Citation Nr: 21071311 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 16-18 622 DATE: November 30, 2021 REMANDED The issue of service connection for coronary artery disease is remanded. The issue of service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to January 1989. This case comes before the Board of Veterans' Appeals (Board) from a May 2015 rating decision from a Department of Veterans Affairs (VA) regional office (RO). The above issues along with the issue of service connection for hypertension were remanded in May 2020. Service connection for hypertension was granted in a September 2021 rating decision. A supplemental statement of the case was issued in October 2021. 1. Entitlement to service connection for coronary artery disease is remanded. 2. Entitlement to service connection for diabetes mellitus is remanded. The matters are REMANDED for the following action: 1. Background for the adjudicator: The Veteran's claims of service connection for coronary artery disease and diabetes mellitus were remanded for an examination to determine whether the disabilities were related to his military service. Examinations were provided in September 2021. The examiner provided an opinion stating that the Veteran's coronary artery disease was not related to his active duty because there were not sufficient treatment records to show the disability manifested in service or was caused by an inservice injury or event. However, the opinion does not address whether the coronary artery disease WAS CAUSED BY OR WORSENED BY his recently service-connected hypertension. The Veteran's treatment records indicated he has hypertensive heart disease. Therefore, a remand is necessary to determine if the Veteran's coronary heart disease WAS CAUSED BY OR WORSENED BY his hypertension. The issue of entitlement to service connection for diabetes mellitus is inextricably intertwined with the issue of service connection. The Veteran has raised the issue of secondary service connection, stating in his February 2015 correspondence that his high glucose is due to his coronary artery disease. Therefore, adjudicating the issue of service connection for diabetes mellitus prior to coronary artery disease would be judicially inefficient. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 2. Return the claims file to the September 2021 VA clinician, and request s/he again review the entire claims file and respond to the inquiry below. If the examiner is not available, arrange for another appropriately-qualified VA examiner to provide an addendum medical opinion to assist in determining the etiology of the Veteran's coronary artery disease. All appropriate tests, studies and consultations must be accomplished, including a new medical examination if necessary, and all clinical findings should be reported in detail in the narrative portion of the examination report. The examiner must provide an opinion as to the following: (a.) whether the Veteran's coronary artery disease was caused by his service-connected hypertension. (b.) whether the Veteran's coronary artery disease was aggravated (made worse) by his service-connected hypertension. THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION, INCLUDING: An August 2011 general VA compensation and pension examination where the Veteran's diagnosed with hypertensive heart disease. 3. If any only if the Veteran's coronary artery disease is found to have BEEN CAUSED OR WORSENED BY his service-connected hypertension, return the claims file to the September 2021 VA clinician WHO CONDUCTED THE DIABETES MELLITUS EXAMINATION, and request s/he again review the entire claims file and respond to the inquiry below. If the examiner is not available, arrange for another appropriately-qualified VA examiner to provide an addendum medical opinion to assist in determining the etiology of the Veteran's diabetes mellitus. All appropriate tests, studies and consultations must be accomplished, including a new medical examination if necessary, and all clinical findings should be reported in detail in the narrative portion of the examination report. The examiner must provide an opinion as to the following: (a.) whether the Veteran's diabetes mellitus was CAUSED OR WORSENED by his coronary artery disease. (b.) whether the Veteran's diabetes mellitus was CAUSED OR WORSENED by his hypertension. THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION. (CONTINUED ON THE NEXT PAGE) 4. Thereafter, readjudicate the issues on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable period in which to respond. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Reed, Counsel The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.