Citation Nr: 18158986 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 11-23 610 DATE: December 18, 2018 ORDER Entitlement to service connection for hypertension, to include as due to exposure to herbicides, is granted. REMANDED Entitlement to service connection for scrotal cellulitis and perineal ulcers, to include as due to exposure to herbicides and/or secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD), to include as secondary to service-connected diabetes mellitus is remanded. FINDING OF FACT Affording the Veteran the benefit of the doubt, hypertension is presumptively related to in-service herbicide exposure. CONCLUSION OF LAW The criteria for service connection for hypertension, as a result of exposure to herbicides, have been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to June 1970 in the United States Army. He received the Combat Infantryman Badge (CIB). This matter come before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA). In November 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ). Entitlement to service connection for hypertension, to include as due to exposure to herbicides The Veteran has been diagnosed with hypertension. He served in Vietnam and therefore in-service herbicide exposure is presumed. See 38 U.S.C. § 1116 (f) (2012); 38 C.F.R. § 3.307 (a)(6)(iii) (2017); DD 214. The Board notes that while hypertension is not recognized as a presumptive condition due to herbicide exposure, the National Academy of Sciences (NAS) has indicated that there is sufficient evidence of an association between hypertension and herbicide exposure. 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. See Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War: Update November 15, 2018; see also 38 C.F.R. § 3.309 (2017). There are no contrary opinions of record and hypertension has not been related to any other risks factors, to include his diabetes mellitus. Notably, the November 2010 VA examiner opined hypertension was not a complication of diabetes as it pre-dated diabetes by more than 25 years. Affording the Veteran all reasonable doubt, hypertension is presumptively related to in-service herbicide exposure. As such, service connection for hypertension is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 REASONS FOR REMAND 1. Entitlement to service connection for scrotal cellulitis and perineal ulcers, to include as due to exposure to herbicides and/or secondary to service-connected diabetes mellitus is remanded. The Veteran testified that his scrotal cellulitis and perineal ulcers are the result of Agent Orange exposure and/or the result of or aggravated by his diabetes mellitus. The Veteran was afforded VA skin examination in December 2010, the examiner did not address whether his scrotal cellulitis and perineal ulcers were related to his presumed herbicide exposure. Though these conditions are not specifically listed as a disease presumptively associated with exposure to Agent Orange, it does not preclude direct service connection for other conditions based on exposure to Agent Orange. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Whether there is a potential relationship between the Veteran’s scrotal cellulitis and perineal ulcers and herbicide exposure must be addressed by an examiner. Additionally, the December 2010 examiner indicated the Veteran’s scrotal cellulitis and perineal ulcers were not “induced by” diabetes mellitus; however, the examiner did not address the aggravation component. For these reasons a new examination is necessary. Updated VA treatment records dated from November 2010 to the present must also be obtained upon Remand. 38 C.F.R. § 3.159(c)(2). 2. Entitlement to service connection for PTSD, to include as secondary to service-connected diabetes mellitus is remanded. The Veteran testified that he had recently been diagnosed with PTSD by treatment providers. He additionally asserted that his PTSD was aggravated by his diabetes mellitus. The Veteran was afforded VA PTSD examination in March 2010; however, the examiner found the Veteran did not meet the full criteria for PTSD and there was no evidence of a mental disorder. A new examination is necessary to determine whether the Veteran currently has PTSD and if so, whether it is related to verified stressors (the Veteran has been awarded the CIB) and/or aggravated by his diabetes mellitus. Updated VA treatment records dated from November 2010 to the present must also be obtained upon Remand. 38 C.F.R. § 3.159(c)(2). The matters are REMANDED for the following action: 1. Secure for the record copies of updated VA treatment records of the Veteran dated from November 2010 to the present. All requests for records and their responses must be associated with the claims folder. 2. Thereafter, the Veteran must be afforded the appropriate VA examination to determine the nature and etiology of the claimed PTSD. The examiner is notified that an in-service stressor has been conceded as the Veteran has been awarded the CIB. Any indicated diagnostic tests and studies must be accomplished. The examiner should then respond to the following: is a diagnosis of PTSD warranted? If so, is it at least as likely as not (a 50% or higher degree of probability) causally related to the Veteran’s corroborated stressors during service? If a diagnosis of PTSD is not warranted, is it at least as likely as not (a 50% or higher degree of probability) that an acquired psychiatric disorder other than PTSD, is causally related to the Veteran’s active military service, including corroborated stressors, or proximately due to, the result of or aggravated by (beyond the natural progression of the disease) his diabetes mellitus. The examiner must provide a complete rationale for all opinions expressed. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Thereafter, the Veteran must be afforded the appropriate VA examination to determine the etiology of the claimed scrotal cellulitis and perineal ulcers. Any indicated diagnostic tests and studies must be accomplished. Please state whether the Veteran’s scrotal cellulitis and perineal ulcers are at least as likely as not (a 50 percent or greater probability) related or otherwise attributable to his presumed herbicide exposure regardless of whether the condition is a listed disease under 38 C.F.R. § 3.309(e); and whether is it at least as likely as not (a 50% or higher degree of probability) that scrotal cellulitis and perineal ulcers are proximately due to, the result of or aggravated by (beyond the natural progression of the disease) his diabetes mellitus. The examiner must provide a complete rationale for all opinions expressed. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. If upon completion of the above action, the claims remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. L. Wallin, Counsel