Citation Nr: A21020517 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 190403-11505 DATE: December 27, 2021 ORDER The appeal with respect to entitlement to service connection for pseudofolliculitis barbae (PFB) is dismissed. REMANDED Entitlement to service connection for hypertension as secondary to service-connected major depressive disorder and anxiety disorder not otherwise specified, with alcohol use related to depression and anxiety (in remission) (acquired psychiatric disability), and/or obstructive sleep apnea (OSA), is remanded. Entitlement to service connection for coronary artery disease (CAD) as secondary to service-connected acquired psychiatric disability, and/or non-service-connected hypertension, is remanded. FINDING OF FACT On the record at a July 2021 hearing, prior to the promulgation of an appellate decision on the matter, the Veteran requested, through his representative, that his appeal with respect to entitlement to service connection for PFB be withdrawn. CONCLUSION OF LAW The criteria for withdrawal of the appeal of the issue of entitlement to service connection for PFB have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from January 1974 to February 1978. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran timely appealed to the Board, electing the Board hearing review option. 38 C.F.R. §§ 20.201, 20.202(b)(2). In July 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. The Board notes that other issues are pending before the Board in a separate appeal stream. They will be the subject of a separate decision. The appeal with respect to entitlement to service connection for PFB is dismissed. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. See 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in an appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Only an appellant, or an appellant's authorized representative, may withdraw an appeal. Id. Appeal withdrawals must include the name of the veteran, the name of the claimant or appellant if other than the veteran (e.g., a veteran's survivor, a guardian, or a fiduciary appointed to receive VA benefits on an individual's behalf), the applicable VA file number, and a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. Id. In this case, on the record at the July 2021 Board hearing, prior to the promulgation of a Board decision on the matter, the Veteran requested, through his representative, that his appeal with respect to entitlement to service connection for PFB be withdrawn. That request has since been reduced to writing in a transcript, received by the Board, which includes the Veteran's name and his VA file number. Under the circumstances, the Board finds that the requirements for a proper withdrawal have been satisfied. See, e.g., Tomlin v. Brown, 5 Vet. App. 355 (1993). As the Veteran has withdrawn his appeal of this issue, there remain no allegations of error of fact or law for appellate consideration with respect to this issue. Accordingly, the Board does not have jurisdiction to review the issue and the appeal must be dismissed. REASONS FOR REMAND 1. Entitlement to service connection for hypertension as secondary to service-connected acquired psychiatric disability, and/or OSA, is remanded. 2. Entitlement to service connection for CAD as secondary to service-connected acquired psychiatric disability, and/or non-service-connected hypertension, is remanded. The Veteran contends that his hypertension is secondary to his service-connected acquired psychiatric disability and/or OSA. Specifically, at the July 2021 hearing he and his representative contended that his service-connected disabilities were risk factors for developing hypertension. The Veteran also contends that his CAD is secondary to his service-connected acquired psychiatric disability and/or his non-service-connected hypertension. In support of his contentions, the Veteran submitted several medical articles on the day of his hearing. One article indicates that depression increases the risk of hypertension; two others indicate that OSA increases the risk of hypertension; and another article outlines risk factors for the development of CAD, which include elevated blood pressure. The Veteran clarified at the hearing that was seeking service connection for hypertension and CAD solely on the theory that they are secondary to his service-connected disabilities, and not on a direct basis. As an initial matter, the Board notes that the Veteran has current diagnoses of both hypertension and CAD, as demonstrated by an October 2007 VA treatment record. The first element of service connection has therefore been established. As to the link, or nexus, between the Veteran's current diagnoses and his service-connected disabilities, the agency of original jurisdiction (AOJ) obtained a VA medical opinion in February 2019. The examiner offered unfavorable opinions as to secondary service connection for both hypertension and CAD, reasoning that the Veteran had multiple comorbidities and risk factors for hypertension and CAD, and that there was no specific reason for her to believe that his blood pressure or heart problems were due to military service as opposed to comorbidities and risk factors. The Board finds that the February 2019 VA medical opinion is not fully adequate. While the examiner noted that the Veteran had multiple comorbidities, she did not offer further explanation as to what those comorbidities were, or whether they included the Veteran's service-connected disabilities. Still further, the examiner did not provide an opinion with respect to the aggravation prong of secondary service connection. See, e.g., El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Under the circumstances, the AOJ should have sought further medical opinion evidence before adjudicating the Veteran's claims. The failure to do so constitutes a pre-decisional duty to assist error that must be corrected. These matters are REMANDED for the following action: 1. Arrange to provide the record on appeal to the VA examiner who offered an opinion with respect to the etiology of the Veteran's hypertension in February 2019. The examiner should review the expanded record. After reviewing the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's hypertension was a) caused or b) aggravated (i.e., permanently or temporarily worsened beyond natural progression) by his service-connected acquired psychiatric disability and/or OSA. If the February 2019 VA examiner is no longer employed by VA, or is otherwise unable to provide the requested opinion, arrange to obtain the requested information from another qualified examiner. The need for an in-person and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinion. A complete medical rationale for all opinions expressed must be provided. 2. Also arrange to provide the record on appeal to the VA examiner who offered an opinion with respect to the etiology of the Veteran's CAD in February 2019. The examiner should review the expanded record. After reviewing the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's CAD was a) caused or b) aggravated (i.e., permanently or temporarily worsened beyond its natural progression) by his service-connected acquired psychiatric disability and/or his non-service-connected hypertension. If the February 2019 VA examiner is no longer employed by VA, or is otherwise unable to provide the requested opinions, arrange to obtain the requested information from another qualified examiner. The need for an in-person and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinion. A complete medical rationale for all opinions expressed must be provided. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Oldroyd, 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.