Citation Nr: 21025195 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-02 104A DATE: April 27, 2021 REMANDED The claim of entitlement to service connection for hypertension is remanded. The claim of entitlement to service connection for diabetes mellitus, type II (diabetes) is remanded. The claim of entitlement to service connection for congestive heart failure is remanded. The claim of entitlement to service connection for right eye disability is remanded. The claim of entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served in the Air Force from July 1974 to August 1982. He died in 2018. The Appellant, the Veteran’s surviving spouse, was granted substitution as claimant for the issues on appeal. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified at a hearing before the Board. A copy of the hearing transcript is included in the electronic claims file and has been reviewed. In August 2018 and August 2020, the Board remanded the claims for additional development. The case is again before the Board for appellate review. Service Records While the claims are being remanded for the reasons below, the Board finds that on remand the RO should conduct additional development, to the extent it is possible, to obtain any outstanding service records, including service treatment records and personnel records. It appears the Veteran’s complete service treatment records have not been associated with the file. While the Board acknowledges the August 2016 correspondence from the regional office to the Veteran, reporting that further efforts would be futile, an additional search should be done. Also, a formal finding of unavailability consistent with the remand directions should be added to the file if these records cannot be obtained. 1. Entitlement to service connection for diabetes mellitus, type II, hypertension, and congestive heart failure are remanded. Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). These claims were previously remanded for etiology opinions. The post-remand October 2020 opinions for direct service connection report the Veteran’s diabetes mellitus, type II, hypertension, and congestive heart failure are not related to service because the examiner could find no evidence the Veteran was treated for, evaluated for, or had any symptoms or diagnosis of diabetes mellitus, type II, hypertension, or congestive heart failure during service. As it relates to the specific hypertension opinion, the examiner also noted that the Veteran’s initial medication began in 2001. Even in the portion of the opinion that discusses the conflicting medical evidence of the two opinions from private clinicians in the record, both the diabetes and hypertension opinions rely on the absence of the conditions existing during service. The Board finds this is inadequate. Notably, as discussed, the Veteran’s STR’s are incomplete, thus an opinion that primarily relies on the absence of corroborating service treatment records is inadequate to deny the Veteran’s claims. Moreover, the examiner only provides conclusory statements and relies on the absence of evidence without explanation as to its significance. A mere conclusion without an underlying rationale is of no probative value. Miller v. West, 11 Vet. App. 345 (1998). Also, as it relates specifically to the Veteran’s claim for congestive heart failure, the examiner concluded, the Veteran’s conditions of hypertension and diabetes “certainly did contribute to worsening congestive heart failure.” Accordingly, the claim for congestive heart failure is inextricably intertwined with the claims for hypertension and diabetes. Accordingly, a remand for adequate direct opinions consistent with the previous remand instructions is needed. 2. Service connection for right eye disability, to include a stroke is remanded. Because a decision on the remanded issues of entitlement to service connection for congestive heart failure, hypertension, and diabetes mellitus could significantly impact a decision on the issue of entitlement to service connection for a right eye disability, to include a stroke, the issues are inextricably intertwined. A remand of the claim of entitlement to service connection for a right eye disability is required. 3. Total disability due to individual unemployability is remanded. Finally, because a decision on the remanded issues of entitlement to service connection for diabetes mellitus, hypertension, congestive heart failure, and a right eye disability, to include a stroke, could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for TDIU is required. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s diagnosed hypertension. (a.) The examiner must opine whether it is at least as likely as not that the Veteran’s hypertension is related to an in-service injury, event, or disease, including an in-service November 1981 EKG finding of minor, non-specific ST-T wave changes or an August 1982 finding of elevated cholesterol. The examiner is asked to comment on the lay statements of the Veteran and his brother concerning onset of hypertension, as well as a letter from the Veteran’s physician indicating a diagnosis of hypertension in 1983. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. 2. Obtain an opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s diagnosed diabetes mellitus, type II. (a.) The examiner must opine whether it is at least as likely as not that the Veteran’s diabetes mellitus, type II is related to an in-service injury, event, or disease, including an in-service August 1982 finding of elevated cholesterol. The examiner is asked to comment on the lay statements of the Veteran and his brother concerning onset of diabetes mellitus, as well as a letter from the Veteran’s physician indicating a diagnosis of diabetes in 1983. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. 3. Obtain an opinion from an appropriate clinician to determine the nature and etiology of any diagnosed heart condition, to include congestive heart failure. (a.) The examiner must opine whether it is at least as likely as not that the Veteran’s congestive heart failure is related to an in-service injury, event, or disease, including an in-service November 1981 EKG finding of minor, non-specific ST-T wave changes or an August 1982 finding of elevated cholesterol. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. 4. If the Veteran is service-connected for congestive heart failure, hypertension, or diabetes mellitus, type II, then obtain an opinion from an appropriate clinician to determine the nature and etiology of any diagnosed right eye disability, to include a stroke. (a.) The examiner must opine whether it is at least as likely as not that the Veteran’s right eye disability, to include a stroke, is caused or aggravated by his diagnosed congestive heart failure, hypertension, or diabetes mellitus, type II. The examiner is also advised that the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.