Citation Nr: 21032462 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 09-40 308 DATE: May 27, 2021 REMANDED Entitlement to service connection for a cardiovascular disorder, to include hypertension, dilated cardiomyopathy, and congestive heart failure, on a direct basis or as secondary to service-connected left kidney hydronephrosis is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from June 1984 to August 1984 and from March 1985 to September 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2008 rating decision. The Board previously remanded this matter for additional development in May 2013 and March 2016. In June 2017, this appeal was forwarded to the Veterans Health Administration (VHA) for an expert medical opinion. In May 2018, the Board again remanded this matter for additional development. In March 2020, the Board denied the appeal. In January 2021, the parties filed a Joint Motion for Remand (Joint Motion), which was granted by Order of the United States Court of Appeals for Veterans Claims (Court) that same month. It was noted that the Board had erred when it failed to ensure compliance with its prior remand instructions. Entitlement to service connection for a cardiovascular disorder, to include hypertension, dilated cardiomyopathy, and congestive heart failure, on a direct basis or as secondary to service-connected left kidney hydronephrosis is remanded. In the May 2018 Remand, the Board instructed the AOJ to obtain a VA medical opinion that specifically addressed in-service elevated blood pressure readings and whether it was at least as likely as not that hypertension had manifested during service. VA examination reports/medical opinions dated in July 2019 addressed blood pressure readings from service but did not state whether it was at least as likely as not that hypertension had manifested during service. Unfortunately, as there has not been substantial compliance with the Board's previous May 2018 remand directives regarding this matter, another remand is required to obtain an additional VA medical opinion to clarify whether hypertension manifested during active service. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following actions: 1. Obtain a VA medical opinion to clarify the etiology of one of the Veteran's claimed cardiovascular disorders, specifically hypertension, from an appropriate examiner. If an opinion cannot be provided without an examination, one should be provided. The electronic claims file must be made available to the examiner, and the examiner must specify in the report that the file has been reviewed. Based on a review of the evidence of record and with consideration of the Veteran's statements as well as documented in-service elevated blood pressure readings, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that hypertension had its onset during active service, or manifested to a compensable degree within a year after service separation in September 1991. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). The Veteran is hereby advised that failure to report for any scheduled VA examination without good cause shown may have adverse effects on his claim. 38 C.F.R. § 3.655 (2020). 2. After completing the above actions and any other necessary development, the claim on appeal must be re-adjudicated, taking into consideration all relevant evidence associated with the evidence of record since the October 2019 SSOC. If the benefit on appeal remains denied, a SSOC must be provided to the Veteran and his representative. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. D. Deane, 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.