Citation Nr: 20021938 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 14-33 564 DATE: March 30, 2020 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to November 1970, including service in the Republic of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) from a February 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The issue on appeal was denied by the Board in an April 2018 decision. The Veteran appealed this decision to the U.S. Court of Appeals for Veterans Claims (Court). In August 2019, pursuant to a Joint Motion for Remand (JMR), the Court vacated the Board’s decision and remanded the Veteran’s service connection claim for hypertension, for additional development and consideration. 1. Entitlement to service connection for hypertension is remanded. The Board notes that the Veteran has not been afforded a VA examination with regard to his claim for service connection for hypertension. The Board finds that one should be provided as the evidence shows a current disability and an in-service event. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). VA has conceded the Veteran’s exposure to Agent Orange based on his Vietnam service. Although VA has not conceded a relationship between hypertension and Agent Orange, it is significant to note that prior to 2006, the National Academy of Science (NAS) placed hypertension in the “Inadequate or Insufficient Evidence” category. However, in November 2018, the NAS published a new study reflecting there is now evidence of a positive association between hypertension and exposure to tactical herbicides rather than limited or suggestive evidence of an association. The suggestive evidence of an association is sufficient to establish an “indication” that the current disability “may be related” to herbicide exposure during service, as contemplated by 38 U.S.C. § 5103A(d)(2)(B). In this regard, the Court has described this threshold of the statute as being low. McLendon, 20 Vet. App. at 83. Given that no medical opinion has been offered as to whether the Veteran’s hypertension is related to his military service, including Agent Orange exposure, the Board finds that a remand for a VA examination is warranted. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA or private treatment records. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his hypertension. The claims folder must be made available to and be reviewed by the examiner. The examiner should offer a well-reasoned opinion as to whether it is at least as likely as not that the Veteran’s hypertension began in service, within one year of service separation, or is otherwise related to his time on active duty, to include his presumed exposure to herbicide agents, including Agent Orange. In answering these questions, the VA examiner should note that the Veteran is presumed to have been exposed to herbicide agents during service. The examiner should address the NAS Institute of Medicine’s upgrade of hypertension from its previous classification in the category of limited or suggestive evidence of an association with exposure to Agent Orange to the category of sufficient evidence of an association in Update 11 (2018). According to NAS, the sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. A complete rationale must be provided for all opinions expressed. If an opinion cannot be provided without resort to speculation, the examiner should provide reasons why this is so and state whether the inability to provide the needed opinion is due to the limits of medical knowledge or missing evidence. The examiner must consider all relevant lay and medical evidence of record. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G.C., 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.