Citation Nr: 22016226 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 16-49 603 DATE: March 21, 2022 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1, 2006, to November 2007, with additional service in the Navy Reserves. These matters come to the Board of Veterans' Appeals (Board) from a March 2015 rating decision which denied service connection for hypertension and sleep apnea. In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In November 2019 and August 2021, the Board remanded these matters for additional development. Hypertension The Board finds that remand is required to obtain an addendum VA medical opinion. The evidence of record appears to show a diagnosis of hypertension in June 2006. The VA examiner appeared to provide conflicting statements in a December 2019 opinion on whether there was clear and unmistakable evidence that hypertension existed prior to service, and the examiner did not resolve this inconsistency despite mentioning blood pressure readings in a July 2020 addendum opinion. Moreover, while the VA examiner stated in the July 2020 addendum opinion that there was clear and unmistakable evidence that any worsening of hypertension during service was the natural progress of the disability, the examiner did not acknowledge that the dosage of the Veteran's lisinopril was increased to 10 milligrams once per day in October 2007. Sleep Apnea The Board finds that remand is required to obtain an addendum VA medical opinion. The evidence of record appears to show a diagnosis of obstructive sleep apnea prior to November 2006. However, the claims file does not contain a VA medical opinion on whether there is clear and unmistakable evidence that any increase in this disability during service was due to the natural progress of the disability. As these claims are being remanded, the AOJ should update the Veteran's VA treatment records. Moreover, while the Veteran did not complete a VA Form 21-4142 for private treatment for sleep apnea that was sent following the August 2021 remand, the Board will provide the Veteran with another opportunity to identify any relevant private treatment. The Board, however, informs the Veteran that failure to complete the VA Form 21-4142 may result in relevant evidence not being considered. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (stating that the Veteran that has a duty to assist the AOJ in developing evidence). The matters are REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records for the period from February 2021 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private medical providers providing treatment for hypertension or sleep apnea. Make two requests for the authorized records from each provider, unless it is clear after the first request that a second request would be futile. 3. Obtain an addendum opinion from the December 2019 VA examiner, if possible, or from an appropriate clinician on the Veteran's hypertension. The examiner must review the claims file and provide a rationale for all opinions. The examiner must opine whether it is at least as likely as not that the Veteran's hypertension had onset in service or at least as likely as not permanently increased in severity during service. If preexisting, the examiner must opine whether the increase in severity of the Veteran's hypertension was clearly and unmistakably (undebatable) due to the natural progress of the disability. Consideration must be given to blood pressure readings in June 2006; and any changes in medication during active service, to include the prescription of lisinopril, initially at 5 milligrams once per day and then in October 2007 at 10 milligrams once per day. 4. Obtain an addendum opinion from the December 2021 VA examiner, if possible, or from an appropriate clinician on the Veteran's sleep apnea. The examiner must review the claims file and provide a rationale for all opinions. The examiner must opine whether the Veteran's sleep apnea at least as likely as not permanently increased in severity during this service. If so, the examiner must opine whether the increase in severity of the Veteran's sleep apnea was clearly and unmistakably (undebatable) due to the natural progress of the disability. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, 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.