Citation Nr: 18157155 Decision Date: 12/13/18 Archive Date: 12/11/18 DOCKET NO. 12-00 815 DATE: December 13, 2018 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from April 1966 to March 1969. This matter becomes before the Board of Veteran’s Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified at a hearing in May 2015 before the undersigned Veterans Law Judge (VLJ). The transcript from this hearing is of record. This matter was previously before the Board in February 2016 and November 2017. As discussed below, further development is required regarding the Veteran’s claims of entitlement to service connection for hypertension. Entitlement to service connection for hypertension is remanded. Although the Board regrets the additional delay, after a thorough review of the claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to service connection for hypertension. Specifically, upon remand, the RO must obtain an adequate addendum opinion regarding the Veteran’s claimed hypertension. The Veteran has asserted that his hypertension is due to his exposure to herbicides, specifically agent orange, during his service in Vietnam. Hypertension is not one of the specified diseases for which service connection may be presumed based upon the Veteran’s presumed exposure to herbicides during his service in the Republic of Vietnam. See 38 C.F.R. § 3.309 (e) (2017); see also 68 Fed. Reg. at 630. The Veteran was afforded a VA examination in March 2017. While the VA examiner ultimately opined that the Veteran’s hypertension was not due to active service, the examiner did not address whether the Veteran’s hypertension was directly caused by his exposure to herbicides. In March 2018 the VA examiner provided an addendum to her March 2017 VA Examination. In the addendum the examiner opined that “[t]here is no objective evidence to support Veteran’s hypertension is related to an in-service injury, event or illness to include herbicide exposure. Hypertension has not been conceded as an Agent Orange presumptive condition at this time,” and that the Veteran did not report hypertension in 2003 when he first sought treatment at the VA Medical Center. See March 2017 VA Examination Addendum. The Board finds the VA examiner’s rationale to be inadequate. The VA examiner concluded that hypertension is not due to exposure to agent orange simply because hypertension is not a disease that was enumerated in 38 C.F.R. § 3.309 (e). Furthermore, while the appeal was pending, the National Academy of Sciences (NAS) moved hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and exposure to agent orange. See Veterans and Agent Orange: Update 2018. As such, this case is remanded for further development. Upon remand, VA must obtain an adequate opinion which properly considers whether the Veteran’s hypertension is etiologically related to his presumed exposure to herbicides during active service in Vietnam. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matter is REMANDED for the following action: 1. Obtain an addendum VA medical opinion regarding the Veteran’s claim of entitlement to service connection for hypertension. If a VA examiner deems that a full VA examination is required, schedule the Veteran for a full VA hypertension examination. The claims file must be made available to the examiner for review, and the examination report should reflect that such review was accomplished. Specifically, the VA examiner should provide an opinion whether it is as likely as not (a 50 percent probability or greater) that the Veteran’s diagnosed hypertension is related to his active service, including his presumed exposure to herbicides in Vietnam. In rendering the requested opinion, the examiner must specifically consider and discuss all relevant evidence of record, in addition to the 2018 NAS update which changed hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. A negative nexus opinion based on the fact that hypertension is not a chronic disease listed at 38 C.F.R. § 3.309(e) is insufficient. 2. Review the above opinion to ensure compliance with the above remand directives, and if any opinion is inadequate, take any corrective measures warranted. Additionally, conduct any additional development warranted regarding the Veteran’s claims on appeal as a result of the above. 3. If any benefit sought remains denied, issue a supplemental statement of the case (SSOC) to the Veteran and his representative, and allow a reasonable opportunity to response before returning the matter to the Board for further adjudication, if otherwise in order. The Veteran in this case has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). Furthermore, his claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.B.Y. Nguyen, Law Clerk