Citation Nr: 20022286 Decision Date: 03/31/20 Archive Date: 03/31/20 DOCKET NO. 04-12 074A DATE: March 31, 2020 ISSUES 1. Entitlement to service connection for hypertension, to include as due to herbicide exposure, and as secondary to the service-connected ischemic heart disease. 2. Entitlement to service connection for headaches, to include as due to herbicide exposure, and as secondary to the service-connected anxiety reaction, and as secondary to hypertension. 3. Entitlement to service connection for glaucoma, to include as secondary to hypertension. REMANDED Entitlement to service connection for hypertension, to include as due to herbicide exposure, and as secondary to the service-connected ischemic heart disease is remanded. Entitlement to service connection for headaches, to include as due to herbicide exposure, and as secondary to the service-connected anxiety reaction, and as secondary to hypertension is remanded. Entitlement to service connection for glaucoma, to include as secondary to hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1959 to August 1966. Service in the Republic of Vietnam as well as receipt of the Purple Heart and Combat Infantryman Badge are indicated by the record. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Jurisdiction is currently held by the RO in Detroit, Michigan. In October 2014 a travel Board hearing was held before the undersigned Veterans Law Judge (VLJ). A transcript of this proceeding has been associated with the record. In a May 2019 decision, the Board denied the Veteran’s claims on appeal. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In December 2019 the Veteran filed a joint motion for remand (JMR). The Court granted the JMR in the same month and remanded the claim to the Board. Pursuant to the JMR, the Board notes that since a January 2017 VA examiner’s opinion, the National Academy of Sciences, Engineering and Medicine (NAS) released the 2018 update to the report “Veterans and Agent Orange” wherein hypertension was upgraded from its previous classification in the category of “limited or suggestive” evidence of an association to herbicide agents, to the category of “sufficient” evidence of an association to herbicide agents. According to the NAS, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide agent exposure. The Board declines to take judicial notice of the findings and conclusions found in the 2018 update to the NAS report, as this literature does not include facts of universal notoriety that are not subject to reasonable dispute. Monzingo v. Shinseki, 22 Vet. App. 97, 103 (2012). However, the Board will take judicial notice that the 2018 update to the NAS report “Veteran and Agent Orange” exists, and finds than an addendum medical opinion is warranted for an appropriate VA examiner to consider this report in relationship to the Veteran’s medical history. Additionally, as to the claim of entitlement to service connection for headaches, the Veteran has argued that they are caused or aggravated by his service-connected anxiety reaction. As such, this theory of service connection should be addressed in the requested addendum opinion. The matters are REMANDED for the following action: 1. Provide access to the Veteran’s electronic claims file to the January 2017 VA examiner, or a suitable substitute if this individual is not available, for an addendum opinion. If the examiner determines that the Veteran should be provided another examination, one should be scheduled. Following a review of the file, the examiner should provide the following opinions: a. Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s hypertension had its onset in service, or is otherwise etiologically related to his period of active duty service, to include his credible report of herbicide exposure during service in Vietnam. In making this determination, the examiner should address the NAS 2018 updates in which hypertension was upgraded from its previous classification in the category of “limited or suggestive” evidence of an association to herbicide agents, to the category of “sufficient” evidence of an association to herbicide agents. The examiner should also address the Veteran’s contention of experiencing high blood pressure within the first year after discharge from service as well as medical treatment record dated October 1966 documenting a blood pressure reading of 130/80. b. Whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s hypertension is related to or was aggravated (i.e., permanently worsened beyond the normal progression of the disability) by his service-connected ischemic heart disease. c. Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s diagnosed headaches disability is related to his active military service, to include his credible report of herbicide exposure during service in Vietnam. d. Whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s headaches are related to or aggravated (i.e., permanently worsened beyond the normal progression of the disability) by his service-connected ischemic heart disease. e. Whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s headaches are related to or aggravated (i.e., permanently worsened beyond the normal progression of the disability) by his service-connected anxiety reaction. f. If, and only if, the examiner determines that the Veteran’s hypertension is related to his military service or his service-connected ischemic heart disease, whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s headaches are related to or aggravated (i.e., permanently worsened beyond the normal progression of the disability) by his hypertension. g. If, and only if, the examiner determines that the Veteran’s hypertension is related to his military service or his service-connected ischemic heart disease, whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s glaucoma is related to or aggravated (i.e., permanently worsened beyond the normal progression of the disability) his hypertension. The examiner should indicate in his/her report that the claims file was reviewed. A rationale for all opinions expressed should be provided. A report should be prepared and associated with the record. 2. When the development requested has been completed, the case should be reviewed on the basis of additional evidence. If the benefits sought are not granted, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.M.K., 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.