Citation Nr: 18157949 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-54 898 DATE: December 13, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus, type II is remanded. REASONS FOR REMAND The Veteran served in active duty in the United States Navy from November 1964 to December 1972. This case comes before the Board of Veteran Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus, type II 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 for service connection for hypertension. Specifically, upon remand, the RO must obtain an adequate medical opinion which properly considers whether the Veteran’s hypertension is etiologically related to his presumed exposure to herbicides. Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Combee v. Brown, 34 F.3d. 1039 (Fed. Cir. 1994). In addition, the RO must obtain an adequate opinion which considers whether the Veteran’s hypertension was caused or aggravated by his service-connected diabetes mellitus, type II. The VA is required to provide a veteran with an examination when there is (1) competent evidence of a current disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period, and (3) an indication that the disability or persistent or recurrent symptom of a disability is service-related, but (4) there is insufficient competent medical evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board finds that there is competent evidence of a current disability. Medical treatment records show that the Veteran has a diagnosis of hypertension. Additionally, the Veteran’s exposure to agent orange was conceded by the RO in its October 2012 rating decision, providing evidence of an event, injury, or disease that occurred in service. While hypertension is not a disability presumptively associated with herbicide exposure, the National Academy of Sciences (NAS) placed hypertension in the category of “limited or suggestive evidence of an association” with exposure to herbicides. See e.g., Health Effects Not Associated with Exposure to Certain Herbicide Agents, 75 Fed. Reg. 32,540, 32,549 (June 8, 2010). In November 2018, the 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. Although there is sufficient evidence showing a current disability, in-service event or injury, and an indication that the hypertension may be due to service, there is insufficient medical evidence for the Board to decide the case. The record lacks a medical nexus opinion that considers whether the Veteran’s hypertension is etiologically related to his presumed exposure to herbicides during active service. Without such an opinion, the Board cannot decide the case. Therefore, the Board finds that the McLendon elements have been met, and a remand for a medical examination that considers whether the Veteran’s hypertension is etiologically related to his presumed exposure to herbicides during service is warranted. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed hypertension. The entire claims file must be made available to and reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. The examiner is asked to provide an opinion regarding whether it is at least as likely as not (a probability of 50 percent or greater) that the current hypertension had its onset during the Veteran’s active service or is otherwise causally related to his service, to include herbicide exposure. The examiner is advised to consider the NAS Updates which concluded that there was “sufficient” evidence of an association between hypertension and herbicide exposure. It is not adequate to conclude that the Veteran’s hypertension is not directly caused by herbicide exposure by stating that hypertension is not listed in VA regulations as presumptively service-connected. In the alternative, the examiner is asked to determine whether it is at least as likely as not that hypertension was caused or aggravated by the service-connected diabetes mellitus, type II. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements, and the opinion should reflect such consideration. A complete rationale must be given for all opinions and conclusions expressed. 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. (Continued on the next page)   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