Citation Nr: 18139943 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 15-38 163 DATE: October 1, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for psoriasis is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to June 1970 in the United States Army. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. Service Connection – Hypertension and Psoriasis In this case, the Veteran maintains that his hypertension and psoriasis were incurred during, or are otherwise related to his active service. The Board notes that he served in the Republic of Vietnam from December 1968 to November 1969 and it is presumed that he was exposed to herbicide agents. See 38 C.F.R. § 3.307(a)(6)(iii) (2018). In February 2012, after reviewing the claims file, the VA examiner opined that the Veteran’s psoriasis and hypertension were less likely than not incurred in or caused by his military service. The examiner noted that psoriasis and hypertension were not diagnosed during service; however, she did not address whether the claimed disabilities were related to herbicide exposure. Therefore, a remand is necessary to obtain a supplemental medical opinion. The Board notes that although hypertension and psoriasis are not on the list of diseases that VA has associated with Agent Orange exposure, the regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. §§ 3.303(d), 3.309(e); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Board also notes that the National Academy of Sciences’ (NAS) Institute of Medicine’s Veterans and Agent Orange: Update 2010 (2010 Update) concluded that there is limited or suggestive evidence of an association between exposure to Agent Orange and hypertension. Thus, a VA medical opinion is also needed to address this issue. Additionally, current treatment records should be identified and obtained before a decision is made in this case. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, return the case to the VA examiner who conducted the January 2012 examination for psoriasis and hypertension for an addendum opinion. After a review of the evidence of record, to include consideration of the newly received records, as well as the Veteran’s lay statements, the VA examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s psoriasis is related to his active service, including herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The VA examiner should also provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s hypertension is related to his active service, including herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The examiner must also address the NAS Institute of Medicine’s Veterans and Agent Orange: Update 2010 (2010 Update), which concluded that there was limited or suggestive evidence of an association between exposure to Agent Orange and hypertension. A rationale for all opinions expressed must be provided. If the January 2012 VA examiner is unavailable, the claims file should be forwarded to an examiner with appropriate expertise to provide the requested opinion. A VA examination should only be performed if determined necessary by the examiner providing the requested opinion. 3. Confirm that the VA examination report and all opinions provided comport with this remand and undertake any other development found to be warranted. 4. Then, readjudicate the issues on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, Counsel