Citation Nr: 21032059
Decision Date: 05/25/21	Archive Date: 05/25/21

DOCKET NO. 15-23 859
DATE: May 25, 2021

REMANDED

Entitlement to service connection for hypertension, to include as secondary to service-connected ischemic heart disease, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from October 1967 to August 1969, with service in the Republic of Vietnam from April 1968 through March 1969.

The Veteran appeals a September 2012 rating decision by the Agency of Original Jurisdiction (AOJ) denying service connection for hypertension.  The Veteran's claim was remanded for additional development in August 2018 and July 2020.  Unfortunately, for the reasons discussed below, another remand is required. 

The Board's previous remands directed that an opinion be obtained regarding whether the Veteran's claimed hypertension was related to service, to include presumed exposure to herbicide agents, or was caused or aggravated by his service-connected coronary artery disease.

New opinions were obtained in December 2020 and February 2021.  In the February 2021 opinion, the reviewing clinician rendered a negative opinion, reasoning that there was not a "pathophysiologic mechanism for IHD to cause HTN."  The clinician noted that the Veteran had mild, non-obstructive coronary artery disease rather than ischemic heart disease, then concluded that mild non-obstructive coronary artery disease did not cause the Veteran's hypertension.

The clinician's rationale is conclusory with respect to causation.  Moreover, the rationale did not address whether the Veteran's coronary artery disease aggravated his hypertension.  Remand is necessary for a new opinion.  

This matter is REMANDED for the following actions:

1. Obtain any outstanding pertinent medical treatment records from VA and private healthcare providers.

2. Thereafter, obtain a new opinion from a qualified clinician other than the author of the December 2020 and February 2021 opinions.  The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. 

After the record review, the reviewing clinician is asked to respond to the following inquiries: 

(a.) Is it at least as likely as not that the Veteran's hypertension was the result of an injury, disease, or event in service, to include his presumed herbicide exposure?

(b.) Is it at least as likely as not that the Veteran's hypertension was caused by his service-connected coronary artery disease?

(c.) Is it at least as likely as not that the Veteran's hypertension was aggravated by his service-connected coronary artery disease?

For the purposes of this opinion, the VA reviewing clinician is to apply the proper aggravation standard, which is that any degree of worsening of a condition by a service-connected condition is sufficient to establish aggravation in this case. 

The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 

3. Thereafter, readjudicate the claim.  If the benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC) and return the case to the Board.

 

 

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Pelican, Luke H.

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.