Citation Nr: 18147525
Decision Date: 11/05/18	Archive Date: 11/05/18

DOCKET NO. 17-23 006
DATE:	November 5, 2018
REMANDED
Entitlement to service connection for the cause of the Veteran’s death is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 1953 to October 1976.  He died in August 2000.  
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).
The Veteran is presumed to have been exposed to herbicide agents in service as his service personnel records reflect that he served in the Republic of Vietnam during the Vietnam War Era. 
The Veteran’s death certificate indicates that he died of hypertensive cardiovascular disease with contributing hyperlipidemia.  
As the Veteran is presumed to have been exposed to herbicide agents, remand is necessary to attempt to obtain private and VA treatment records to determine whether he had ischemic heart disease.  Remand is also necessary to obtain a VA medical opinion as to whether any in-service event, injury, disease, or disorder, including his presumed in-service herbicide agent exposure, caused his hypertensive cardiovascular disease.
In this regard, VA 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 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 that there may be an association between hypertension and herbicide agent exposure, a VA opinion must be obtained.
The matter is REMANDED for the following action:
1. Obtain a medical opinion to determine the likely etiology of the Veteran’s hypertensive cardiovascular disease prior to his death in 2000.  After examining the Veteran and reviewing the claims file, the examiner is asked to:
(a.) State whether the Veteran had ischemic heart disease prior to his death.
(b.) Opine whether it is at least as likely as not that the Veteran’s hypertension was related to service, to include exposure to Agent Orange.  In providing the above opinion, the examiner should consider the NAS 2006 and 2008 updates which concluded that there was “limited or suggestive evidence of an association” between hypertension and herbicide exposure.  See 75 Fed. Reg. 32,540, 32,549 (June 8, 2010); 75 Fed. Reg. 81,332, 81,333 (December 27, 2010).
(c.) The examiner is requested to provide a fully reasoned explanation for his or her opinions, based on his or her clinical experience, medical expertise, and established medical principles.
2. Readjudicate the issue on appeal.  
 
ROMINA CASADEI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. E. Miller, Associate Counsel