudicate the claim.

 

 

V. Chiappetta

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Hennessy, 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.