Citation Nr: 21025544 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 08-20 217 DATE: April 28, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for end-stage renal disease (ESRD), to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1974 to June 1978. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. This matter has previously been before the Board, most recently in July 2019. At that time, the Board remanded the Veteran’s claims for service connection for hypertension and ESRD to obtain a VA medical opinion in accordance with the terms of a Joint Motion for Remand (JMR) entered into by the Veteran and VA in February 2019. Pursuant to the JMR, the Court of Appeals of Veterans Claims (CAVC) vacated an April 2018 Board decision denying the claims for service connection. Although a VA medical opinion was obtained in November 2019, the Board finds the opinion inadequate, requiring another remand. Hypertension Pursuant to the terms of the JMR, the Board remanded the matter in July 2019 to obtain a new or clarifying VA medical opinion to address whether the Veteran’s hypertension was etiologically related to his pre-hypertension in service. As noted in the April 2018 Board decision, pre-hypertension for VA purposes is considered to be systolic readings between 120 and 139 and diastolic readings between 80 and 89. The Veteran’s service treatment records include at least three blood pressure readings that meet the VA criteria for pre-hypertension. Specifically, the Veteran had a blood pressure reading of 122/80 in January 1977, a reading of 120/80 in June 1977 and a reading of 130/80 during his June 1978 separation examination. Nonetheless, the November 2019 VA medical opinion concluded that the Veteran did not have pre-hypertension in service. The VA examiner only referred to a March 1975 blood pressure reading that met the requirements of pre-hypertension and noted that it occurred in the context of an injury. As the November 2019 VA medical opinion failed to address the Veteran’s in-service pre-hypertension, it is inadequate, and remand is required. ESRD, to include as secondary to hypertension Pursuant to the terms of the JMR, the claim for service connection for ESRD, to include as secondary to hypertension, must also be remanded because it is inextricably intertwined with the claim for service connection for hypertension. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (stating that issues are inextricable intertwined when a decision on one issue would have a significant impact on another issue). The matters are REMANDED for the following action: 1. Obtain updated treatment records and associate them with the record. 2. After completing the development in item 1, obtain a VA medical opinion to determine the etiology of the Veteran’s hypertension. A copy of the claims file, including this remand, should be provided to and reviewed by the examiner. Following review of the claims filed, the examiner is asked to address whether it is at least as likely as not that the Veteran’s hypertension began in service or is otherwise related to service. In rendering this opinion, the examiner must acknowledge and address the Veteran’s pre-hypertension during service. Specifically, the Veteran had at least three readings of blood pressure readings that meet the VA criteria for pre-hypertension in service, in January 1977, June 1977 and during his June 1978 separation examination. If the examiner determines that the Veteran’s current hypertension is not etiologically related to service, the examiner must explain why the Veteran’s pre-hypertensive status in service is considered to be of no (or minimal) clinical significance. In addressing the etiology of the current hypertension, the examiner must also acknowledge and address the positive March 2015 private medical opinion stating that pre-hypertension increases the risk of hypertension and that hypertension usually does not cause end-stage renal disease in a short amount of time, but rather over a many years of hypertension, suggesting that there is an etiological relationship between the current hypertension and the Veterans’ pre-hypertensive status in service. If the examiner does not consider this opinion to be persuasive, he or she should explain the reasons why this is so. S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Snyder, 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.