Citation Nr: 21005385 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 14-31 617A DATE: February 1, 2021 REMANDED Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service in the Air Force from July 1971 to August 1973. The appeal originates from June 2012 and January 2015 decisions of a Department of Veterans Affairs (VA) Regional Office. It is noted that the Board remanded the claim of service connection for bilateral hearing loss in September 2018. A June 2020 rating decision granted service connection for bilateral hearing loss. For that reason, the issue is no longer before the Board. 1. Entitlement to service connection for coronary artery disease is remanded. 2. Entitlement to service connection for hypertension is remanded. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. The Veteran contends that his diagnosed heart disease is related to in-service chest symptoms. He also relates his hypertension to service or as being secondary to heart disease. See April 2014 Medical Treatment Record; March 2018 Appellate Brief. The matter was remanded in September 2018 to obtain updated VA treatment records, private treatment records, and a VA examination. VA treatment records were obtained. VA requested authorization to obtain private treatment records in June 2019. No response was received from the Veteran. The Veteran was afforded a VA examination with opinion in August 2019. The examiner opined that a heart disorder is less likely as not related to service as “no diagnosis or diagnostic test associated with a cardiovascular condition was evident” during service. However, it well-established that the absence of in-service diagnosis of a disability does not necessarily preclude service connection. See 38 C.F.R. § 3.303(d). A new opinion should thereby be obtained. With respect to hypertension, there is some question as to whether the Veteran has a current diagnosis. However, as noted in the September 2018 Remand, a diagnosis during the appeal period is indicated in a private opinion but not elsewhere in the record. See April 2014 Medical Treatment Record. The August 2019 examiner did not appear to diagnose hypertension and indicated that blood pressure levels were normal at the examination and other times preceding the appeal. Clarification of the Veteran’s diagnosis during the appeal should be obtained in the opinion. As to TDIU, the issue is intertwined with the service connection claims and cannot be adjudicated at this time. The matters are REMANDED for the following action: Request an addendum opinion from the August 2019 examiner. The examiner is asked to address the following: 1. Specify whether the Veteran has had a clinical diagnosis of hypertension at any time during the appeal. The examiner must address the April 2014 private opinion indicating a diagnosis of hypertension. 2. If the examiner finds that the Veteran has had a current diagnosis of hypertension, is it at least as likely as not that hypertension had its onset in or is otherwise etiologically related to active service? The examiner is advised that a rationale should not be based solely on the absence of an in-service diagnosis. 3. Is it at least as likely as not that a heart disorder had its onset in service? In addressing this question, the examiner should state Whether there is any evidence to accept or reject the proposition that the Veteran experienced any type of injury to his heart or experienced a chronic heart disorder in service. The examiner is advised that a rationale should not be based solely on the absence of an in-service diagnosis. 4. Is it at least as likely as not that a heart disorder is related to the Veteran’s active service? If the examiner finds that the Veteran has had a current diagnosis of hypertension and determines that a heart disorder is related to service, please address the following: 5. Is it at least as likely as not that hypertension was proximately caused by a heart disorder? 6. Is it at least as likely as not that hypertension underwent any incremental increase in disability, regardless of its permanence, due to a heart disorder? The term “incremental increase in disability” means additional impairment of earning capacity.  Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.  Moreover, any “incremental increase in disability” need not be permanent.  MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alhinnawi 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.