Citation Nr: 22014222 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 18-23 108 DATE: March 11, 2022 REMANDED Entitlement to service connection for hypertension, including as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy (USN) from October 1966 to December 1969. This appeal to the Board of Veterans' Appeals (Board) is from an April 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In March 2020, the Board determined there was new and material evidence and, therefore, reopened this claim. But rather than immediately readjudicating this claim on its underlying merits, de novo, the Board instead then proceeded to remand this claim back to the RO, so back to the AOJ, for further development and consideration that included obtaining a medical opinion concerning the origins of the Veteran's hypertension especially in terms of the likelihood it is secondary to (meaning caused or aggravated by) his already determined to be service-connected posttraumatic stress disorder (PTSD). See 38 C.F.R. § 3.310(a) and (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board, notably, also remanded a claim for service connection for obstructive sleep apnea (OSA) that also was being alleged to be secondary to the already service-connected PTSD because additional medical comment also was needed to address this other posited correlation. In a July 2020 decision since issued, on remand, a Decision Review Officer (DRO) at the RO granted service connection for OSA since confirmed to be associated with so secondary to the already determined to be service-connected PTSD. This is significant because the additional medical opinion obtained on remand only additionally addressed whether the hypertension also is associated with so secondary to the PTSD, not also whether it alternatively is secondary to the now service-connected OSA. The Board consequently must again remand this claim for service connection for hypertension to also obtain medical comment that is additionally needed to make this other critical determination since, in deciding a claim, all potential bases of entitlement must be considered. See Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004) VA has a duty to address all arguments put forth by a claimant and/or theories under which entitlement to benefits sought may be awarded. Robinson v. Peake, 21 Vet. App. 545, 552 (2008) (noting the Board is required to consider all issues raised either by the claimant or reasonably by the evidence of record), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). Entitlement to service connection for hypertension again is remanded. Although the May 2020 VA examiner concluded the Veteran's service-connected PTSD is not causing or aggravating his hypertension, this examiner explained that there are several other factors known to either cause or aggravate hypertension, and he specifically mentioned OSA (albeit among others). At the time of that examination and opinion, OSA was not an adjudicated service-connected disability, but it now is because the July 2020 DRO rating decision since issued determined that service connection was warranted for the OSA since associated with again, meaning secondary to, the already determined to be service-connected PTSD. Because the OSA has been implicated as a possible source or factor in the Veteran's hypertension (meaning potentially causes or aggravates it), the Board must obtain more medical comment concerning this additional possibility before deciding the appeal of this claim. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that, when VA endeavors to provide an examination for an opinion, it must ensure the examination and opinion are adequate). Accordingly, this claim is again REMANDED for the following still additional development and consideration: Obtain still more medical comment regarding the etiology of the Veteran's hypertension especially in terms of whether it as likely as not (meaning 50 percent or more probable) is caused OR aggravated by his now service-connected OSA. To assist in making this important determination, provide the examiner a complete copy of this remand and all other relevant evidence. *In responding, this current examiner must address the report of the May 2020 VA examination listing OSA as a condition (albeit among others) having a "causal medical relationship" with hypertension. That said, the examiner must understand that the OSA must cause OR aggravate the hypertension, not vice versa. Rationale for the opinion is essential, regardless of whether favorable or conversely unfavorable to this claim, preferably citing to findings or other evidence of record supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Neville, 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.