Citation Nr: 22014972 Decision Date: 03/15/22 Archive Date: 03/15/22 DOCKET NO. 15-06 332A DATE: March 15, 2022 REMANDED Service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD). REASONS FOR REMAND The Veteran served on active duty from November 1983 to October 1987, from November 1990 to May 1991, and from April 2010 to September 2010. The case is on appeal from a May 2016 rating decision. In December 2018 and April 2021, the Board remanded the matter for additional development. In August 2021, the Veteran requested a Board hearing. In February 2022, the Veteran stated that he did not wish to have a BVA Hearing. See February 2022 Email Correspondence. Thus, the hearing request is withdrawn. Service connection for hypertension, to include as secondary to service-connected PTSD. Pursuant to the Board's April 2021 remand, the Veteran was afforded a VA examination in June 2021 for an opinion as to whether his service-connected PTSD aggravated his hypertension. The examiner provided a negative opinion noting no documentation of elevated blood pressure after service until 2016. However, the examiner may not have completely considered the Veteran's lay statements with respect to elevated blood pressure after service, and particularly when under stress. See December 2018 Board remand. Thus, the opinion is not completely adequate. In addition, the Veteran stated that at the time of the examination, the blood pressure cuff was not working because the Velcro was missing, and that after the examiner was unable to manually hold the cuff on, a request to the front desk had to be made to obtain properly functioning equipment. In view of the foregoing, together with the assertions in the February 2022 Appellate Brief, remand for another VA examination is warranted. On remand, the RO will have an opportunity to consider the additional evidence associated with the file since the July 2021 supplemental statement of the case. In light of the remand, updated VA treatment records should be associated with the file. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records since July 2021 and associate them with the claims file. 2. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician, other than the June 2021 examiner, to determine the nature and etiology of hypertension. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that hypertension had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease, or is caused by or aggravated by service-connected PTSD. Aggravation is an increase in severity beyond the natural progress of the disease. If the reviewing examiner concludes that hypertension has been aggravated by service-connected PTSD, then the examiner should attempt to establish a baseline severity of the hypertension prior to the aggravation. The reviewing examiner is advised that the Veteran believes his hypertension, which was diagnosed prior to his third period of active duty service, is related to his service-connected PTSD, which was diagnosed based on stressors that occurred during his deployment to Haiti during his third period of active duty service in 2010. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Taylor 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.