Citation Nr: A25035266 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240712-455561 DATE: April 16, 2025 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected tinnitus, is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty for training from March 1983 to August 1983. In July of 2024, the Veteran filed a notice of disagreement (NOD) in which he requested the direct review lane under the Appeals Modernization Act (AMA) review system in response to a May 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Under direct review, no development may be undertaken; the Board of Veterans' Appeals considers the same record as the RO in rendering a decision. The only exception is if, as here, the Board finds that there was pre-decisional error by the RO. 1. Entitlement to service connection for hypertension, to include as secondary to service-connected tinnitus, is remanded. As conceded in the May 2024 rating decision, the Veteran's current treatment records note a hypertension condition. Further, it is uncontroverted that the Veteran has been awarded service connection for tinnitus. And as the claimed hypertension issue is being considered, in part, as secondary to his service-connected tinnitus, it was a pre-decisional error for this case to not have been forwarded to a VA clinician so that a VA examination could have been afforded from which an opinion could be authored. Further, as the Veteran has asserted that this condition is "stress related" and that the stressful in-service incidents he experienced included "carrying patients in gurneys", an opinion regarding service connection on a direct basis should also have been authored. See February 2023 VA 21-526EZ. 2. Entitlement to service connection for obstructive sleep apnea is remanded. Turning next to the Veteran's sleep apnea claim, the Board observes that the Veteran also has not yet been afforded a VA examination in regard to this issue from which an opinion could be authored though it was conceded in the May 2024 rating decision that a sleep study showed a diagnosis of obstructive sleep apnea. The Veteran has argued that the sleep apnea resulted from military training, to include "gas chamber" training. As such, this issue must also be remanded so that this pre-decisional error may be corrected. The matters are REMANDED for the following actions: 1. Schedule the Veteran for respective VA examinations to determine the nature and etiology of the Veteran's claimed (1) hypertension and (2) obstructive sleep apnea conditions. The entire claims file, including a complete copy of this remand and the Veteran's lay assertions, should be made available to and be reviewed by each clinician, and it should be confirmed that such records were available for review. It should be clarified: (a.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's claimed condition manifested in service or is otherwise related to his active service. In so opining, the clinician is asked to reconcile, to the extent possible, the lay statements of record in so opining, to include the above-noted allegations that the claimed hypertension condition is "stress related" as well as the Veteran's contention that his claimed obstructive sleep apnea is the result of being exposed to a "gas chamber" in basic training. (b.) In regard to the claimed hypertension condition, it should be additionally clarified whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that Veteran's claimed condition is (1) proximately due to; or (2) aggravated by his service-connected tinnitus condition. A complete rationale must be provided for all opinions, which cannot be solely predicated solely on the absence of in-service evidence but must consider the broader evidentiary picture, including lay evidence. It is emphasized that all conclusions reached should wholly address and reconcile to the extent possible the lay contentions recorded in the record. Where applicable, the question of secondary aggravation must be addressed separately from the question of secondary causation. If there is a medical basis to support or doubt the history provided by the Veteran, the clinician should provide a fully reasoned explanation, and the clinician is additionally asked to reconcile to the extent possible any conflicting evidence or opinions of record. A clear basis for all opinions should be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board, to include whether the Veteran's claimed condition in question has manifested in a presentation that aligns with the contentions that have been made. If the clinician is unable to provide any of the requested information without resorting to speculation, he or she should so state, and further explain why it is not feasible to provide a medical opinion. 2. Thereafter, adjudicate the claims after consideration of the pertinent evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Smith, 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.