Citation Nr: 18144849 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-25 890 DATE: October 25, 2018 ORDER Service connection for coronary artery disease as secondary to service-connected acquired psychiatric disability other than posttraumatic stress disorder (PTSD) is granted. Service connection for hypertension as secondary to service-connected acquired psychiatric disability other than PTSD is granted. REMANDED A rating in excess of 50 percent for service-connected acquired psychiatric disability other than PTSD. An effective date earlier than April 9, 2013 for the grant of an increased rating of 50 percent for service-connected acquired psychiatric disability other than PTSD. FINDINGS OF FACT 1. The Veteran served on active duty from January 1981 to September 1982. 2. Coronary artery disease is caused or aggravated by the service connected acquired psychiatric disability other than PTSD. 3. Hypertension is caused or aggravated by the service connected acquired psychiatric disability other than PTSD. CONCLUSIONS OF LAW 1. Coronary artery disease is proximately due or aggravated by the service-connected acquired psychiatric disability other than PTSD. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2018). 2. Hypertension is proximately due or aggravated by the service-connected acquired psychiatric disability other than PTSD. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran claims that service connection is warranted for a heart disability and hypertension because they are secondary to the service-connected acquired psychiatric disability other than PTSD. It is not in dispute that the Veteran has diagnoses of coronary artery disease and hypertension. Therefore, the first element has been met with respect to both disorders. Next, the service treatment records are silent for high blood pressure, hypertension or coronary artery disease, and the evidence shows that hypertension and coronary artery disease were diagnosed over 15 years following her discharge from active duty. The Veteran has not alleged, and the competent evidence of record does not show, that she had hypertension or coronary artery disease in service or that either has been ongoing since service. Consequently, service connection for coronary artery disease and hypertension on the basis that they became manifest in service and persisted is not warranted. Further, there is no contention or medical evidence suggesting that the current hypertension or coronary artery disease is otherwise directly related to active service. With respect to secondary service-connection, in December 2016, the Veteran submitted a September 2016 private medical opinion regarding the etiology of her coronary artery disease and hypertension. The private physician opined that it was at least as likely as not that the Veteran’s acquired psychiatric disability aided in the development of and permanently aggravated her hypertension and coronary artery disease. The physician reasoned that anxiety and depression caused overactive nerve activity, dysfunctional immune response, and activation of the hormone system that controls blood pressure. It was further noted that medical research showed that anxiety and depression were predictive of later incidence of hypertension. Additionally, medical literature showed that depression was a risk factor for both the development and worsening of coronary artery disease. The physician related that based upon his experience, interview with the Veteran, supporting medical literature, and review of the medical records, he concluded that it was more likely than not that the Veteran’s acquired psychiatric disability aided in the development of and permanently aggravated her hypertension and coronary artery disease. He also concluded that hypertension aided in the development of and permanently aggravated coronary artery disease. While the private physician does not appear to have physically examined the Veteran, she was interviewed, and he reviewed her medical records and cited to medical literature in support of the medical opinions. Further, there is no medical opinion weighing against the claims. As such, the appeals are granted. REASONS FOR REMAND With respect to an increased rating for a psychiatric disability other than PTSD, a remand is needed. Specifically, a remand is required in order to obtain up-to-date VA treatment records, and to schedule the Veteran for an examination in order to determine the current severity of her acquired psychiatric disability. Further, the November 2016 private psychiatric examination report reflects that the Veteran receives disability benefits from the Social Security Administration (SSA) in part for her psychiatric disorder. As such, on remand the SSA records should be obtained. With respect to the claim for an effective date for the grant of a 50 percent rating for an acquired psychiatric disability other than PTSD, a remand is needed. Specifically, this issue is inextricably intertwined with the issue of entitlement to a rating in excess of 50 percent for an acquired psychiatric disability other than PTSD. Therefore, it must also be remanded. The matters are REMANDED for the following actions: 1. Obtain copies of the Veteran’s VA treatment records dating from December 2015 to the present and associate them with the claims file. 2. Obtain and associate with the claims file the SSA disability benefits decision, to include the medical records on which that decision was based. Schedule the Veteran for an examination in order to determine the current severity of her psychiatric disability other than PTSD. The examiner is asked to describe the impact of the Veteran’s psychiatric disability on her occupational and social functioning and on her activities of daily living, including the overall functional impact. 3. After completing the actions detailed above, readjudicate the claims on appeal. If the claims are   denied, a supplemental statement of the case must be provided to the Veteran and her representative. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Redman, Counsel