Citation Nr: 18131224
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 15-21 565
DATE:	August 31, 2018
REMANDED
Entitlement to service connection for hypertension, to include as secondary to coronary artery disease, is remanded.
REASONS FOR REMAND
The Veteran had active air service from June 1973 to June 1993
This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina.  
The Board finds that additional development is required before the claim on appeal is decided.
The Veteran asserts that his hypertension is related to his active service, or in the alternative, was caused or chronically worsened by his service-connected coronary artery disease.  The Board notes that the Veteran has a diagnosis of hypertension, and that treatment notes dating back to 2000 indicate that the Veteran had a prior history of hypertension.      
In an August 2013 VA medical opinion, a VA examiner opined that the Veteran’s hypertension was less likely than not related to service.  In support of that conclusion, the examiner indicated that the Veteran’s service treatment records (STRs) did not reveal a diagnosis of hypertension.  The examiner also indicated that the Veteran was prescribed heart medication while on active duty, but that such medication was related to a myocardial infarction, and not hypertension.  The examiner did not provide an opinion with regard to hypertension on a secondary basis.  
The Board finds that the August 2013 VA opinion is inadequate to decide the claim.  In this regard, the examiner used the absence of a diagnosis of hypertension in service as the basis for the negative nexus opinion.  However, an examiner cannot rely solely on the absence of a diagnosis as a basis for a negative medical opinion.  Moreover, the Veteran has claimed that his hypertension is secondary to his coronary artery disease; however, the August 2013 VA opinion does not address the issue on a secondary basis.  
Therefore, the Board finds the Veteran should be afforded a VA examination and medical opinion to determine the nature and etiology of his diagnosed hypertension. 
The matter is REMANDED for the following action:
1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file.  
2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of his hypertension.  The claims file must be made available to, and reviewed by the examiner.  Any indicated studies should be performed.  
Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s hypertension had its onset during active service, or is otherwise etiologically related to active service, to include any elevated blood pressure readings reported therein.  
The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s hypertension was caused or chronically worsened by service-connected coronary artery disease.  
The rationale for all opinions expressed must be provided.  
3. Confirm that the VA examination report and all medical opinions provided comport with this remand and undertake any other development determined to be warranted.  
4. Then, readjudicate the issue on appeal.  If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response.  Then, return the case to the Board.
 
Kristin Haddock
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. O’Donnell, Associate Counsel

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