Citation Nr: 21021669 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 12-15 186 DATE: April 13, 2021 REFERRED Entitlement to service connection for hypertension, to include as due to herbicide exposure or as secondary to the service-connected coronary artery disease disability (CAD), has been raised by the record, but has not been adjudicated by the agency of original jurisdiction (AOJ). Thus, the Board does not have jurisdiction over it, and it is referred to the AOJ for initial adjudication. 38 C.F.R. § 19.9 (b). REMANDED Entitlement to an initial disability rating in excess of 10 percent for arteriosclerotic cardiovascular disease (coronary artery disease), status post coronary artery bypass graft, prior to November 24, 2010 and from March 1, 2011 is remanded. REASONS FOR REFERRAL AND REMAND The Veteran served on active duty from February 1970 to February 1973. This matter comes to the Board of Veterans’ Appeals (Board) from a February 2011 rating decision which granted service connection for arteriosclerotic cardiovascular disease, evaluated at 10 percent, effective May 9, 2010. In an April 2012 rating decision, the RO granted a temporary total evaluation based on surgical or other treatment necessitating convalescence for arteriosclerotic cardiovascular disease, status post coronary artery bypass graft, effective November 24, 2010, and assigned a 10 percent evaluation from March 1, 2011. As this does not represent a maximum grant of the benefit sought, the increased rating claim remains pending before the Board. In September 2018, the Board remanded the matter for further development, to include obtaining any outstanding private and VA treatment records and a VA examination and medical opinion. The Board remanded the case once more in an October 2020 decision seeking additional records and an additional VA examination. The matter is once again before the Board for consideration. Referred Claim for Hypertension VA treatment records show a diagnosis of hypertension. The Veteran’s exposure to herbicide agents has been conceded by the Agency of Original Jurisdiction (AOJ). Moreover, the National Academy of Sciences (NAS), in November 2018, upgraded the relationship between hypertension and herbicide exposure from limited/suggestive to “sufficient,” indicating that “there is enough epidemiologic evidence to conclude that there is a possible association” between hypertension and herbicide exposure. See National Academies of Sciences, Engineering, and Medicine. 2018. Veterans and Agent Orange: Update 11 (2018). The claim for service connection for hypertension has not been adjudicated by the agency of original jurisdiction (AOJ). Thus, the Board does not have jurisdiction over it, and it is referred to the AOJ for initial adjudication. 38 C.F.R. § 19.9 (b). CAD Disability The Veteran’s claim for a higher rating for the CAD disability is intertwined with the referred claim discussed above. In this regard, a November 2020 VA medical opinion indicated that the Veteran’s hypertrophy, diagnosed in 2016, was caused by his hypertension. The presence of cardiac hypertrophy may warrant a higher rating for the CAD disability. See 38 C.F.R. § 4.104, Diagnostic Code 7005 (30 percent rating is warranted when workload is greater than 5 METs but not greater than 7 METs; or, with evidence of cardiac hypertrophy or dilatation on EKG, ECG, or X-ray). As such, this issue is deferred pending adjudication of the claim for service connection for hypertension. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Moreover, on remand, the AOJ should make an additional attempt at obtaining private treatment records from Dr. J. K. and any other cardiology treatment since 2010. The matters are REMANDED for the following actions: 1. Adjudicate the REFERRED issue of service connection for hypertension, to include as due to herbicide exposure or as secondary to the service-connected CAD disability. **In adjudicating the claim, the AOJ is asked to consider the 2018 National Academy of Sciences (NAS) upgraded relationship between hypertension and herbicide exposure from limited/suggestive to “sufficient,” indicating that “there is enough epidemiologic evidence to conclude that there is a possible association” between hypertension and herbicide exposure. See National Academies of Sciences, Engineering, and Medicine. 2018. Veterans and Agent Orange: Update 11 (2018). 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. J.K. and any other cardiology treatment since 2010. Make two requests for the signed form from the Veteran if not initially returned, unless it is clear after the first request that a second request would be futile. Make two requests for the authorized records from the identified providers, unless it is clear after the first request that a second request would be futile. 3. Then, readjudicate the claim on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Lee Feldman, 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.