Citation Nr: 18160283 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 15-20 830 DATE: December 26, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease, to include as secondary to hypertension, is remanded. Entitlement to service connection for supraventricular arrhythmias, to include as secondary to hypertension, is remanded. Entitlement to service connection for abdominal aortic aneurysm, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran had active naval service from May 1946 to August 1969. 1. Entitlement to Service Connection for Hypertension Is Remanded The Board previously remanded the Veteran’s claim in November 2017 to obtain a VA examination. The Veteran was scheduled for a VA examination in December 2017 that he did not attend. According to a January 2018 Report of General Information, the Veteran could not attend because he required medical transportation due to his age and infirmities. The AOJ approved a second VA examination after speaking with the Veteran in February 2018; however, the record indicates that the Veteran asked that the examination be cancelled in March 2018. The Veteran may not have been able to attend a VA examination due to his age and infirmities; see 38 C.F.R. § 3.655(a); however, the Board concludes that an etiological opinion is still necessary to adjudicate the Veteran’s claim. As previously noted in the Board’s November 2017 decision and remand, the Veteran’s diastolic blood pressure increased significantly during active service. The Veteran’s blood pressure was 106/66 at entrance in May 1946, increased to 118/70 in May 1950, 122/76 in May 1956, 130/90 in July 1959, 134/86 in April 1964, and 142/86 at discharge in July 1969. A VA opinion on the etiology of the Veteran’s hypertension is necessary to address the question of whether the elevated blood pressure reading recorded in service represented the initial onset of his hypertension. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to Service Connection for Residuals of Coronary Artery Bypass Graft Surgery, Atrial Fibrillation, and Abdominal Aortic Aneurysm, to Include as Secondary to Hypertension, Are Remanded The Veteran contends that residuals of coronary artery bypass graft surgery, atrial fibrillation, and abdominal aortic aneurysm are all etiologically related to his hypertension. While the Veteran’s claim file includes an October 2010 positive nexus opinion regarding atrial fibrillation as secondary to hypertension, opinions are needed to determine whether the Veteran’s residuals of coronary artery disease bypass graft surgery and abdominal aortic aneurysm are etiologically related to his hypertension. A decision on whether the Veteran is entitled to service connection for hypertension directly impacts his entitlement to service connection for residuals of coronary artery bypass graft surgery, atrial fibrillation, and abdominal aortic; therefore, his claims are inextricable intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless all are adjudicated). In this circumstance, the appropriate remedy is a remand. See id. The matters are REMANDED for the following action: 1. Provide the Veteran’s complete claims file to an appropriate clinician to provide opinions on the following questions: (a.) Whether it is at least as likely as not that the Veteran’s hypertension had its initial onset in service or within a year of service discharge or is otherwise related to his active service. The clinician MUST address whether the Veteran’s hypertension first manifested during his active service. In doing so, the clinician should discuss the clinical significance, if any, the elevated blood pressure readings that were recorded during the Veteran’s active service as documented in his service treatment records. (b.) Whether residuals of coronary artery bypass surgery were at least as likely as not (1) proximately due to hypertension, or (2) aggravated beyond their natural progression by hypertension. (c.) Whether the Veteran’s abdominal aortic aneurysm was at least as likely as not (1) proximately due to hypertension, or (2) aggravated by hypertension. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Douglas M. Humphrey, Associate Counsel