Citation Nr: 18155144 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 16-56 918 DATE: December 4, 2018 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The appellant served on active duty in the United States Marine Corps from February 1966 to February 1969. He served in the Republic of Vietnam and is therefore presumed to have been exposed to herbicide agents during such service. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) wherein it was determined that the appellant’s hypertension was neither incurred in service, nor was caused or aggravated by his service-connected type 2 diabetes mellitus. The appellant asserts that his hypertension is related to his active service. He contends that the disability was caused by exposure to herbicide agents, or alternatively is caused by, or aggravated beyond its normal progression by, his type 2 diabetes mellitus. After a review of the evidence of record, the Board finds that remand is necessary prior to adjudicating this claim because an opinion has not yet been obtained on whether the appellant’s hypertension is caused by his exposure to herbicide agents during his service in the Republic of Vietnam. Service connection is presumed for certain specifically enumerated diseases if a Veteran was exposed to an herbicide agent, such as Agent Orange, during active service if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The Board notes that hypertension is not among the enumerated diseases currently listed in the applicable regulation. 38 C.F.R. § 3.309(e). Despite the presumptive regulations, however, a claimant may establish service connection based on exposure to herbicide agents with proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In 2018, the National Academies of Sciences, Engineering, and Medicine (NAS) published their “Veterans and Agent Orange: Update 11.” In this update, the classification of hypertension was upgraded from the category of “limited or suggestive” evidence of an association between herbicide exposure and hypertension, to the category of “sufficient” evidence of an association. See Veterans and Agent Orange: Update 11 (2018). According to NAS, the sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. Although the NAS has noted only a positive association, rather than a causal relationship, the Board finds that, as the appellant has hypertension, is presumed exposed to herbicide agents, and there are some indicia of a link between hypertension and exposure to herbicide agents, remand is necessary to obtain an opinion on the etiology of the appellant’s hypertension, to include as due to his presumed exposure to herbicide agents. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the appellant’s hypertension is at least as likely as not related to his presumed exposure to herbicide agents while serving in the Republic of Vietnam. In rendering an opinion, the examiner should consider and address the 2018 the National Academies of Sciences, Engineering, and Medicine (NAS) “Veterans and Agent Orange: Update 11,” which upgraded hypertension from the limited or suggestive evidence of an association category to the sufficient evidence of an association category. According to NAS, the sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kleponis, Associate Counsel