Citation Nr: 19149054 Decision Date: 06/25/19 Archive Date: 06/24/19 DOCKET NO. 14-11 018 DATE: June 25, 2019 REMANDED Entitlement to service connection for hypertension, to include as due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to July 1968, which includes service in the Republic of Vietnam. This matter initially came before the Board of Veterans’ Appeals (Board) from an April 2012 rating decision. In October 2015 and January 2018, the Board remanded this matter for further development. Entitlement to service connection for hypertension, to include as due to Agent Orange exposure, is remanded. The Veteran contends that he has hypertension which is related to service, to include his presumed exposure to Agent Orange in Vietnam. In February 2018, a VA physician reviewed the Veteran’s claims file and opined that it was not likely that his hypertension had its onset in service or within the one year following service, or was otherwise related to service. He reasoned, in pertinent part, that there was no evidence of a diagnosis of or treatment for hypertension in the Veteran’s service treatment records, that hypertension was first diagnosed in approximately 1995, and that there was no known mechanism by which remote chemical exposure could cause hypertension with an onset approximately 29 years later. The physician acknowledged findings by the National Academy of Sciences (NAS) that there was limited or suggestive evidence of an association between hypertension and Agent Orange exposure, but he explained that “limited or suggestive evidence” does not prove a causal association on an “as likely as not” basis. Moreover, the physician explained that there was no evidence in the Veteran’s claims file that Agent Orange “definitively” caused his hypertension and that there was no “definitive proof” in the medical literature that environmental exposure to Agent Orange caused his hypertension. The February 2018 opinion is inadequate because subsequent to the opinion, the NAS moved hypertension from the “limited or suggestive” category and indicated that there is now “sufficient evidence” of an association between hypertension and Agent Orange exposure. See Veterans and Agent Orange: Update 11 (2018). In addition, the Board points out that it does not need to be shown that Agent Orange “definitively” caused the Veteran’s hypertension. Rather, it need only be “at least as likely as not” (i.e. at least a 50 percent probability) that a relationship exists between his hypertension and Agent Orange exposure. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for hypertension because no VA examiner has adequately opined whether the Veteran’s hypertension is related to his Agent Orange exposure in service. Therefore, an appropriate medical opinion should be obtained upon remand. Also, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the VA Northern California Health Care System and are dated to December 2018. Any VA treatment records are within VA’s constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. The matter is REMANDED for the following action: 1. Ask the Veteran to identify the location and name of any VA or private medical facility where he has received treatment for hypertension, to include the dates of any such treatment. Ask the Veteran to complete a VA Form 21-4142 for all records of his treatment for hypertension from any sufficiently identified private treatment provider from whom records have not already been obtained. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s outstanding VA treatment records from the VA Northern California Health Care System for the period since December 2018; and all such relevant records from any other sufficiently identified VA facility. 3. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an addendum opinion from an appropriate clinician regarding whether any hypertension experienced by the Veteran since approximately August 2010 at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service; or (3) is related to an in-service injury, event, or disease, including his presumed exposure to Agent Orange. The clinician must provide reasons for each opinion given. In this regard, the clinician should address the NAS’s determination that there is now sufficient evidence of an association between hypertension and Agent Orange exposure (See Veterans and Agent Orange: Update 11 (2018)). The fact that hypertension is not yet on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Elwood, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.