Citation Nr: 18157490 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 09-30 331 DATE: December 13, 2018 REMANDED Entitlement to service connection for a heart disability, to include as due to exposure to herbicides, is remanded. Entitlement to service connection for hypertension, to include as due to exposure to herbicides, is remanded. REASONS FOR REMAND The Veteran had active military service from July 1979 to January 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board finds that additional development is required before the appeal is decided. Although exposure to herbicides has not been established, the regulations governing presumptive service connection do not preclude the Veteran from establishing service connection for a heart disability and hypertension with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (1994). Service treatment records (STRs) are silent for complaints of, treatment for, or diagnosis of a heart disability and hypertension. However, the Veteran had elevated blood pressure readings in August 1982 and December 1986. A review of post-service treatment records revealed that the Veteran had a pacemaker implanted in 1995 and was diagnosed with hypertension in September 1997. The Veteran was afforded VA examinations in February 2018. The Veteran was diagnosed with hypertension, valvular heart disease, and bradycardia. The examiner opined that the Veteran’s hypertension and heart disability were less likely than not related to service, to include as due to exposure to herbicides. In support of this opinion, the examiner stated that the Veteran’s hypertension and heart disabilities were not diagnosed or did not occur within one year of separation from service. Additionally, the examiner noted that hypertension and bradycardia were not associated with diabetes and/or ischemic heart conditions and the Veteran was not exposed to herbicides per VA. The Board finds that the February 2018 VA examiner did not address the elevated blood pressure readings documented in the Veteran’s STRs. For this reason, the February 2018 examination is inadequate, and remand is necessary for an addendum opinion to determine the nature and etiology of the Veteran’s hypertension and heart disability. In addition, current treatment records should be identified and obtained before a decision is made with regard to the appeal. The matters are REMANDED for the following action: 1. Obtain all VA treatment records for the Veteran dated from May 2018 to the present and associate them with the claims file. 2. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present hypertension. The claims file must be made available to, and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present hypertension began in service, was caused by service, or is otherwise etiologically related to the Veteran’s active service. The examiner must specifically discuss the elevated blood pressure readings noted in the Veteran’s STRs in August 1982 and December 1986. A complete rationale for all opinions expressed must be provided. 3. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present heart disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present heart disability began in service, was caused by service, or is otherwise etiologically related to the Veteran’s active service. The examiner must specifically discuss the elevated blood pressure readings noted in the Veteran’s STRs in August 1982 and December 1986. A complete rationale for all opinions expressed must be provided. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel