Citation Nr: 23027178 Decision Date: 05/07/23 Archive Date: 05/07/23 DOCKET NO. 19-22 394 DATE: May 7, 2023 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service in the United States Air Force from March 2003 to August 2004. He had additional service in the Air Force Reserves. A July 2020 deferred rating decision also shows "Service in the AF Res/NG from June 26, 2010 to June 27, 2010 (UTA), is now considered active service based on the grant of SC for right shoulder rotator cuff injury status post repair with degenerative changes that was incurred in the line of duty during this period of service." This matter comes before the Board of Veterans' Appeals (Board) from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This decision declined to reopen the Veteran's claims for service connection for gastroesophageal reflux disease (GERD) and for hypertension because new and material evidence had not been received. In September 2021, the Board issued a decision reopening both claims, granting service connection for GERD, and remanding the claim for service connection for hypertension for VA examination. The Veteran was afforded a VA examination in October 2021 and the hypertension issue is now again before the Board. The Veteran contends service connection is warranted for hypertension because he feels his hypertension had its onset in service and has continued ever since. The Veteran has a current diagnosis of hypertension as evidenced by his clinical records throughout much of the claim period and most recently confirmed at his October 2021 VA examination. The Board has reviewed the Veteran's service treatment records. There is no indication of an explicit hypertension diagnosis within his records for his March 2003 to August 2004 period of service, but there are several indications of elevated systolic blood pressure during this period of service. A clinical record dated in April 2003 shows normal blood pressure of 118/90. However, a July 2003 record at the time of treatment for a right knee injury shows his blood pressure was elevated at the time to 160/76. September 2003 blood pressure reading was 140/82. In January 2004 it was recorded as 145/73. In February 2004, it was 133/79. And, in April 2004, his blood pressure was recorded as 140/76. July 2009 private records from the Veteran's primary care physician noted blood pressure of 140/108 and 140/100. He was assessed as having "new onset HTN" at that time. The Board observes that the blood pressure systolic readings at the time of this diagnosis were similar to what was shown in service. Medication was prescribed at the time of the July 2009 office visit. August 2009 records from the same physician show the Veteran continued to be assessed as having hypertension, but that he was not taking his blood pressure medication. In a March 2012 progress note, a private clinician documented the Veteran's report that he had gone to Florida and checked his blood pressure while there and learned it was elevated. The clinician suggested the Veteran had "Never been on BP medication before. Never had any BP problems in the past." He was again assessed as having hypertension at this time. Hypertension has been shown in the record ever since. In October 2021, a VA examiner issued an opinion concluding the Veteran's hypertension was not at least as likely as not incurred during his active service. The examiner listed several pieces of evidence and suggested the Veteran's hypertension was diagnosed in January 2012. No mention was made of the July 2009 diagnosis. Further, there was no reference to any blood pressure readings during the Veteran's initial period of active service. Thus, the examiner's opinion is without apparent consideration of relevant evidence as to the initial onset of the Veteran's hypertension. For this reason, this matter must be again remanded in order for an opinion to be obtained based upon consideration of the Veteran's full medical history as to his hypertension. This matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not related to service. The examiner must review the claims file and note the various indications of elevated systolic blood pressure in service (several of which are noted above), which were not discussed by the October 2021 examiner, and also note the July 2009 diagnosis of hypertension, which was overlooked by the October 2021 examiner. With consideration of the complete record and history of elevated blood pressure readings, the examiner is asked to provide an opinion as to whether the Veteran's current hypertension is at least as likely as not related to service. Because hypertension is a recognized chronic disease, the examiner must address whether it is at least as likely as not that the hypertension (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. A well-reasoned rationale should be provided for any opinion expressed. 2. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the action taken in the preceding paragraph, the Veteran's claim should be readjudicated based on the entirety of the evidence. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Adamson, 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.