Citation Nr: 21041925 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 15-41 868 DATE: July 10, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for chronic kidney disease is remanded. REASONS FOR REMAND The Veteran had active service in the Army from June 1974 to October 1974, and from May 1975 to May 1977. This matter comes before the Board of Veterans Appeals (Board) on appeal from a rating decision issued in August 2014 by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). In February 2019, the Veteran testified at a Travel Board Hearing before the undersigned Veterans Law Judge. The transcript of that hearing is of record. A remand was issued in August 2020 to engage in additional development. 1. Entitlement to Service Connection for Hypertension is Remanded. The Veteran contends that his hypertension is related to an in-service injury to his hand, He states the traumatic event caused an increase in his blood pressure which ultimately led to his hypertension and kidney failure. Pursuant to the August 2020 Board Remand directives, an addendum VA medical opinion was obtained in September 2020. In providing the medical opinion, the Board's directives included the instruction that the clinician address the clinical significance of a treatise/article submitted by the Veteran in February 2019, titled: "Hypertension guidelines, one year later: monitoring the change." No such commentary is included in the September 2020 opinion. The examiner indicated that he could not locate the document in the claims folder but that he would be glad to comment on it if it could be made available. A review of the record shows that the treatise/article remains in the Veteran's claims file and is identified as "Correspondence" that was received by VA on February 18, 2019. The Board has confirmed the location of the document in VBMS and Caseflow. Consequently, the VA medical opinion does not address whether the literature submitted by the Veteran is applicable or persuasive. The Board, therefore, finds there has not been substantial compliance with the Board's previous remand directives regarding this issue and another remand is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to Service Connection for Chronic Kidney Disease is Remanded. The Veteran's claim for entitlement to service connection for chronic kidney disease is inextricably intertwined with the remaining claim on appeal. Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). As the claims should be considered together, it follows that, any Board action on the Veteran's claim for entitlement to service connection for chronic kidney disease, at this juncture, would be premature. Hence, a remand of this matter is warranted, as well. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the clinician who conducted the January 2020 examinations and provided the September 2020 addendum VA medical opinions to determine the nature and etiology of the Veteran's hypertension and chronic kidney disorder. After reviewing the record and examining the Veteran, the examiner must address the following: a. Whether it is at least as likely as not that the Veteran's hypertension had its (1) initial onset in service, or (2) within a year of service discharge, or (3) is otherwise etiologically related to his active service. In providing this opinion, the examiner must address the clinical significance, if any, of the treatise submitted by the Veteran in February 2019 titled "Hypertension guidelines, one year later: monitoring the change." In this regard, the RO should obtain this treatise and ensure that it is provided to the clinician. b. If service connection for hypertension is established, state whether it is at least likely as not that the Veteran's kidney disorder was (1) was proximately due to hypertension, or (2) underwent any incremental increase in disability, regardless of its permanence, due to hypertension. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. Complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, along with the reasons for such a conclusion. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.