Citation Nr: 18143421 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 13-23 368 DATE: October 19, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for chronic renal disease secondary to prostate cancer is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had active military service from January 1962 to December 1969, including service in the Republic of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2011 and June 2013 rating decisions of the Department of Veteran’s Affairs (VA) Regional Office (RO) in Houston, Texas. In September 2018, the Veteran failed to show without good cause for a video conference hearing scheduled before a Veterans Law Judge. He has not explained the reason for his failure to appear and has not requested that the hearing be rescheduled. The hearing request is therefore deemed withdrawn. 1. Entitlement to service connection for hypertension is remanded. A remand is necessary to obtain an addendum opinion regarding the etiology of the Veteran’s hypertension. The Veteran has a current diagnosis of hypertension. See April 2011 VA examination. The Veteran essentially relates his current hypertension to his military service. He had service in the Republic of Vietnam during the Vietnam Era, and is therefore presumed to have been exposed to herbicide agents during such service. Current regulations do not provide hypertension as a presumptive disability associated with herbicide exposure. However, the National Academy of Sciences (NAS), in 2006 and 2008 updates, concluded that there was “limited or suggestive evidence of an association” between hypertension and herbicide agent exposure. See 75 Fed. Reg. 32, 540, 32, 549 (June 8, 2010); 75 Fed. Reg. 81, 332, 81, 333 (December 27, 2010). As there is evidence indicating there may be an association between hypertension and herbicide exposure, a VA opinion must be obtained. 2. Entitlement to service connection for chronic renal disease is remanded. The Veteran is also diagnosed with stage 3 chronic renal disease. See April 2011 VA examination. A remand is necessary to obtain an addendum opinion regarding the etiology of the Veteran’s chronic renal disease, which he attributes to his service-connected prostate cancer or alternatively, to his hypertension on appeal here. The Veteran was afforded a VA genitourinary examination for compensation purposes in April 2011. The VA examiner concluded that the Veteran’s chronic kidney disease is less likely as not related to his service-connected prostate cancer. Although the opinion addressed causation, it did not address aggravation, as required. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Consequently, the opinion is inadequate to decide the claim and a remand for an addendum opinion that addresses aggravation is necessary. Moreover, with regard to the Veteran’s alternative theory, the Board notes that the Veteran’s renal and hypertension claims are intertwined. In this regard, a favorable outcome on the hypertension claim may favorably impact the outcome of the renal claim. Indeed, there is medical evidence of record that suggests that the Veteran’s chronic renal disease is secondary to his hypertension. See Dr. R.’s private medical records; and an October 2014 DBQ. The matters are REMANDED for the following action: 1. Obtain an addendum regarding the etiology of the Veteran’s hypertension. If the designated examiner determines that an additional examination is needed, one should be afforded to the Veteran. (a) Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension is caused or aggravated by his presumed herbicide exposure during Vietnam service. In doing so, please address the NAS studies suggesting limited evidence of a relationship between hypertension and herbicide exposure. (b) Provide and opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension is proximately due to or aggravated by a service-connected disability. (c) Comment on any relationship between the Veteran’s hypertension and his chronic renal disease. In so doing, address the medical evidence of record indicating a relationship between the two. A complete rationale should be provided for any opinion given. 2. Obtain an addendum regarding the etiology of the Veteran’s chronic renal disease. If the designated examiner determines that an additional examination is needed, one should be afforded to the Veteran. Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s chronic renal disease is aggravated by his service-connected prostate cancer. Please provide supportive rationale. A complete rationale should be provided for any opinion given. 3. Then, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Ross, Law Clerk