Citation Nr: 21027735 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-12 440 DATE: May 6, 2021 REMANDED The issue of entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from June to October 1974 and from May 1979 to May 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office. In February 2019, the Board remanded the claim to obtain a VA examination opinion. After obtaining that VA opinion, the Board denied the claim in an August 2019 decision. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (CAVC), which resulted in a September 2020 Memorandum Decision which remanded the claim due to the Board's failure to provide adequate reasons and bases for the decision. After a review of the record and a critical examination of the justification for that August 2019 decision, the Board now finds that remand for a new VA examination and opinion is necessary. That decision was wholly predicated on an inadequate negative nexus opinion. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the one VA opinion regarding the Veteran's claim of entitlement to service connection for hypertension was based on inaccurate facts and failed to consider the Veteran's lay statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301, 304 (2008). According to the opinion, the evidence only revealed an isolated incident of elevated blood pressure in October 1980. However, there are at least two instances of elevated blood pressure reflected in the record. See 9/21/2015 STR- Medical (reflecting a blood pressure reading of 140/100 on October 21, 1980); 9/21/2015 STR-Dental (reflecting a blood pressure reading of 140/95 on October 26, 1980). Furthermore, while the Veteran attributed the dearth of medical records reflecting continuity of symptomatology to his having not received medical care due to lack of insurance and homelessness of over 15 years, the examiner did not consider this in the opinion. See 7/25/2015 Correspondence. For the foregoing reasons, remand is necessary to obtain a new VA opinion. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination with a different but appropriate clinician to determine the nature and etiology of his hypertension. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. After examining the Veteran and considering his reported history, the clinician should provide an opinion regarding the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension had its clinical onset during the Veteran's active service or is otherwise related to active service, or that there is a continuity of symptomology from service attributable to the Veteran's currently diagnosed hypertension? In addressing this question, please discuss (1) the Veteran's report of having issues with blood pressure in his teens and 20's, (2) the Veteran's claim of recurring headaches while in service, (3) multiple instances of high blood pressure in service, and (4) the Veteran's more than 20 years of homelessness and lack of insurance as explanation for the lack of continuous, chronological clinical evidence, and determine whether a nexus to service is "medically plausible" based on the same. A complete rationale for the examiner's opinion should be provided, citing to specific evidence of record, as necessary. 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). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sloley, 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.