Citation Nr: 21040942 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-26 110 DATE: July 7, 2021 REMANDED Entitlement to service connection for hepatitis C, to include as secondary to service-connected residuals of a traumatic brain injury (TBI) is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1981 to October 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The Veteran expressed disagreement with this determination in a timely manner, and the present appeal ensued. These appealed issues, among others, were previously before the Board in December 2017, March 2019, August 202 and February 2021, when it was determined that remand was necessary to ensure that VA fulfilled its duty to assist the Veteran in substantiating her appealed issues and that the Board's prior remand directives has been substantially completed. The Board's prior remand directives and the subsequent actions of the Agency of Original Jurisdiction (AOJ) will be discussed below. The Veteran's appealed issues have been returned to the Board for further appellate consideration. 1. Entitlement to service connection for hepatitis C, to include as secondary to service-connected residuals of a TBI is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities is remanded. Pursuant to the February 2021 Board remand, an addendum opinion was obtained in March 2021 to determine whether the Veteran's hepatitis C and hypertension were caused or aggravated by her service-connected residuals of a TBI. In regard to the Veteran's hepatitis C, the March 2021 VA examiner found that it was not caused by the Veteran's TBI, explaining that hepatitis C and TBI are not medically related. The examiner also stated that the Veteran's hepatitis C was not aggravated by her TBI, explaining that "there is no medical evidence presented to support the hep c is due to or aggravated by her TBI." The examiner did not discuss the Veteran's main assertion, raised by her representative, that she used intranasal drugs as self-medication for her service-connected TBI. See June 2020 Appellate Brief. Due to the above-noted deficiency, the Board finds the March 2021 VA medical opinion inadequate. Additionally, the Board finds the March 2021 VA examiner's aggravation opinion conclusory, as no rationale was provided. 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). Accordingly, another remand to obtain an adequate medical nexus opinion is warranted. In regard to the Veteran's hypertension, the March 2021 VA examiner found that this disability was not caused by the Veteran's TBI, explaining that hypertension and TBI are not medically related. In regard to aggravation, the VA examiner stated that her hypertension was also not aggravated by her TBI, as "medical literature does not support TBI years ago as a cause or aggravator of HTN." The Board finds the March 2021 VA examiner's opinion on aggravation conclusory, with no rationale to support the negative nexus conclusion. Furthermore, as with the Veterans' claim for hepatitis C above, the examiner did not discuss the Veteran's main assertion, raised by her representative, that the medications she takes for her TBI caused or aggravated her hypertension. See June 2020 Appellate Brief. To this point, the March 2021 opinion makes no mention of the Veteran's TBI medications. Finally, the Veteran asserts that her hypertension is associated with her arthritis, stress, and anxiety. See October 2020 Correspondence. The Veteran submitted a statement from her VA physician stating that "as for the blood pressure, we expect it to go up during periods of discomfort." See October 2020 VA Medical Treatment Record. As the March 2021 VA medical opinion does not consider the relevant evidentiary record, further remand for additional medical opinions is warranted. The matters are REMANDED for the following action: 1. The AOJ must obtain the Veteran's VA treatment records dated from September 2020 to the present. 2. Thereafter, the AOJ must transfer the Veteran's electronic VA file to an appropriate VA clinician for the purpose of providing addendum opinions regarding the likely etiology of her hepatitis C and hypertension, to specifically include as secondary to her service-connected disabilities and the medications prescribed for treatment of such. After a review of the file, the examiner is asked to address the following: a. Provide an opinion concerning whether the Veteran's hepatitis C is at least as likely as not caused by a service-connected disability, to include the medications prescribed for treatment of such. b. Provide an opinion concerning whether the Veteran's hepatitis C is at least as likely as not aggravated by a service-connected disability, to include the medications prescribed for treatment of such. *In addressing parts (a) and (b), the examiner is asked to discuss the entire evidence of record, including the Veteran's lay statements. The examiner must specifically discuss the Veteran's assertion, raised by her representative, that she used intranasal drugs as self-medication for her service-connected TBI, therefore her hepatitis C is secondary to her TBI. See June 2020 Appellate Brief. c. Provide an opinion concerning whether the Veteran's hypertension is at least as likely as not caused by a service-connected disability, to include the medications prescribed for treatment of such. d. Provide an opinion concerning whether the Veteran's hypertension is at least as likely as not aggravated by a service-connected disability, to include the medications prescribed for treatment of such. *In addressing parts (c) and (d), the examiner must discuss the entire evidence of record, including the Veteran's lay statements. The examiner must specifically discuss the Veteran's assertion, raised by her representative, that the medications she takes for her TBI caused or aggravated her hypertension. See June 2020 Appellate Brief. The examiner must also discuss the Veteran's assertion that her hypertension is associated with her arthritis, stress, and anxiety. See October 2020 Correspondence. The Board notes that the Veteran is service-connected for traumatic brain injury with posttraumatic stress disorder, major depressive disorder, and cognitive disorder, as well as degenerative arthritis of the thoracolumbar spine. In this regard, the Veteran submitted a statement from her VA physician stating that "as for the blood pressure, we expect it to go up during periods of discomfort." See October 2020 VA Medical Treatment Record. All opinions must be accompanied by a fully stated rationale that cites to specific evidence in the Veteran's file and/or medical literature bolstering the conclusions reached. 3. Thereafter, the AOJ must readjudicate the Veteran's appealed issues in light of the totality of evidence of record. If any benefit sought is not granted to the fullest extent, the AOJ must provide the Veteran and her representative with a copy of the readjudication and afford them an appropriate period to respond. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Mohammad 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.