Citation Nr: 20007381 Decision Date: 01/30/20 Archive Date: 01/29/20 DOCKET NO. 18-47 515 DATE: January 30, 2020 REMANDED Entitlement to service connection for an aortic aneurysm is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to September 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision by a Department of Veterans Affairs (VA) regional office (RO). The Board issued a decision in February 2019 that, in pertinent part, remanded the issues of entitlement to service connection for hypertension and right ear hearing loss as well as the claims for increased ratings for left ear hearing loss, the residuals of prostate cancer, and erectile dysfunction. Those matters are still undergoing development at the RO. Accordingly, those issues will not be addressed in this decision. Entitlement to service connection for aortic aneurysm is remanded. The Veteran contends he should be granted service connection for an aortic aneurysm. Specifically, he believes his diagnosed hypertension (HTN) caused and permanently aggravated his disability. In the instant matter, the Veteran submitted the opinion of Dr. H.S., M.D. who found that the Veteran’s HTN, more likely than not, materially and substantially contributed to his aortic aneurysm. As indicated above, the claim for service connection for hypertension was remanded in February 2019 and is undergoing development at the RO. The Board finds that the question of service connection for an aortic aneurysm is inextricably intertwined with the February 2019 remanded issue of service connection for HTN. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). A decision on the issue of entitlement to service connection for aortic aneurysm must be deferred until after the outcome of his claim for HTN. The record indicates that the Veteran was admitted to Baptist Memorial Hospital for cardiovascular and thoracic surgery on October 17, 2017 and underwent a 7-Day Post-Op examination with Dr. B.W., M.D. These records have not been obtained by VA. The Veteran has not been provided with a VA examination to determine whether his aortic aneurysm is etiologically related to herbicide agent exposure, or proximately due to or aggravated by his HTN disability. Accordingly, a remand is necessary for a VA examination and nexus opinion. McLendon v. Nicholson, 20 Vet. App. 79, 81-84 (2006); see also 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4). The matters are REMANDED for the following action: 1. With the Veteran’s assistance, obtain any outstanding records of pertinent medical treatment from VA or private health care providers, including surgical notes from Baptist Memorial Hospital related to the Veteran’s October 2017 cardiovascular surgery, and medical records from Dr. B.W., M.D. All reasonable attempts to obtain such records should be made and documented. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. 2. After the above records request has been completed, to the extent possible, obtain a VA examination and opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s aortic aneurysm. The claims folder, including a copy of this remand, the two January 2019 medical opinions by Dr. H.S., M.D., the medical article titled Prevalence of abdominal aortic aneurysm in a hypertensive population, and counsel’s argument, must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. (a.) The examiner must opine whether an aortic aneurysm is at least as likely as not related to an in-service injury, event, or disease, to include in-service herbicide agent (Agent Orange) exposure. (b.) Whether an aortic aneurysm is at least as likely as not (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. (c.) Whether an aortic aneurysm is at least as likely as not (1) proximately due to hypertension, or (2) aggravated beyond its natural progression by hypertension. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, Associate 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.