Citation Nr: 22016706 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 18-47 535 DATE: March 23, 2022 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected sleep apnea with asthma is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1991 to October 1996 in the United States Marine Corps. This matter comes to the Board of Veterans' Appeals (Board) on appeal from the May 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that although the RO addressed this matter as one of new and material evidence, the November 2017 rating decision was not final as new and material evidence pursuant to 38 C.F.R. § 3.156(b) was received within one year of the rating decision. Therefore, the Board will address the issue of service connection for hypertension on the merits. In March 2022, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. Entitlement to service connection for hypertension, to include as secondary to service-connected sleep apnea with asthma is remanded. The Veteran was afforded a VA examination in August 2018 to assess the nature and etiology of his hypertension. The examiner opined that it is less likely than not that the Veteran's hypertension is due to or the result of sleep apnea with asthma. It was reasoned that hypertension preceded sleep apnea; that he has hypertension since 2006; and that he was diagnosed with obstructive sleep apnea with a sleep study two months prior. In addition, it was reasoned there is no evidence based medical literature that would provide scientific evidence to support the contention that the Veteran's hypertension is caused by obstructive sleep apnea with asthma. The Board notes first and foremost that while the examiner provided an etiological opinion based on secondary service connection, an opinion based on aggravation was not provided. Additionally, while the examiner indicates there is no medical literature supportive of a causal connection between hypertension and sleep apnea with asthma, medical literature submitted by the Veteran entitled "Obstructive Sleep Apnea and Hypertension: An Update," suggests that sleep apnea is the most prevalent secondary contributor to elevated blood pressure. This study was not addressed by the VA examiner. At the March 2022 hearing, the Veteran and his representative addressed in-service elevated blood pressure readings, headaches, and nosebleeds, as well as erectile dysfunction diagnosis, which they believe can be early indicators of hypertension. The VA examiner also did not address these records or contentions. The Board therefore finds that a VA addendum opinion is necessary for proper adjudication of this claim. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA and private treatment records pertinent to his claim. 2. Thereafter, obtain an addendum opinion from an appropriate medical professional. The medical professional must be provided with and review the entire claims file, to include a copy of this remand. If it is determined that a new examination is needed, please schedule the Veteran for a VA examination. Following a review of the evidence of record, to include the Veteran's lay statements, the medical professional must provide ALL of the following opinions: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension had its onset during active duty or is causally or etiologically related to any in-service event, disease, or injury; b. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is caused or etiologically related to service-connected sleep apnea with asthma; and c. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is aggravated by sleep apnea with asthma. The examiner must specifically address in-service high blood pressure readings, nose bleeds, headaches, erectile dysfunction, and any other symptoms suggesting of hypertension. The examiner must specifically address the medical literature of record, including "Obstructive Sleep Apnea and Hypertension: An Update". A complete rationale for any opinions expressed should be set forth. The examiner must not rely on the lack of treatment for, or diagnosis of, hypertension in service. If unable to opine without resorting to speculation, please provide a basis for reaching this conclusion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.