Citation Nr: 18156500 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 07-31 834 DATE: December 10, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a liver disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1967 to September 1971, including service in Vietnam, with additional Reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2011, the Veteran testified before the undersigned Veterans Law Judge. In February 2012 and November 2017, the Board remanded the claims for further development. 1. Entitlement to service connection for hypertension is remanded. Remand is warranted for the Veteran’s claim of entitlement to hypertension, because the December 2017 VA examiner’s opinion is inadequate. Specifically, the examiner did not discuss the Veteran’s elevated blood pressure readings during his Reserve service. Additionally, a review of the record indicates that the Veteran served in Vietnam, and thus, his exposure to herbicide agents is presumed. Although the Veteran’s hypertension is not a disease associated with herbicide agent exposure under 38 C.F.R. § 3.309(e), the National Academy of Sciences Institute of Medicine (NAS) has concluded that there is “sufficient evidence of an association” between herbicide agent exposure and hypertension. See NAS, Veterans & Agent Orange: Update 11 (2018). Therefore, as a review of the record raises the possibility of this theory of entitlement, an opinion is warranted on remand. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Furthermore, the Veteran’s duty status from December 1991 to January 1996, e.g. whether he was on a period of active duty for training (ACDUTRA) or inactive duty for training (INACDUTRA), should be verified on remand, as he had elevated blood pressure readings and was diagnosed with hypertension during that time. 2. Entitlement to service connection for a liver disorder is remanded. Remand is warranted for the Veteran’s claim of entitlement to service connection for a liver disorder, as the December 2017 VA examiner did not provide an opinion on secondary service connection based on aggravation. Additionally, the examiner opined that the Veteran’s liver disorder was not secondary to his diabetes based on the fact that the diagnosed liver condition preceded his diagnosis of diabetes. However, to establish causation, there is no temporal requirement that the primary condition be service-connected, or even diagnosed, at the time the secondary condition is incurred. See Frost v. Shulkin, 29 Vet. App. 131 (2017). Accordingly, an addendum opinion is necessary. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Any outstanding VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Verify all periods of ACDUTRA and INACDUTRA during the Veteran’s service with the Air Force Reserve from December 1991 to January 1996. A written report should be prepared detailing the beginning and ending dates of each period of ACDUTRA and INACDUTRA, to the extent possible. Retirement points will not suffice. 4. Then refer the claims file to an examiner for preparation of an addendum opinion as to the etiology of the Veteran’s hypertension. The entire claims file should be made available to the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension: (a) had its onset during active service or a verified period of ACDUTRA; (b) is otherwise the result of a disease or injury incurred during active duty or a verified period of ACDUTRA, to include as a result of conceded exposure to film-processing chemicals, such as formaldehyde, and herbicide agents therein; or (c) is otherwise the result of an injury incurred during a verified period of INACDUTRA. In addressing these questions, please consider the Veteran’s elevated blood pressure readings during his Reserve service (see December 1991 and January 1992 service treatment records) and address the NAS findings of “sufficient evidence of an association” between herbicide agent exposure and hypertension. A complete rationale should be given for all opinions and conclusions expressed. 5. Then refer the claims file to a VA examiner for preparation of an addendum opinion as to the etiology of the Veteran’s liver disorder. The entire claims file should be made available to the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should opine as to whether it is as least as likely as not (50 percent or greater probability) that the Veteran’s liver disorder: (a) is proximately due to his service-connected diabetes mellitus type II; or (b) has been aggravated (worsened beyond natural progression) by his service-connected diabetes mellitus type II. (Continued on the next page)   A complete rationale should be given for all opinions and conclusions expressed. Please note that it is not necessary that diabetes mellitus be service-connected, or even diagnosed, at the time the Veteran’s liver disorder is incurred to support secondary service connection, and reliance on this fact in support of a negative opinion will render it inadequate. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.S. Mahoney, Associate Counsel