Citation Nr: 22010555
Decision Date: 02/23/22	Archive Date: 02/23/22

DOCKET NO. 17-12 067
DATE: February 23, 2022

REMANDED

Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus or coronary artery disease, is remanded is remanded.

REASONS FOR REMAND

The Veteran served on active duty from September 1964 to August 1967.

The Veteran is represented in this case pursuant to 38 C.F.R. § 14.630. This provision allows for representation by an individual unaccredited by VA for one time only. The Veteran completed the necessary requirements with the filing of a VA Form 21-22a in December 2020, signed by him and the representative, stating that no compensation would be paid or charged for the services. 38 C.F.R. § 14.630(a).

In September 2021, the Board remanded the appeal so that the Veteran could be afforded a VA examination that addressed whether his hypertension was secondary to his service-connected diabetes mellitus.

Although the Veteran was afforded an examination in December 2021, the opinion does not substantially comply with the prior remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).

While the examiner indicated that a diagnosis of essential hypertension means the condition was not secondary to any other condition, the examiner explained that this meant that the Veteran's hypertension was not "caused" by any other condition, including renovascular hypertension and diabetes.  Unfortunately, the opinion fails to address whether the Veteran's hypertension was aggravated by his diabetes mellitus. 

When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Given that the medical evidence of record fails to adequately address the issues raised, the Board finds that another opinion is necessary. 

The matters are REMANDED for the following action:

1. Associate any VA treatment records dated from May 19, 2021, to the present with the Veteran's claims file.

2. Obtain an addendum opinion to address whether the Veteran's hypertension is secondary to his service-connected diabetes mellitus. The record must be sent to, and reviewed by, the medical professional. The need for an additional examination is left to the discretion of the medical professional selected to write the opinion.

Following review of the record, the opinion provider should respond to the following:

Is it at least as likely as not (approximately 50 percent probability) that the Veteran's hypertension was caused or aggravated by his service-connected diabetes mellitus?

The examiner should consider and comment upon notation in the record of deterioration in kidney function in recent years.  The examiner must also note that causation and aggravation are two separate inquires and both must be answered.

All opinions should be supported by a medical explanation or rationale.

3. Thereafter, readjudicate the appeal.

 

 

V. Chiappetta

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	James R. Springer, 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.