Citation Nr: 21027168 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-43 531 DATE: May 4, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1965 to October 1968. The claim was most recently before the Board in July 2020. Entitlement to service connection for hypertension, to include as secondary to PTSD, is remanded. The claim must be remanded again because the August 2020 VA medical opinion is inadequate. Stegall v. West, 11 Vet. App. 268, 271 (1998). The August 2020 VA examiner was directed to discuss the Federal Register that suggest an association between PTSD and hypertension. See Presumptions of Service Connection for Diseases Associated with Service Involving Detention or Internment as a Prisoner of War, 70 Fed. Reg. 37040 (June 28, 2005); Presumptions of Service Connection for Diseases Associated with Service Involving Detention or Internment as a Prisoner of War, 69 Fed. Reg. 60083 (Oct. 7, 2004). Within these documents an association is suggested between PTSD and hypertension. Although these Federal Register documents focus on prisoners of war (POW) having a high rate of PTSD, the relevant focus was on a possible association between PTSD and cardiovascular disease, to include hypertension. In the August 2020 VA opinion, the examiner stopped the requested analysis with the statement that since there was no evidence that the Veteran was a POW, the Federal Register is inapplicable, which is simply not the focus of the relevance of an association between hypertension and PTSD in this Veteran's claim. Since, the opinion is inadequate, an addendum opinion that discusses a possible association between PTSD and hypertension as found with POW's with PTSD is warranted. The matters are REMANDED for the following action: 1. Obtain a supplemental medical opinion from an appropriate VA examiner on the nature and etiology of the Veteran's hypertension. Forward the claims file and copies of all pertinent records to the examiner. If the examiner believes that an opinion cannot be made without an examination, then one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). (a) Is it at least as likely as not (50 percent or higher degree of probability) that any currently diagnosed hypertension is caused by the Veteran's service-connected PTSD? The fact that this Veteran was not a POW is NOT determinative. (b) Is it at least as likely as not that the Veteran's service-connected PTSD aggravated any current hypertension? The examiner must review and discuss the VA material cited above suggesting an association between PTSD and hypertension without focusing on the Veteran's non-POW status. See Presumptions of Service Connection for Diseases Associated with Service Involving Detention or Internment as a Prisoner of War, 70 Fed. Reg. 37040 (June 28, 2005); Presumptions of Service Connection for Diseases Associated with Service Involving Detention or Internment as a Prisoner of War, 69 Fed. Reg. 60083 (Oct. 7, 2004). The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 2. If the examiner makes the determination that an in-person VA examination is necessary to submit a supplemental VA medical opinion, and the Veteran fails to report to the scheduled examination, the AOJ should obtain and associate with the claims file any copies of correspondence referencing the date and time of the examination-preferably, any notices of examination-sent to him by the pertinent medical facility. The Veteran must be notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequence for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. 3. Confirm that the VA medical opinions provided comports with this remand, specifically the opinion discusses the suggested association between PTSD and hypertension in the above cited Federal Register materials. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.