Citation Nr: 21032080 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 19-08 794A DATE: May 25, 2021 REMANDED Entitlement to a compensable disability rating for service-connected hypertension is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from October 1973 to December 1993. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a January 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Board previously denied the Veteran's claim to a compensable rating for service-connected hypertension in a September 2019 Board decision. The Veteran appealed the Board's September 2019 decision to the Court of Appeals for Veterans Claims (CAVC). In February 2021, the CAVC issued a Joint Motion for Remand (JMR). In the JMR, the CAVC stated that the Board failed to provide an adequate statement of reasons and bases for its denial. As such, the issue on appeal have been returned to the Board for readjudication. Entitlement to a compensable disability rating for service-connected hypertension is remanded. The Veteran contends that his service-connected hypertension has become severe enough to warrant him a compensable rating. See April 2019 VA Form 9. In January 2018, the Veteran was afforded a VA examination for hypertension. The examination confirmed his current diagnosis of hypertension. The examiner responded in the negative as to (1) whether the Veteran has a history of diastolic blood pressure elevation to predominantly 100 or more, and (2) whether the Veteran's hypertension impacts his ability to work. The Board finds the January 2018 VA examination for hypertension to be inadequate for decision making purposes. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The examiner failed to provide supporting rationale for any of his findings in the January 2019 VA examination. An adequate medical opinion must be based upon consideration of the relevant evidence and must provide the Board with a foundation sufficient to evaluate the probative worth of that opinion. See Adison v. Brown, 6 Vet. App. 405, 407 (1994). Here, it is unclear what evidence the examiner took into consideration when rendering the negative opinion. The examiner failed to note which blood pressure readings he reviewed and considered. Additionally, there is no foundation to support the negative opinion provided by the examiner, because no rationale was provided. It is noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Due to the foregoing, a remand is necessary to obtain an updated VA examination and adequate medical opinion. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Schedule the Veteran for a new VA examination to determine the nature and severity of his hypertension. The examiner must review the electronics claims file, including a copy of this remand. The examiner is requested to do the following: Note the current severity and manifestations of the Veteran's hypertension, including (1) whether the diastolic pressure is predominantly 100mmHg or more; (2) whether the systolic pressure is predominantly 160 mmHg or more; and (3) whether the Veteran has a history of diastolic pressure of 100mmHg or more and the Veteran requires continuous medication for control of his hypertension. The examiner must consider that the Veteran has taken continuous medication for hypertension since approximately 1987. In addition, the examiner must consider and address the pre-2011 blood pressure readings indicating diastolic pressure of 100m or greater in treatment records from the following dates: March 31, 2003; January 8, 2004; May 9, 2005; May 11, 2005; November 21, 2006; July 16, 2007; October 5, 2007; October 15, 2010. The examiner must also comment on the functional effects of the Veteran's hypertension. The examiner must provide a complete and fully articulated explanatory rationale for any opinion expressed that is based on the examiner's clinical experience and medical expertise; established medical principles; and the evidence in the electronic claims file. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Law Clerk for the Board N. Jamordee 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.