Citation Nr: 18147293
Decision Date: 11/02/18	Archive Date: 11/02/18

DOCKET NO. 08-26 123A
DATE:	November 2, 2018
REMANDED
Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veterans served on active duty from October 1966 to June 1969 in the United States Army, to include in the Republic of Vietnam.  This matter comes before the Board of Veterans’ Appeals (Board) from a January 2005 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA).  The Board previously considered and remanded this matter in September 2014 and January 2016, and September 2016 for further evidentiary development.  The Board denied the Veteran’s claim in a decision issued in July 2017.  The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court), which issued a May 2018 Order granting a Joint Motion for Remand (JMR) which requested that the July 2017 Board decision be vacated and remanded.
Entitlement to service connection for hypertension, to include as due to presumed exposure to an herbicide agent and on a secondary basis due to service-connected PTSD, is remanded.
In the April 2018 JMR, the Board was found to have erroneously determined that there had been substantial compliance with its September 2016 remand directives pursuant to Stegall v. West, 11 Vet. App. 268, 271 (1998).  That remand directed VA to obtain a medical opinion that addressed an update from the National Academy of Sciences (NAS) suggesting there was some “limited or suggestive evidence of an association” between hypertension and exposure to an herbicide agent.  Pursuant to the Board’s remand directives, VA obtained medical opinions in September 2016 and October 2016.  Because the clinician who provided those opinions did not explicitly address the NAS update, the JMR found that there had not been substantial compliance with the Board’s September 2016 remand directives.  
The matter is REMANDED for the following action:
1. Obtain an addendum opinion from an appropriate medical professional to address the following questions:
(a.) Is it at least as likely as not that the Veteran’s hypertension is etiologically related to his presumed exposure to an herbicide agent?  Why do you say so? In answering this question, the examiner MUST SPECIFICALLY address the NAS update suggesting a “limited or suggestive evidence of an association” between hypertension and exposure to an herbicide agent.
(Continued on the next page)
 
(b.) Is it at least as likely as not that the Veteran’s hypertension has been aggravated by (worsened in severity beyond the natural progression of the disease) the Veteran’s service-connected PTSD?  Why do you say so? In answering this question, the examiner MUST SPECIFICALLY address the Veteran’s contention that his PTSD exacerbates his hypertension by preventing him from getting adequate sleep and thereby raising his blood pressure.
 
MATTHEW TENNER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Whitelaw, Associate Counsel