Citation Nr: 18157705
Decision Date: 12/14/18	Archive Date: 12/13/18

DOCKET NO. 17-04 627
DATE:	December 14, 2018
REMANDED
The issue of entitlement to service connection for hypertension is remanded.  
REASONS FOR REMAND
The Veteran served on active duty from June 1967 to April 1971.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) regional office (RO).
The issue on appeal must be remanded for additional medical inquiry.  
The Veteran asserts that he developed hypertension as the result of service-connected diabetes mellitus type 2 (diabetes) and as the result of service in the Republic of Vietnam and exposure to herbicides there.  
The Veteran underwent VA examination into this claim in August 2016.  The examiner commented on the secondary service connection claim but not on the direct service connection claim.  On remand, an addendum medical opinion should be added to the record.  
The matter is REMANDED for the following action:
1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claim. Include in the record any outstanding VA treatment records.  All records/responses received must be associated with the electronic claims file. 
2. Return the case to the VA examiner who conducted the August 2016 examination (or to a suitable substitute).  After reviewing the claims file again, the examiner should answer the following question.
Is it at least as likely as not (i.e., probability of 50 percent or greater) that hypertension is related to a disease, event, or injury during service? 
In answering this question, review and consider the lay assertions of record, to include the Veteran’s argument that his hypertension relates to herbicide exposure in Vietnam. 
Hypertension may not be presumed service connected based on herbicide exposure in the way diabetes may be presumed service connected.  See 38 C.F.R. §§ 3.307, 3.309.  Nevertheless, the National Academy of Sciences, Institute of Health, has found “limited/suggestive” evidence that hypertension is related to herbicide exposure.  As such, the exposure must be considered when deciding whether a service connection finding is as likely as not warranted here.
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Please explain in detail any opinion provided.
 
G. A. WASIK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Christopher McEntee, Counsel