Citation Nr: 24002308 Decision Date: 01/16/24 Archive Date: 01/16/24 DOCKET NO. 20-20 528 DATE: January 16, 2024 REMANDED Entitlement to service connection for a heart condition, to include atherosclerotic heart disease of native coronary artery without angina pectoris, is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The appellant served in the United States Navy from February 1979 to January 1986; and from March 1987 to September 1999. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2018 rating decision of the Department of Veterans Affairs' (VA) Veterans Benefits Administration (the agency of original jurisdiction (AOJ)), which denied service connection for hypertension and service connection for heart condition. In April 2020, the appellant filed a timely substantive appeal and requested a Board hearing. See VA Form 9, April 23, 2020. In December 2022, the appellant's representative stated that the appellant wished to withdraw his request for a Board hearing. See VA Form 20-10208, November 7, 2022. Therefore, the hearing request is withdrawn pursuant to 38 C.F.R. § 20.603. While delay is regrettable, a remand is required to fairly decide the appellant's claim. 1. Entitlement to service connection for a heart condition, to include atherosclerotic heart disease of native coronary artery without angina pectoris is remanded. The appellant asserts that service connection is warranted for a heart condition. Review of service treatment records (STR) reflect that the appellant complained of chest pains several times during service and was diagnosed with noncardiac atypical chest pain. See STR, May 19, 1999. In January 2020, the appellant was afforded a VA examination. See VA Heart Conditions Disability Benefits Questionnaire (DBQ), January 31, 2020. The clinician indicated that the appellant did not have a diagnosed heart condition. In December 2020, additional VA treatment records were added to the appellant's claims file. Review of those records reflects that in March 2020, the appellant was diagnosed with atherosclerotic heart disease of native coronary artery without angina pectoris. See VA treatment records, March 20, 2020. Given this diagnosis, the appellant must be afforded a new VA examination to determine the nature and etiology of his diagnosed heart disability. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) 2. Entitlement to service connection for hypertension is remanded. The appellant asserts that service connection is warranted for his hypertension. In December 2022, the appellant's representative specifically raised the issues of whether the appellant's hypertension is secondary to his service-connected gastroesophageal reflux disease (GERD) and whether his service-connected GERD and sleep apnea acted in concert to cause his hypertension. See Third Party Correspondence, December 8, 2022. An opinion addressing these contentions have not been yet obtained. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, a remand is necessary in order to obtain secondary service connection opinions. The matters are REMANDED for the following action: 1. Schedule the appellant a VA examination with an appropriate clinician in order to determine the nature and etiology of his atherosclerotic heart disease of native coronary artery without angina pectoris. The entire claims file, and a copy of this REMAND, must be reviewed by the clinician, and such review must be noted in the examination report. The clinician is to conduct all necessary tests and studies. The clinician must provide an opinion addressing the following: State whether the appellant's atherosclerotic heart disease of native coronary artery without angina pectoris is likely (an approximate balance of the positive and negative evidence) is caused by or related to his military service. A complete rationale for all opinions should be provided. If the examiner cannot render an opinion without resorting to mere speculation, a full explanation for why an opinion cannot be rendered should be provided. 2. Obtain an addendum medical opinion addressing the appellant's hypertension on a secondary basis. The entire claims file, and a copy of this REMAND, must be reviewed by the clinician, and such review must be noted in the examination report. If the clinician determines that an examination is necessary, please schedule as needed. The clinician is requested to provide an opinion addressing the following: (a) State whether the appellant's hypertension is likely (an approximate balance of the positive and negative evidence) proximately due to or the result of any service-connected disability. (b) State whether the appellant's service-connected sleep apnea and GERD likely (an approximate balance of the positive and negative evidence) acted in concert to cause his hypertension. (c) State whether the appellant's hypertension was caused or aggravated by any service-connected disability. Temporary aggravation may suffice for secondary service connection. Ward v. Wilkie, 31 Vet. App. 233 (2019). In answering these questions, the clinician should take into consideration the appellant's lay statements regarding his in-service high blood pressure and continuity of these symptoms since service. The Board does not make a credibility determination on these lay statements at this time. An opinion based on the absence of treatment records without consideration of an appellant's competent lay statements is inadequate. 3. Thereafter, readjudicate the claims. K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.