Citation Nr: 22044131 Decision Date: 08/03/22 Archive Date: 08/03/22 DOCKET NO. 14-22 343 DATE: August 3, 2022 REMANDED Entitlement to an initial rating higher than 20 percent for hyperaldosteronism is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1974 to August 1976 and from December 1976 to December 1980. The claim comes to the Board of Veteran's Appeals (Board) from a January 2016 rating decision. Notably, in a May 2018 decision, the Board granted an initial 20 percent rating for hyperaldosteronism (an increase from 0 percent) but denied the claims for an initial rating in excess of 10 percent for GERD and the assignment of a TDIU prior to June 25, 1999. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). By an April 2020 Order, the Court, pursuant to a joint motion for remand (JMR), vacated the Board's May 2018 decision and remanded the claims to the Board for further development consistent with the JMR. The claims were most recently before the Board in September 2021. At that time, the Board granted entitlement to an initial 30 percent rating for gastroesophageal reflux disease (GERD) prior to August 2, 2018, and 60 percent thereafter and denied entitlement to an effective date earlier than June 25, 1999, for the award of a total disability rating based on individual unemployability (TDIU). With respect to the issue of entitlement to an initial rating higher than 20 percent for hyperaldosteronism, the Board remanded for further development. The Veteran testified at a hearing in October 2017 and transcript of the hearing is of record. The Veterans Law Judge (VLJ) who held that hearing is retired from the Board. In April 2021 the Veteran was notified and offered another hearing before a different VLJ. He responded that he did not wish to appear at another hearing. The Board will proceed to adjudicate the appeal. 1. Entitlement to an initial rating higher than 20 percent for hyperaldosteronism is remanded. While the Board regrets further delay, a remand is required to obtain an addendum opinion that complies with the directives of the September 2021 Board remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). In the April 2020 JMR, the parties agreed that the Board's May 2018 decision did not discuss DC 7917. Under DC 7917, hyperaldosteronism is rated based on whether it is benign or malignant. Benign neoplasm is rated under DC 7915 as residuals of endocrine dysfunction, while malignant neoplasm is rated under DC 7914. A November 2016 VA examination reflects that the Veteran's neoplasm was benign. In the May 2018 decision, the Board indicated that the Veteran has benign neoplasm without discussing the February 2016 and October 2017 examinations that showed that the Veteran has malignant neoplasm. The parties agreed a remand is necessary for the Board to discuss the February 2016 and October 2017 examinations findings of malignant neoplasm. In August 2020, the claim was returned to the Board. At that time, in its remand text, the Board noted that there is conflicting medical evidence in the record as to whether the Veteran's neoplasm is malignant or benign, and concluded that a medical opinion to reconcile the conflicting medical evidence is necessary before the claim can be adjudicated. Pursuant to the Board's remand, the Veteran underwent a VA examination in September 2020, where the examiner found that the Veteran's hyperaldosteronism is benign. The examiner, however, did not reconcile his finding with the February 2016 and October 2017 examinations that found that the Veteran has malignant neoplasm. Therefore, a remand to obtain a medical opinion that reconciles the conflicting medical evidence of record was requested. Pursuant to the Board's remand in September 2021, the Veteran underwent a VA examination in May 2022, where the examiner found that the Veteran's hyperaldosteronism is benign. The examiner opined that the Veteran's claimed hyperaldosteronism is at least as likely as not manifested by benign neoplasm. The examiner stated that the "CT abdomen without contrast exam dated on July 24, 2012, showed benign adenomas (2.8 x 2.1 cm and 1.0 x 1.0 cm left benign adrenal adenomas; likely two subcentimeter benign adenomas in the right adrenal gland)." The examiner noted that the "CT A/P in September 2013 showed unchanged adrenal adenomas." Thus, the examiner stated that these adenomas are benign and the cause of hyperaldosteronism. After review, the Board finds that the VA examiner did not reconcile the findings, as requested by the Board, with the February 2016 and October 2017 examinations that found that the Veteran has malignant neoplasm. Here, the examiner simply stated that the Veteran's hyperaldosteronism is at least as likely as not manifested by benign neoplasm based on CT scans. The examiner did not discuss the previous VA examinations that found malignant neoplasm. Therefore, a remand to obtain a medical opinion that reconciles the conflicting medical evidence of record is necessary before the claim can be adjudicated. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to an endocrinologist in order to provide an addendum medical opinion regarding hyperaldosteronism. The examiner must review the Veteran's entire claims file, to include a copy of this REMAND, and that review must be noted in the report. An in-person examination is not required unless deemed necessary by the examiner. After comprehensive review of the Veteran's medical records, the examiner is asked to: 1. Reconcile the conflicting findings in the medical evidence of record, including the February 2016 and October 2017 examinations that found that the Veteran has malignant neoplasm. 2. Provide a medical opinion stating whether it is at least as likely as not that the Veteran's hyperaldosteronism manifested by benign or malignant neoplasm during any period of the appeal to include the findings in February 2016 and October 2017 examinations that found the Veteran had malignant neoplasms. If the examiner can not reconcile the findings, he must state so and provide an explanation. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. 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.