Citation Nr: 18161124 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-41 008A DATE: December 28, 2018 REMANDED Entitlement to an initial rating in excess of 30 percent disabling for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for hypertension, to include as due to in-service exposure to herbicide agents, is remanded. REASONS FOR REMAND Introduction The Veteran served on active duty in the United States Army from August 1969 to March 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. The Board finds that additional development is required before the claims on appeal are decided. 1. Entitlement to an initial rating in excess of 30 percent disabling for PTSD The Board notes that in the Veteran’s Form 9, the Veteran asserted that his PTSD has worsened since his most recent VA PTSD examination, which was conducted in May 2014. The Veteran stated that his psychiatric symptoms, included difficulty establishing and maintaining relationship both at work and socially, depression, and nightmares. Moreover, he stated that his psychiatric symptoms are affecting his income and his marriage. Where a Veteran asserts that a disability has worsened since his last VA examination, and the last examination is too remote to constitute a contemporaneous examination, a new examination is required. See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). See also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Therefore, the Board finds that an additional VA examination is necessary to assess the current severity of the Veteran’s service-connected PTSD. 2. Entitlement to service connection for hypertension The Veteran has asserted entitlement to service connection for hypertension. A diagnosis of hypertension appears in the Veteran’s VA outpatient records. The Veteran contends that his hypertension was caused by in-service exposure to herbicide agents. The Board notes that exposure to herbicides (to include Agent Orange) is presumed for veterans who served in the Republic of Vietnam during the Vietnam War. See 38 C.F.R. § 3.307 (a)(6)(iii). Because the record shows the Veteran had such service, in-service herbicide exposure is presumed. While certain conditions are presumptively service-connected on the basis of in-service herbicide exposure, hypertension is not among them. See 38 C.F.R. § 3.309 (e) (2017). However, recently the National Academy of Science (NAS) issued the 2018 Veterans and Agent Orange Update, which in turn found “sufficient” evidence of an association between hypertension and herbicide agent exposure. Therefore, a new examination must be obtained to consider this new finding. The Board next notes that VA must provide a medical examination or obtain a medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing that certain diseases manifested during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C.A. § 5103A (d)(2) (West 2015); 38 C.F.R. § 3.159 (c)(4)(i) (2017). The third prong, which requires that the evidence of record “indicate” that the claimed disability or symptoms “may be” associated with the established event, disease or injury is a low threshold. McLendon, 20 Vet. App. at 83. In this case, no VA examination has been obtained to address the Veteran’s hypertension claim. Under the circumstances outlined above, the Board finds VA must provide such examinations pursuant to McLendon. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by a psychiatrist or psychologist with sufficient expertise to fully assess the severity of the Veteran’s service-connected PTSD. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay statements. The examiner must provide all information required for rating purposes. If the examiner is unable to conduct any required testing or concludes any required testing is not necessary, he or she should clearly explain why that is the case. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his hypertension. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated tests and studies should be performed. Following the examination and a review of the relevant records and lay statements, the examiner should state whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension originated during or is otherwise etiologically related to his military service, to include his presumed in-service exposure to herbicide agents. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) In providing his or her opinion, the examiner must address the Veteran’s statements to the effect that he never had hypertension or high blood pressure prior to service. A clear rationale for all opinions should be expressed, and a discussion of the facts and medical principles involved should be noted. (Continued on the next page)   3. After completing the above development, and after conducting any additional development deemed necessary, the RO should readjudicate the claim. If it remains denied, the Veteran should be provided with a supplemental statement of the case and an opportunity to respond before the case is returned to the Board. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Dion Roberts, Law Clerk