Citation Nr: 18144017
Decision Date: 10/22/18	Archive Date: 10/22/18

DOCKET NO. 13-34 500
DATE:	October 22, 2018
REMANDED
Entitlement to service connection for hypertension is remanded.
REASONS FOR REMAND
The Veteran served on active duty from December 1965 to October 1967 in the United States Army.  
This case initially came before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee.  
In a July 2017 decision, the Board denied service connection for hypertension.  The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court).  In July 2018, pursuant to a Joint Motion for Remand (Joint Motion), the Court vacated the Board’s decision.
The Veteran asserts that his hypertension is etiologically related to his active service, to include exposure to Agent Orange.  He also contends that his hypertension is secondary to his service-connected diabetes mellitus.
In this case, a VA examination was conducted in September 2016; however, the examiner did not address whether the Veteran’s hypertension was directly related to service and Agent Orange exposure.  
As noted in the Joint Motion, although hypertension is not on the list of diseases that VA has associated with Agent Orange exposure, the National Academy of Sciences’ (NAS) Institute of Medicine’s Veterans and Agent Orange:  Update 2006 (2006 Update) concluded that there is limited or suggestive evidence of an association between exposure to Agent Orange and hypertension.  Therefore, the Board finds that a remand is necessary for a VA examination.  
Additionally, current treatment records should be identified and obtained before a decision is made with regard to the issue on appeal.
The matter is REMANDED for the following action:
1. Identify and obtain any outstanding, pertinent VA and private treatment records not already of record in the claims file.
2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of any hypertension that may be present.  The claims file must be made available to, and reviewed by the examiner.  Any indicated studies should be performed. 
Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present hypertension is etiologically related to the Veteran’s active service, to include in-service exposure to Agent Orange.
The examiner must also address the NAS Institute of Medicine’s Veterans and Agent Orange:  Update 2006 (2006 Update), which concluded that there was limited or suggestive evidence of an association between exposure to Agent Orange and hypertension.
The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or better) that any currently present hypertension was caused or chronically worsened by the Veteran’s diabetes mellitus.  
A rationale for all opinions expressed must be provided.
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 issue 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