Citation Nr: 21028306 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-38 289 DATE: May 10, 2021 ORDER Service connection for hypertension is granted. REMANDED Entitlement to an initial rating in excess of 30 percent for coronary artery disease with myocardial infarction residuals is remanded. FINDINGS OF FACT 1. Service connection has been established for coronary artery disease with myocardial infarction residuals, Type II diabetes mellitus, right lower extremity diabetic neuropathy, left lower extremity diabetic neuropathy, bilateral hearing loss, tinnitus, and erectile dysfunction. 2. It is at least as likely as not that hypertension is related to the coronary artery disease with myocardial infarction residuals. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service from September 1969 to July 1971. He served in the Republic of Vietnam. Service Connection for Hypertension Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for coronary artery disease with myocardial infarction residuals, Type II diabetes mellitus, right lower extremity diabetic neuropathy, left lower extremity diabetic neuropathy, bilateral hearing loss, tinnitus, and erectile dysfunction. An August 2019 cardiological evaluation from C. Stark, M.D., states that the Veteran was diagnosed with hypertension and coronary artery disease. The doctor commented that "atherosclerosis, which is the basis for coronary artery disease, can increase one's risk of developing hypertension and it is possible that some individuals with coronary artery disease have hypertension as a possible complication of the atherosclerosis" and coronary artery disease is "certainly a risk factor" for the development of hypertension. The report of a June 2020 Department of Veterans Affairs (VA) hypertension examination states that the Veteran was diagnosed with hypertension. The examiner opined that "I concur with his cardiologist Dr. Stark that generally hypertension is not caused by coronary artery disease but certainly is a risk factor." The Veteran has been diagnosed with hypertension by both VA and private physicians. Dr. Stark and a VA examiner acknowledged that the diagnosed hypertension could be related to the service connected coronary artery disease. The Board of Veterans' Appeals (Board) finds that the evidence is in at least equipoise as to whether the diagnosed hypertension is related to the service connected coronary artery disease and myocardial infarction residuals. Resolving all reasonable doubt in the Veteran's favor, the Board concludes that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to an initial rating in excess of 30 percent for coronary artery disease with myocardial infarction residuals is remanded. The Veteran asserts that an initial rating in excess of 30 percent for coronary artery disease with myocardial infarction residuals is warranted. A March 2021 VA treatment record states that the Veteran reported he was "doing biking at low intensity to not aggravate his knee, 1.7 miles in 20 minutes;" "used to use weights at home, planning on buying some while he is in Florida for next few weeks;" and "did begin walking more at slow pace due to knee." VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Given the reported exercise activity and as the Veteran was last afforded a VA cardiovascular examination in March 2020, the Board finds that further VA evaluation is needed to determine the current severity of the service connected disability. This matter is therefore REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for the service-connected coronary artery disease with myocardial infarction residuals. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA clinical documentation not already of record. 3. Schedule the Veteran for a VA cardiovascular examination to assist in determining the nature and severity of service-connected coronary artery disease with myocardial infarction residuals. The examiner must review the record and should note that review in the report. All indicated tests and studies, including echocardiographic and METs testing, should be accomplished and the findings then reported in detail. If METs testing is medically contraindicated, the examiner should so state and the examiner should provide a METs estimate. A rationale for all opinions should be provided. The examiner should: (a) Specifically note whether chronic congestive heart failure is present and the frequency of any episodes. (b) Provide an opinion as to the impact of the cardiovascular disability on the Veteran's vocational pursuits and whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the effects of the cardiovascular disability and the other service connected disabilities. If the Veteran is felt capable of work despite the service connected disabilities, the examiner should describe what type of work and what accommodations would be necessary due to the service-connected disabilities. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Blore, 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.