Citation Nr: 22014085 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 17-30 944 DATE: March 11, 2022 REMANDED Entitlement to service connection for hypertension as secondary to service-connected diabetes mellitus type II with erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 to June 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal of a January 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case for further development in November 2021. That development has been completed, and the case has since been returned to the Board for appellate review. Upon review, the Board finds that further development is needed prior to adjudication of the issue on appeal. The Veteran contends that his hypertension is secondary to his service-connected diabetes mellitus type II with erectile dysfunction. Specifically, the Veteran reports being told that his hypertension was caused by the medications he takes for his diabetes mellitus type II. The Veteran was afforded a VA examination and medical opinion in December 2016. The examiner opined that the Veteran's hypertension is less likely than not proximately due to or the result of his service-connected diabetes mellitus type II. In so finding, the examiner stated that there is no evidence of diabetic nephropathy in the available records to support hypertension as being the result of diabetes. The examiner also opined that most cases of hypertension are classified as "essential or primary" (90% to 95% of cases), with no identifiable causes of hypertension. See December 2016 VA medical opinion. The Board finds that the December 2016 examiner did not provide a supporting rationale for his opinion. Further, the opinion was general in nature and did not clearly address whether the Veteran's hypertension was caused or aggravated by his service-connected diabetes mellitus type II. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013); Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (finding a medical opinion inadequate because it does not address aggravation and causation separately with rationale specific to those findings). Therefore, an additional medical opinion is needed to obtain a new VA medical opinion. The matter is REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for hypertension that are not already of record. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the AOJ should refer the Veteran's claim to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of the Veteran's hypertension. An additional physical examination should be performed only if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's hypertension is either caused by or aggravated by his service-connected type II diabetes mellitus. In rendering his or her opinion, the examiner should address both the causation and aggravation questions in his or her rationale. In other words, even if the Veteran's service-connected type II diabetes mellitus did not cause the Veteran's hypertension, the examiner should still address whether his service-connected type II diabetes mellitus could have worsened his hypertension. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should ensure compliance with the directives and conduct any other development as may be indicated. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. DeVerter, Associate 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.