Citation Nr: 20031341 Decision Date: 05/05/20 Archive Date: 05/05/20 DOCKET NO. 10-44 799 DATE: May 5, 2020 REMANDED Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and as secondary to service-connected posttraumatic stress disorder (PTSD) and diabetes mellitus (diabetes) is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps (USMC) from December 1968 to November 1970, with service in the Republic of Vietnam (RVN). This appeal comes to the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) September 2010 rating decision of the Agency of Original Jurisdiction (AOJ). In October 2016 the Veteran testified at a videoconference Board hearing. A transcript of the hearing has been reviewed by the Board and has been associated with the claims file. The Board notes that the Veterans Law Judge who conducted the hearing is no longer employed by the Board. However, in May 2018 the Veteran, through his representative, waived his right to another hearing. In April 2017 and June 2018, the Board remanded the Veteran’s claim for additional development, noting that the VA medical examinations conducted at that point were inadequate for adjudication purposes. The Board’s remand directives requested that an additional medical opinion regarding the etiology of the Veteran’s hypertension be acquired. A Board remand confers upon the appellant the right to a certain degree of compliance with that order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Substantial compliance, rather than strict compliance, is required. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). After a review, the Board finds that for the reasons discussed below, the requested VA examination is inadequate for adjudication purposes and therefore there has not been substantial compliance with the remand directives. 1. Entitlement to service connection for hypertension, to include exposure to herbicide agents and as secondary to service-connected posttraumatic stress disorder and diabetes mellitus is remanded. The Veteran contends that his hypertension is due to, or aggravated by, his service-connected PTSD and/or diabetes. Additionally, the Veteran contends that his exposure to herbicide agents, to include but not limited to Agent Orange, while deployed to the RVN caused his hypertension. While the Veteran claims his hypertension is somehow linked to his service-connected disabilities as well as exposure to herbicide agents, the etiology of hypertension is a complex medical determination that cannot be made by a lay person. Rather, only a qualified medical professional may offer probative evidence regarding the etiology of conditions such as hypertension. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has undergone VA examinations in August 2010, June 2017, and May 2019 to determine the cause of his hypertension. The Board has found the August 2010 and June 2017 VA examinations inadequate for adjudication purposes. In April 2017, the Board held that no VA examination at that time opined on whether the Veteran’s hypertension was secondary to his other service-connected disabilities. In June 2018 the Board held that the June 2017 exam was inadequate because it did not adequately address the relationship, if any, between PTSD and hypertension, nor did the examiner adequately address whether there is a relationship between the Veteran’s in-service exposure to herbicide agents and his hypertension. In May 2019 the Veteran was seen for another VA examination. The Board notes that the examiner’s opinions regarding secondary service connection are adequate, and no further development on those grounds is necessary. However, the examiner did not sufficiently address the Board’s remand directives regarding providing an opinion regarding exposure to herbicide agents and the subsequent development of hypertension. In its June 2018 remand, the Board noted that the “National Academy of Sciences (NAS) has found “limited or suggestive” evidence of a relationship between herbicide exposure and development of hypertension.” In the remand directives, the examiner was asked “to review the relevant literature” and provide their opinion after doing so. The May 2019 examiner claimed that a search on the NAS website found “no results for [their] search.” No further discussion or opinion regarding the relationship between herbicide exposure and hypertension was offered by the examiner. The Board notes that the examiner conducted a limited search and did not act with due diligence in researching the relevant medical literature. The Board’s directive to “review the relevant literature” should be construed broadly, in that the examiner should have looked at medical literature that was relevant to the opinion requested, in this case the relationship, if any, between exposure to herbicide agents and hypertension. The Board finds that due to the lack of rationale given by the May 2019 examiner, combined with a lack of discussion of relevant medical literature as directed by the Board’s June 2018 remand directives, the opinion provided by the May 2019 examiner regarding whether or not the Veteran’s hypertension is related to his military service is inadequate for adjudication purposes. While the Board regrets the additional delay, a further remand is necessary to more fully develop the Veteran’s claim. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion as to whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran’s hypertension is related to his exposure to herbicide agents, to include but not limited to Agent Orange. The examiner is instructed to review medical literature and scholarly articles on the matter, which should be discussed and cited in their opinion. This include the “National Academy of Sciences (NAS)” which has found “limited or suggestive” evidence of a relationship between herbicide exposure and development of hypertension. Any opinion given by the examiner must be accompanied by a complete rationale for their decision. If the examiner is unable to provide an opinion without resorting to mere speculation, they must state why that is the case. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.