Citation Nr: 21030557 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-06 080 DATE: May 19, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 2003 to December 2003 and form October 2004 to December 2005, including service in Southwest Asia during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was most recently before the Board in March 2020 when it was remanded for additional development. The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a February 2018 Travel Board hearing. A transcript of that hearing is associated with the claims file. Entitlement to service connection for hypertension is remanded. As noted above, the Board remanded this claim in March 2020 to obtain an addendum opinion on the nature and etiology of the Veteran's hypertension in light of a January 2020 VA examiner's opinion. That examiner stated that seizures and kidney stone pain can temporarily elevate blood pressure. Further, the examiner cited to medical literature indicating a link between antidepressants and high blood pressure in some people. Unfortunately, the examiner improperly addressed "permanent aggravation" and provided only a speculative opinion regarding any link between the Veteran's hypertension and his prescribed antidepressant. The RO obtained an addendum opinion in June 2020. The examiner found that the Veteran's hypertension was less likely than not caused or aggravated by a service-connected condition or any medications taken therefor. The rationale was that there is no credible medical evidence to support a causal link and that there is no pathophysiology to support a mechanism for aggravation. However, the examiner did not reconcile such findings with the January 2020 examiner's opinion. The Board finds that there is inadequate information to adjudicate the claim at this time. When medical evidence is inadequate, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: Obtain an opinion regarding the nature and etiology of the Veteran's diagnosed hypertension. The claims file, to include a copy of this remand, should be available to and reviewed by the medical professional. If another examination is deemed warranted, one should be arranged. The medical professional should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's hypertension was: (a.) Caused by a service-connected condition, to include medication prescribed to treat his service-connected depressive disorder; or, (b.) Aggravated by a service-connected condition, to include seizure disorder, kidney stones, or medication prescribed to treat his service-connected depressive disorder, at any point during the appeal period (from July 2013). Aggravation means any increase in disability, either temporary or permanent. For VA compensation purposes, hypertension is a disability where there are blood pressure readings that are predominantly of given values. (See 38 C.F.R. § 4.104, Diagnostic Code 7101, and Notes thereto.) Thus, the medical professional should discuss whether the Veteran's seizure disorder or kidney stones, which the evidence of record indicates can create temporary elevations in blood pressure, has impacted the Veteran's hypertension in any way that resulted in any increaseeither temporary or permanentin the predominant blood pressure measurements. Further, the examiner should discuss the February 2020 addendum opinion indicating a link between antidepressants and elevated blood pressure in some people. A rationale should be provided for all conclusions reached. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.