Citation Nr: 21063893 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 16-48 721 DATE: October 18, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a kidney disorder, to include residuals of a kidney transplant, claimed as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1979 to July 1992. He died in June 2019 and the appellant is his surviving spouse who has been accepted as a substitute claimant for the purpose of proceeding this appeal to its completion. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In July 2019, the appeal was remanded for additional development and it now returns for further appellate consideration. 1. Entitlement to service connection for hypertension. The appellant contends that the Veteran had hypertension that had its onset during his military service. Specifically, during his lifetime, he alleged that he had elevated blood pressure readings while on active duty. The appellant also submitted a statement in October 2015 in which she noted that she met the Veteran in 1990, and he was having problems with his blood pressure at the time. In this regard, the Veteran's former representative argued that the Veteran's service treatment records (STRs) revealed that he had an elevated blood pressure reading of 130/88 in September 1981, 130/76 in February 1984, 124/78 in May 1990, and 130/82 in June 1991. The Board also notes that, during his February 1979 enlistment examination, the Veteran's blood pressure reading was 130/90, which current medical guidance suggests is indicative of hypertension. However, for VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. See 38 U.S.C. § 4.104, Diagnostic Code 7101, Note 1. Thus, the Veteran is presumed to have been sound upon entry into service in regard to hypertension. Additionally, his former representative argued that a February 1984 STR requesting a chest X-ray based on a provisional diagnosis of "ertension" was intended to read "hypertension." Thus, in light of such in-service notations and evidence of a diagnosis of hypertension in the Veteran's post-service treatment records, the Board finds that a remand is necessary to obtain an opinion to address the etiology of his hypertension. 2. Entitlement to service connection for a kidney disorder, to include residuals of a kidney transplant, claimed as secondary to hypertension. The appellant contends that the Veteran had a kidney disorder that is secondary to his hypertension. In this regard, in his June 2014 notice of disagreement, the Veteran argued that high blood pressure took years to cause kidney failure. In June 2014, a kidney disability benefits questionnaire (DBQ), Dr. S.F., a private provider, noted that the Veteran had a diagnosis of diabetic nephropathy and kidney transplant in 2006. He indicated that his medical history included exposure to Agent Orange and stated that there was a link between kidney disease and diabetes mellitus. However, the evidence of record has not shown that the Veteran was exposed to herbicide agents during his military service and he is not service-connected for diabetes mellitus. Nonetheless, in a December 2015 letter, Dr. A.U., another private provider, opined that the Veteran's end stage renal disease was due to hypertension. Thus, the claim for service connection for a kidney disorder is inextricably intertwined with the claim for service connection for hypertension remanded herein. Consequently, adjudication of the former claim must be deferred pending the outcome of the latter matter. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Further, as Dr. A.U. did not provide an adequate rationale as he simply noted that the Veteran was seen by his nephrologists and was in end stage renal disease, without recovery, caused by hypertension, the Board finds that, in offering an opinion as to the etiology of the Veteran's hypertension, the examiner should also address whether his kidney disorder is secondary to such disease. The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate VA clinician in order to obtain an opinion addressing the etiology of the Veteran's hypertension. Following a review of the record, the examiner should address the below inquiries: (A) Is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's hypertension had its onset in, or is otherwise related to, his military service? (B) Did the Veteran's hypertension manifest within one year of his separation from service in July 1992, i.e., by July 1993? If so, please describe the manifestations of such disease. In offering such opinions, the examiner should consider and discuss the Veteran's elevated blood pressure readings in service as noted in the September 1981, February 1984, May 1990, and June 1991 STRs, and the February 1984 STR requesting a chest X-ray based on a provisional diagnosis of "ertension," which the Veteran's representative argued was intended to state "hypertension." (C) If the Veteran's hypertension is found to be directly or presumptively related to his military service, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's kidney disorder, diagnosed as diabetic nephropathy and end stage renal disease, was caused or aggravated by his hypertension? For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should consider Dr. A.U.'s December 2015 opinion that the Veteran's end stage renal disease was due to hypertension. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark 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.