Citation Nr: 21041079 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 10-44 142 DATE: July 8, 2021 REMANDED Entitlement to service connection for sleep apnea (OSA) is remanded. Entitlement to service connection for heart disability is remanded. Entitlement to service connection for hypertension (HTN) is remanded. REASONS FOR REMAND On prior review, in a June 2019 decision, the Board denied the above noted claims on both a direct and secondary basis, see 06/13/2019 BVA Decision, and the Veteran appealed the decision to the Court of Appeals for Veterans Claims (Court). In August 2020, while the appeal was still pending, the Veteran, through counsel, and the Secretary, VA, entered into and submitted a Motion for Joint Remand (JMR) and partial vacation. See 08/12/2020 CAVC Decision, P. 2-6. In an Order also dated in August 2020, the Court granted the JMR, vacated the June 2019 Board decision in part, and remanded the case to the Board for further appellate review consistent with the JMR. Id. P. 7. Entitlement to service connection for OSA, a heart disability, and HTN is remanded. The June 2019 Board decision was issued prior to the Court's decision in Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). In Ward, the Court held that when addressing whether a service-connected disability worsens a non-service-connected disorder, the worsening need not be chronic or permanent. The consensus of the parties in the JMR was that a remand was indicated so that the Board could obtain medical opinions that applied the Ward standard. See 08/12/2020 CAVC Decision, P. 2-6. After the case was returned to the Board, the Veteran's representative, under waiver of initial Agency of Original Jurisdiction (AOJ) review and consideration, submitted a private medical opinion by Joseph Klapper, M.D., a Board-Certified cardiologist. See 05/28/2021 Medical Treatment-Government Facility; 05/28/2021 Appellate Brief. The representative asserts that Dr. Klapper's opinion is more than an adequate basis on which to allow the Veteran's claims. Due to the posture of the evidence, including the medical opinions, however, the Board finds that additional medical input from the VA examiner is indicated. Dr. Klapper reviewed a copy of the entire claims file, and he noted that the October 2017 VA examiner (10/30/2017 C&P Exam, 1st Entry) did not consider certain medical studies on the issue of how PTSD and drug and alcohol dependence may cause HTN, OSA, and heart disorders. The general presumption of competence includes a presumption that physicians remain up to date on medical knowledge and current medical studies. See Monzingo v. Shinseki, 26 Vet. App. 97, 106-107 (2012). The VA examiner noted that the applicable medical literature and studies supported his opinion that it was not at least as likely as not that the Veteran's PTSD with alcohol and cocaine dependence caused or worsened his HTN, OSA, or heart disorder, but he did not list or otherwise specify the studies. Treatise evidence must discuss generic relationships with a degree of certainty such that under the facts of a particular case there is at least a plausible causality based on objective facts. See, e.g., Wallin v. West, 11 Vet. App. 509, 514 (1998). See also Timberlake v. Gober, 14 Vet. App. 122, 130 (2000) (citing Hensley v. West, 212 F.3d 1255, 1265 (Fed. Cir. 2000)). Hence, so that the Board will have a complete evidentiary picture on whether either or both medical professionals have applied the medical treatises to the Veteran's individual case, the Board remands for clarification from the VA examiner. The matters are REMANDED for the following action: The AOJ shall send the claims file to the examiner who provided the October 2017 addendum examination report, or an equally qualified clinician. Ask the examiner to review Dr. Klapper's private opinion and to indicate agreement or disagreement with it. If disagreement is expressed, the examiner should explain why this is so. The VA examiner must provide a complete explanation for the basis for any agreement or disagreement. A complete explanation will include the medical studies and treatises generally referenced and relied on in the October 2017 addendum and how they apply to the Veteran's individual case. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. T. Snyder 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.