Citation Nr: 19130985
Decision Date: 04/19/19	Archive Date: 04/19/19

DOCKET NO. 13-01 440
DATE:	April 19, 2019

REMANDED

Entitlement to service connection for hypertension is remanded.

REASONS FOR REMAND

The Veteran served on active duty from August 1969 until May 1971, including service in the Republic of Vietnam.  This matter comes before the Board of Veterans’ Appeals (Board) from a July 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 

The Board remanded this claim for additional development in February 2016 and July 2017.  

In April 2018, the Board requested an advisory opinion from the Veterans Health Administration (VHA). An opinion was received in September 2018. The Board requested an addendum opinion in September 2018, which was received in November 2018.   In January 2019, the Veteran was given 60 days to respond to the opinions.  He submitted additional arguments after the conclusion of this period.

 

Entitlement to service connection for hypertension is remanded.

The Veteran seeks service connection for hypertension.  He had advanced several theories of entitlement to include as the result of exposure to herbicide agents, or in the alternative, as secondary to service-connected coronary artery disease (CAD) and or diabetes mellitus. 

In April 2018, the Board requested a VHA advisory opinion regarding his presumed herbicide agent exposure.  In the request, the Board indicated that the expert medical opinion should include review of the National Academy of Sciences (NAS) finding of “limited or suggestive evidence of an association” between herbicide exposure and hypertension.  

In the September 2018 VHA opinion, the examiner did not specifically list the NAS finding but stated that review of the medical literature showed no correlation between hypertension and exposure to herbicides.  In the November 2018 addendum opinion, the specialist reiterated that the medical literature shows no correlation between hypertension and exposure to herbicide agents. No specific mention of the NAS findings was included.  

In an April 2019 brief, the Veteran’s representative argued that the advisory opinions are devoid of any analysis and review of the NAS findings.  Further, the representative argued that relevant medical literature has since shown a sufficient evidentiary link between herbicide agent exposure and hypertension.  The representative referred to the most recent NAS findings in 2018 (NAS Veterans and Agent Orange: Update 11 (2018)). In Update 11 NAS indicates there is sufficient evidence of an association between hypertension and herbicide exposure.  

In November 2018, almost simultaneous to the VHA addendum, the NAS moved hypertension to the category of “sufficient” evidence of an association, which 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.  While this evidence alone is insufficient to grant the claim, it implicates the need for a new VA opinion addressing all the relevant medical evidence, to include the latest NAS findings.

The matter is REMANDED for the following action:

Obtain an addendum opinion on the etiology of the Veteran’s hypertension.  The examiner should opine as to whether it is at least as likely as not that the Veteran’s hypertension is related to his presumed exposure to herbicide agents.

In doing so, the examiner should review the file and a copy of this remand.  The examiner must consider the November 2018 Update 11 NAS study finding “sufficient” evidence of a positive association between hypertension and exposure to tactical herbicides. See http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137. 

(Continued on the next page)

 

A complete rationale must be provided.  The fact that hypertension is not listed as a presumptive disease cannot be the sole rationale of an opinion, but rather the circumstances of this Veteran’s specific case should be considered.

 

D. JOHNSON

Veterans Law Judge

Board of Veterans’ Appeals

ATTORNEY FOR THE BOARD	K. Vuong, Associate Counsel