Citation Nr: 18159603 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 15-26 218 DATE: December 19, 2018 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND Entitlement to service connection for the cause of the Veteran’s death is remanded. The Veteran served honorably in the United States Army from 1961 through July 1981. The Veteran retired after twenty years of service and he was awarded the Purple Heart, Vietnam Service Medal with three Bronze Service Stars, National Defense Service Medal, Combat Infantryman Badge, Bronze Star Medal with Oak Leaf Cluster, and many other decorations. The Veteran died in October 2014. The Appellant in the present appeal is his surviving widow. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s cause of death is listed as hypertensive heart disease, hypertension, and chronic obstructive pulmonary disease (COPD). The Appellant contends that the Veteran’s hypertensive heart disease and hypertension were related to his presumed exposure to herbicide agents during his period of service in the Republic of Vietnam. Dependency and indemnity compensation (DIC) is payable to the surviving spouse of a deceased veteran in the event of a service-connected death. 38 C.F.R. § 3.5. Service connection may be established for a disability that caused a veteran’s death either principally or contributorily. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. The Appellant believes the Veteran should be service connected for hypertensive heart disease, hypertension, and COPD. The Appellant is seeking entitlement to DIC for service connection for the cause of the Veteran’s death. At the time of the Veteran’s death, service connection was in effect for bilateral hearing loss, tinnitus, and right knee degenerative joint disease. The Board previously remanded the Appellant’s claim for a medical opinion to determine the nature and etiology of the Veteran’s hypertension and hypertensive heart disease. The VA examiner opined that the Veteran’s death was less likely than not due to military service and not due to herbicide exposure while serving in the Republic of Vietnam. The medical opinion determined the available evidence at the time did not establish a positive association between herbicide exposure and hypertension. The medical opinion noted the National Academy of Sciences (NAS) 2010 and 2012 reports on the relation of hypertension and herbicides exposure and that the evidence overall includes a wide variety of results. The Veteran had active service in the Republic of Vietnam during the requisite time period and is, therefore, presumed to have been exposed to herbicide agents, to include Agent Orange. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(iii). The VA had previously determined that there is no positive association between exposure to herbicides and any other condition for which it has not specifically been determined that a presumption of service connection is warranted and entitlement to presumptive service connection is limited to the conditions listed in 38 C.F.R. § 3.309(e). 59 Fed. Reg. 341-46. Hypertension is not currently listed among the disabilities listed in 38 C.F.R. § 3.309(e) for which presumptive service connection is warranted. Nonetheless, current medical literature published in November 2018 suggests a potential relationship between exposure to herbicide agents and the onset of hypertension. The NAS in the most recent Agent Orange update, concluded there was “sufficient evidence of an association between exposure to the chemicals of interest and the following outcomes,” of which hypertension is listed. Veterans and Agent Orange: Update 11 (2018): Health and Medicine Division, http://www.nationalacademies.org/hmd/Reports/2018/veterans-and-agent-orange-update-2018.aspx (last visited December 18, 2018). ___ Fed. Reg. ___ (November 15, 2018). Given the new evidence indicating there may be an association between hypertension and herbicide agent, a new medical opinion regarding this theory must be obtained. The matter is REMANDED for the following action: Obtain a VA medical opinion as to the nature and etiology of the Veteran’s hypertension and hypertensive heart disease, particularly in light of the new determination of sufficient evidence of an association between hypertension and herbicide agent exposure. Following a thorough review of the claims file, the examiner should provide the following opinions: It is at least as likely as not (50 percent or better probability) that the Veteran’s hypertensive heart disease and/or hypertension is etiologically related to his active service, specifically to include his exposure to herbicides while serving in the Republic of Vietnam? In rendering the opinion, the examiner must consider the National Academy of Sciences Update 11, released November 2018, indicating a change in the association between chemicals of interest and hypertension. Please note Veteran’s other causes of death and determine if the other listed causes of death may be related to Veteran’s active duty service. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Mouzakis, Associate Counsel