Citation Nr: 20002018 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 14-24 318 DATE: January 9, 2020 REMANDED Entitlement to service connection for hypertension, to include as due to diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States (U.S.) Army from October 1966 to July 1990. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision of a U.S. Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. In March 2018, the Board remanded this issue back to the RO for further development, which has been substantially completed. Entitlement to service connection for hypertension, to include as due to diabetes mellitus, type II, is remanded. The Veteran alleges, as an alternative to secondary to his service-connected diabetes, that his hypertension began during active duty or was due to in-service herbicide agent exposure in Vietnam. Hypertension is not a listed disease under 38 C.F.R. § 3.309(e) that is entitled to presumptive service connection due to herbicide agent exposure. However, service connection may also be established as directly due to in-service herbicide agent exposure in Vietnam. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The VA has a duty to assist, which includes providing a medical examination when necessary to make a decision on a claim. 38 C.F.R. § 3.159(c)(4)(i). The record contains sufficient evidence to trigger the VA’s duty to assist by providing a VA examination. In his May 2014 substantive appeal to the Board, the Veteran argues that he had hypertension during active duty, but this was misdiagnosed. The Veteran reported symptoms of “frequent spells of dizziness and weakness” during his active service that he had attributed to his peptic ulcers, which VA later connected to his service, but in retrospect the Veteran felt were symptoms of hypertension. A review of his service treatment record supports that he had complained of the following symptoms to his medical providers during his service. For example, in November 1967, he complained of “severe headaches and dizzy spells.” In September 1968 and January and April 1982, he complained of dizziness. In December 1969, January 1972, February 1975, July 1977, October 1980, March, April, and October 1981, February and May 1983, and May 1985, he also complained of headaches. In December 1980 and March 1982, he complained of headaches and his blood pressure was 130/90 or above. In February 1983, he complained of headaches and his systolic blood pressure was 130. The post-service medical records show a current diagnosis of hypertension. However, the record does not contain any evidence pertaining to whether the Veteran’s hypertension is related to herbicide agent exposure or otherwise related to an in-service injury, event, or disease to include the in-service complaints. Therefore, a VA examination for an opinion to determine the etiology of the Veteran’s hypertension is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following actions: 1. Obtain updated VA and/or identified pertinent private treatment records to the extent possible. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's hypertension. The examiner should review the Veteran’s claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. The examiner must opine on the following questions: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) hypertension is related to an in-service injury, event, or disease to include the complaints of dizziness, weakness and headaches during active duty. (b.) Whether it is at least as likely as not (a 50 percent or greater probability) hypertension is related to in-service herbicide agent exposure. Inform the examiner that 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 all opinions rendered, the examiner is advised that the Veteran is competent to report his in-service noise exposure and continued symptoms to the present. The examiner must specifically consider and discuss any lay statements of record and continuity of symptomology since service. The opinion and rationale should reflect such consideration. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A complete rationale for all opinions offered is requested. If a negative opinion is offered based primarily on the length of time between separation and the current diagnosis the examiner should explain the medical significance of this fact, i.e., why this is indicative that any current hypertension is not related to service. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional 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 particular question(s). 3. Readjudicate the appeal. If the full benefits sought for by the Veteran remain denied, issue a supplemental statement of the case and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James Hekel, Associate 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.