Citation Nr: 18154062 Decision Date: 11/29/18 Archive Date: 11/28/18 DOCKET NO. 17-60 681 DATE: November 29, 2018 REMANDED Entitlement to service connection for hypertension, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for end stage renal disease requiring dialysis, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus is remanded. Entitlement to an initial rating in excess of 10 percent for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from October 1961 to October 1964. On his VA Form 9 Substantive Appeal, the Veteran indicated that he wished to have a videoconference hearing before the Board. However, the Veteran failed to attend his scheduled June 2018 hearing and did not request that it be rescheduled or provide good cause for not attending. Therefore, the Veteran’s hearing request is deemed to be withdrawn. While the Board sincerely regrets further delay, additional development is required before the Veteran’s claims may be adjudicated on the merits. 1. Entitlement to service connection for hypertension, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus is remanded. 2. Entitlement to service connection for end stage renal disease requiring dialysis, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus is remanded. 3. Entitlement to an initial rating in excess of 10 percent for diabetes mellitus is remanded. The Board notes that the Veteran was afforded a VA examination in connection with his claims in October 2017. Unfortunately, the Board finds that the examinations are incomplete. Specifically, while an in-person examination was completed, the examiner did not review any of the Veteran’s records, which potentially contained medical evidence relevant to the Veteran’s claims. Additionally, with respect to the Veteran’s claims for entitlement to service connection for hypertension and end stage renal disease, both to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus, the VA examiner failed to provide an etiological opinion on a direct or secondary basis. See, October 2017 VA examination. Accordingly, the Board finds that a remand is warranted for a new examination to determine the current severity of the Veteran’s diabetes mellitus and for an etiological opinion for his hypertension and end stage renal disease. Barr v. Nicholson, 21 Vet. App. 303 (2007). Additionally, the Veteran has asserted that he believes that one of the potential causes for the development of his hypertension is the exposure to herbicide agents during his service in the Republic of Vietnam. In that regard, the Board notes that while hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e)(2017), the National Academy of Sciences Institute of Medicine (NAS) has recently concluded that there is “sufficient” evidence between herbicide exposure and hypertension. See, 77 Fed. Reg. 47924, 47926-927 (Aug. 10, 2012); Veterans and Agent Orange: Update 11 (2018). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the Veteran’s claims file. 2. Once any outstanding records have been received, schedule the Veteran for VA examinations in connection with his claims with the appropriate medical personnel. The Veteran’s claims file, to include a copy of this remand, should be provided to the examiner. The examiner is asked to indicate that the records were reviewed and following the review of the record is asked to provide the following opinions: a. Determine the current level of severity of the Veteran’s service-connected diabetes mellitus. b. Whether it is at least as likely as not that the Veteran’s hypertension is due to his military service, to include exposure to herbicide agents. The opinion should include consideration of the Veteran’s presumed exposure to certain herbicide agents, such as Agent Orange, as the NAS has concluded that there is “sufficient evidence” between herbicide exposure and hypertension, per the most recent update. c. Whether it is at least as likely as not that the Veteran’s hypertension is either caused or aggravated by his service-connected diabetes mellitus. d. Whether it is at least as likely as not that the Veteran’s end stage renal disease is due to his military service, to include exposure to herbicide agents. e. Whether it is at least as likely as not that the Veteran’s end stage renal disease is either cause or aggravated by his service-connected diabetes mellitus. A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Daugherty, Associate Counsel