Citation Nr: 21065363 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 11-27 418 DATE: October 26, 2021 REMANDED Service connection for coronary artery disease (CAD), to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Service connection for hypertension, to include as secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from April 1960 to June 1963. These matters come before the Board of Veterans' Appeals (Board) from an April 2011 rating decision. In a May 2014 decision, the Board denied the Veteran's claim for service connection for a heart disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In December 2014, the Court issued an Order that vacated the May 2014 Board decision and remanded that matter for readjudication consistent with instructions outlined in a Joint Motion for Partial Remand by the parties. In May 2015, the Board issued another decision remanding the claim for further development. In July 2017, the Board issued a decision in which the Veteran's claim was recharacterized and bifurcated into multiple claims (CAD, hypertension, and hyperlipidemia), and the Board denied all three claims. The Veteran again appealed this decision to the Court. In May 2018, the Court issued an Order that vacated the July 2017 Board decision and remanded two of the claims (coronary artery disease and hypertension) for readjudication consistent with instruction outlined by the Joint Motion for Partial Remand by the parties, with a request not to disturb the other issues addressed in the Board decision. In March 2019, June 2020, and December 2020 Board decision, the Veteran's claim of service connection for CAD and hypertension were remanded to obtain addendum VA examination opinions, including whether the Veteran's CAD and hypertension were caused or aggravated by his service-connected PTSD. The claim has since been returned to the Board for review. Although the Board regrets the delay in yet another remand, the Board finds that further development is needed regarding the Veteran's claim of service connection for CAD and hypertension. Regarding the medical evidence related to the Veteran's claim, in January 2006 VA treatment records, during an orthopedic consultation the Veteran is noted as having a history significant for a heart attack in 1997. In May 2006 private treatment records the Veteran is noted as having a history significant for high blood pressure, which was not treated. In May 2007 VA treatment records, the Veteran is noted as a having a diagnosis of hypertension and fairly-well controlled blood pressure with home monitoring. In September 2007 VA treatment records the Veteran is indicated as having a prescription for blood pressure medication. In December 2008 VA treatment records, during a mental health care visit the Veteran reported that earlier that day he underwent a cardiac stress test indicating heart issues and was heading to a private hospital for further evaluation. Subsequently, in December 2008 private treatment records, which consisted of only one page, the Veteran was documented as having a 95 percent heart blockage. In January 2009 VA treatment records, the Veteran is documented as having a diagnosis of CAD and as having underwent a five vessel coronary artery bypass graft in December 2008. Additionally, January 2009 private treatment records regarding the Veteran's spine indicate that he was scheduled to undergo a cardiac clearance regarding spinal surgery, was diagnosed as having a blockage, and underwent coronary artery bypass graft surgery in December 2008 at a private hospital. In September 2014 VA treatment records, the Veteran is documented as undergoing an initial cardiology consultation to establish cardiac care through VA. A review of the evidence of record indicates that VA has not attempted to obtain the private treatment records regarding the Veteran's initial diagnoses and subsequent treatment of CAD and hypertension, including the coronary artery bypass graft surgery in December 2008 and heart attack in 1997. Attempts should be made to obtain the records of that treatment. The matters are REMANDED for the following action: 1. Ask the Veteran to identify any private medical providers who may have treated him for CAD and hypertension. Ask the Veteran to complete a VA Form 21-4142 for each medical provider so identified, and attempt to obtain those records. 2. After any additional development as may become indicated has been accomplished, re-adjudicate the appeal. M. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Page-Nelson, 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.