Citation Nr: 21029172 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 15-26 911 DATE: May 12, 2021 REMANDED Entitlement to service connection for hypertension, including as due to herbicide exposure, is remanded. Entitlement to service connection for abdominal aortic aneurysm, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to November 1970. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) regional office. These matters were remanded in April 2020 for further development and return to the Board for further adjudication. 1. Hypertension In the April 2020 Board remand, the examiner was informed that they must consider the articles submitted by the Veteran suggesting there is sufficient evidence of an association between hypertension and herbicide exposure. The examiner opined that the articles were not the current widely accepted views but did not elaborate or discuss this Veteran's specific circumstances. On remand, an opinion that addresses why any statistical or medical studies considered by the examiner are found to be persuasive or unpersuasive, as well as factors specific to this Veteran, must be obtained. See Polovick v. Shinseki, 23 Vet. App. 48, 53-54 (2009). 2. Abdominal aortic aneurysm Two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered. As the Veteran has asserted that his hypertension caused or aggravated his abdominal aortic aneurysm, a decision on the hypertension claim could significantly impact a decision on this issue. Thus, these two issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined abdominal aortic aneurysm claim is therefore required. In the event service connection for hypertension is warranted, an additional medical opinion on this issue should also be obtained, as an opinion obtained in May 2020 did not adequately address the question of aggravation. The matters are REMANDED for the following action: Obtain a medical opinion from an appropriate clinician in response to the below questions. If the clinician determines that an opinion cannot be provided without an examination, one should be scheduled. Copies of all pertinent records must be made available to the clinician. Following review of the claims file, the clinician should respond to the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension had onset in or is otherwise related to military service, to include herbicide exposure? Please explain why or why not, specifically considering and discussing the Veteran's medical history and risk factors. The clinician should also consider the articles cited by the Veteran in the March 2020 appellate brief. If the articles are not widely accepted, peer reviewed studies by the medical community, the clinician should explain why any statistical or medical studies considered by the clinician are found to be persuasive and why the studies submitted by the Veteran are unpersuasive. (b) If, and only if, hypertension is found to be related to herbicide exposure in service, is it at least as likely as not that the Veteran's abdominal aortic aneurysm is (1) proximately due to his hypertension, or (2) aggravated by his hypertension? The clinician should consider and discuss the articles cited in the March 2020 and April 2021 appellate briefs indicating a connection between hypertension and aortic aneurysms. If the articles are considered not widely accepted peer reviewed studies by the medical community, the clinician should explain any statistical or medical studies considered by the clinician that are found to be persuasive and why the studies submitted by the Veteran are unpersuasive. (Continued on the next page) A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the clinician cannot provide an opinion without resort to speculation, the clinician must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the clinician (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. L. STEPANICK Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.