Citation Nr: 20031848 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 05-23 286 DATE: May 6, 2020 REMANDED Service connection for hypertension, to include as due to service-connected coronary artery disease (CAD).   REASONS FOR REMAND The Veteran served on active duty from August 1951 to October 1971. The case is on appeal from a March 2005 rating decision. In October 2015, the Veteran testified at a Board hearing. Most recently, in a February 2019 decision, the Board denied service connection for cataracts and basal cell carcinoma. At that time, the Board also remanded the hypertension claim for additional development. Service connection for hypertension, to include as due to service-connected CAD. The Veteran seeks service connection for hypertension. He maintains that his hypertension is a result of service, including presumed exposure to herbicides during service in Vietnam, or is secondary to service-connected CAD. As noted in the February 2019 Board remand, although hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e), the Veterans and Agent Orange: Update 11 (2018), by the National Academies of Sciences, Engineering and Medicine (NAS), upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association to Agent Orange to the category of “sufficient” evidence of an association. According to NAS, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. The May 2019 VA addendum opinion that it is less than likely the Veteran’s hypertension is related to service is based, at least in part, on a finding that the Veteran’s duties as an aircraft mechanic during service in Vietnam did not place him in the category of herbicide sprayer, which was noted to have the strongest association with hypertension. However, in a December 2019 submission, the Veteran stated that he was directly sprayed with herbicides while stationed in Bin Thuy, Vietnam. As such, the VA opinion is not completely adequate. Thus, obtaining a new medical addendum opinion is warranted. The matter is REMANDED for the following action: Obtain an addendum medical opinion as to the etiology of the Veteran’s hypertension. Specifically, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension is related to presumed exposure to herbicide agents during service. In rendering an opinion, please consider the November 2018 NAS study finding sufficient evidence of a positive association between hypertension and exposure to herbicides, as well as the Veteran’s competent lay statements. A complete rationale should be provided for any opinion rendered. The fact that hypertension is not listed as a presumptive disease should not be the sole rationale of an opinion, but rather the Veteran’s specific case should be considered. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor 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.