Citation Nr: 21021105 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 18-10 225 DATE: April 9, 2021 REMANDED Entitlement to service connection for heart disability (claimed as a heart attack), identified as coronary artery disease (CAD) and arteriosclerotic cardiovascular disease, including as secondary to service-connected anxiety disorder, is remanded. Entitlement to service connection for hypertension, claimed as high blood pressure, including as secondary to service-connected anxiety disorder, is remanded. Entitlement to service connection for diabetes mellitus, Type II, including as secondary to service-connected anxiety disorder, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1972 to May 1974. This appeal to the Board of Veterans’ Appeals (Board) is from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In July 2019, the Board remanded the case to the AOJ, to defer adjudication for a pending appeal on severance of service connection for an anxiety disorder. In a separate Board decision, the Board has granted the Veteran’s Appeals Modernization Act (AMA) appeal on the severance of service connection for anxiety disorder. The file is again before the Board for further appellate review. 1. Entitlement to service connection for heart disability (claimed as a heart attack), identified as CAD and arteriosclerotic cardiovascular disease, including as secondary to anxiety disorder. 2. Entitlement to service connection for hypertension, claimed as high blood pressure, including as secondary to anxiety disorder. 3. Entitlement to service connection for diabetes mellitus, Type II, including as secondary to anxiety disorder. 4. Entitlement to a TDIU. The Veteran’s service connection for anxiety disorder has been restored in a separate Board decision. In this case, the Veteran primarily contends that his heart disability, hypertension, and diabetes are all secondary to his service-connected anxiety disorder. See 38 C.F.R. § 3.310; and June 2020 attorney’s brief. There is medical opinion evidence indicating the possibility of establishing service connection on a secondary basis. In a June 2014 Disability Benefits Questionnaire (DBQ), a private physician, Dr. A.N., commented on a possible relationship between his psychiatric disability and diabetes, finding, “Poorly controlled diabetes secondary to impairments caused by bipolar disorder.” Also, in a May 2018 opinion, private physician Dr. H.S. opined, “In addition to the veteran’s heart problems, the veteran also has a diagnosis of diabetes that I feel is more likely than not permanently aggravated by his bipolar disorder.” Further, Dr. H.S. stated, “[I]t is my opinion that the Veteran’s service-connected anxiety more likely than not aided in the development of and permanently aggravates his hypertension; and consequently, his anxiety disorder and hypertension more likely than not aided in the development of and permanently aggravates his CAD.” The Veteran has also submitted medical literature on the purported secondary relationship between his psychiatric disability and CAD, and between hypertension and CAD. The Board finds a remand is necessary for medical opinions on the etiology of the heart disability, hypertension, and diabetes claims. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.310. The Veteran asserts the conditions on appeal and his psychiatric disability prevent him from working, so the TDIU issue is inextricably intertwined. See September 2011 claim. The matters are REMANDED for the following action: 1. Obtain a VA examination and medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed diabetes mellitus. The examiner should indicate that the record was reviewed. The examiner should elicit and consider the Veteran’s lay statements on the history of his related problems. All diagnostic testing deemed to be necessary by the examiner should be accomplished. On review of the record, the examiner should express an opinion on whether it is at least as likely as not (50 percent probability or greater) that his claimed diabetes: (A) was caused by or otherwise etiologically related to his active service. (B) was caused and/or aggravated by his service-connected anxiety disorder. A complete rationale should be provided for all opinions rendered. 2. Obtain a VA examination and medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed hypertension. The examiner should indicate that the record was reviewed. The examiner should elicit and consider the Veteran’s lay statements on the history of his related problems. All diagnostic testing deemed to be necessary by the examiner should be accomplished. On review of the record, the examiner should express an opinion on whether it is at least as likely as not (50 percent probability or greater) that his claimed hypertension: (A) was caused by or otherwise etiologically related to his active service. (B) was caused and/or aggravated by his service-connected anxiety disorder. A complete rationale should be provided for all opinions rendered. 3. Obtain a VA examination and medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed heart disorder. The examiner should indicate that the record was reviewed. The examiner should elicit and consider the Veteran’s lay statements on the history of his related problems. All diagnostic testing deemed to be necessary by the examiner should be accomplished. The examiner should provide the following: (A) Identify all currently diagnosed disabilities, including confirming whether the Veteran currently has CAD and/or arteriosclerotic cardiovascular disease. (B) On review of the record, the examiner should express an opinion on whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disability: (i) was caused by or otherwise etiologically related to his active service. (ii) was caused and/or aggravated by hypertension and/or his service-connected anxiety disorder. A complete rationale should be provided for all opinions rendered. 4. Readjudicate all issues on appeal, including the TDIU claim. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Biswajit Chatterjee, 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.