Citation Nr: 18159914 Decision Date: 12/21/18 Archive Date: 12/20/18 DOCKET NO. 17-05 473A DATE: December 21, 2018 REMANDED Entitlement to service connection for hypertension, to include as due to Agent Orange exposure. is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Air Force from September 1964 to September 1990. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) 1. Entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. The Veteran contends that his hypertension is due to Agent Orange exposure while serving on Ubon Airfield in Thailand from August 1968 to August 1969, and in Korat, Thailand from January 1971 to December 1971. See Notice of Disagreement, August 2016. The Board acknowledges that for the purposes of determining whether the Veteran was exposed to herbicide agents during service in Thailand, VA has established a procedure for verifying exposure to herbicide agents in Thailand during the Vietnam era. Exposure to herbicide agents may be established on a factual basis for veterans whose duties placed them on or near the perimeters of Thailand military bases. In this case, the Veteran’s military personnel records indicate he worked as an illuminator operator on the AC-130A Gunship while serving at Ubon airfield in Thailand, where they sprayed chemicals. However, there is no indication of whether these duties or his duties in Korat, Thailand placed him at or near the base perimeters. Therefore, further development is necessary to determine whether the Veteran’s contention of herbicide agents exposure can be verified. Also, VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. The Board finds that there is enough evidence in this instance to trigger VA’s duty to assist to provide a VA examination to evaluate whether the Veteran’s hypertension should be service-connected on a direct basis. The Veteran’s service treatment records (STRs) document that he experienced high blood pressure during active duty on at least two occasions. See e.g., Dental Patient Medical History, September 1988, Report of Medical Examination, July 23, 1990. A summary of defects and diagnoses on the Veteran’s separation examination lists borderline high blood pressure. Notably, the Veteran’s elevated blood pressure which was noted after physical activity required further monitoring. Id. Also of significance is the Veteran’s service entrance medical examination report that documents prior rheumatic fever and a pre-existing systolic Grade I murmur that increased with activity. See Report of Medical Examination, June 1964. Finally, the Veteran indicated in response to VA’s Statement of the Case that he was diagnosed with hypertension within the specific time after retirement from the Air Force. See VA Form-9, February 2017. Since such medical records may relate to a theory of entitlement, on remand they should be associated with the Veteran’s claims file. The matter is REMANDED for the following actions: 1. Contact the Veteran, and, with his assistance, identify and obtain any outstanding records of pertinent medical treatment for his hypertension from VA or private health care providers, to specifically include those that he believes would show a diagnosis of hypertension within one year of his retirement from the Air Force. 2. Ask the Veteran to report the specific nature of the herbicide agents exposure he alleges occurred during active duty service to specifically include whether his duties or other activities at Ubon Airfield and Korat in Thailand, placed him on or near the perimeter (edges) of the base and if so how often. If the AOJ determines that the Veteran’s duties placed him on or near the perimeter of the base the AOJ should concede exposure to herbicide agents. 3. Following the above development, obtain a VA examination and opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s hypertension. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. (a.) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s hypertension had its onset during active service, or is otherwise related to active service (to include exposure to herbicide agents, if applicable). The examiner is advised that the Board is cognizant that there is no VA presumption of service connection for hypertension as due to herbicide agents exposure. The Agent Orange Updates speak to associations between exposure to chemicals and health outcomes in human populations, and not to the likelihood that any individual’s health problem is associated with or caused by the herbicides in question. Thus, the question here is what is the likelihood that this Veteran’s hypertension is related to his herbicide agent exposure (if it is shown that he was exposed to such) given his medical history, family history, and other risk factors. (b.) Is there clear and unmistakable (undebatable) evidence that the Veteran’s hypertension preexisted service, and if so was it aggravated (permanently worsened) during, or was it a result of the Veteran’s active duty service? In rendering an opinion, the examiner is asked to specifically address the Veteran’s enlistment examination June 1964 which documented a systolic Grade I heart murmur that increased with activity and his history of rheumatic fever. (c.) If there was an aggravation (permanent worsening) of the preexisting disability, is there clear and unmistakable (undebatable) evidence that this aggravation (permanent worsening) was due to the natural progress of the condition? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Alexander, Associate Counsel