Citation Nr: 20039959 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 15-08 091 DATE: June 11, 2020 REMANDED Entitlement to service connection for hypertension, to include as secondary to exposure to an herbicide agent, for accrued benefits and/or substitution purposes is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1955 to March 1974. He died in May 2014 and the appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In November 2016, the appellant testified before a Veterans Law Judge (VLJ) who is no longer at the Board. In January 2019, the appellant declined a second hearing before a different VLJ. This case has been remanded previously, most recently in April 2019 for additional development. The case has been returned to the Board for adjudication. 1. Entitlement to service connection for hypertension The appellant contends that the Veteran’s diagnosed hypertension was etiologically related to his exposure to an herbicide agent in service. In April 2019, the Board remanded this matter in order to obtain a VA medical. Specifically, the Board directed VA to obtain an opinion that addressed the National Academies of Sciences, Engineering and Medicine’s (NAS) Veterans and Agent Orange: Update 11, released on November 15, 2018. In this most recent update, the NAS upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with herbicide exposure, 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 April 2019 Board decision found that remand was appropriate for the purpose of obtaining a new VA medical opinion addressing the issue of whether there is a nexus between the Veteran’s exposure to herbicides in service and his diagnosed hypertension in consideration of this evidence. In February 2020, a VA examiner provided a medical opinion concerning the Veteran’s hypertension. The examiner opined that the Veteran’s hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran’s service treatment records were silent to support the diagnostic criteria for hypertension and were silent for treatment for hypertension while in service. The examiner further opined that the Veteran’s hypertension was less likely than not caused by exposure to herbicides during service. The examiner reasoned that the medical literature research is silent for a causal relationship between any herbicides used in the Republic of Vietnam to later cause hypertension to develop. The examiner addressed Veterans and Agent Orange: Update 11, by noting that while the literature suggests hypertension is associated with exposure to herbicides used in the Republic of Vietnam, a true causal relationship had not been clearly established by the medical literature. The Board finds the February 2020 VA examiner’s negative opinion is not adequate for adjudication. The February 2020 examiner’s reasoning stated that the medical literature only “suggests” an association between herbicide exposure and hypertension. However, as the April 2019 Board remand noted, the Veterans and Agent Orange: Update 11, specifically upgraded the category to “sufficient evidence” of association. It appears that the examiner failed to fully address the Veterans and Agent Orange: Update 11’s conclusions as they related to the Veteran’s claim. Thus, a remand is required for an adequate opinion. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate VA examiner addressing whether it is at least as likely as not that the Veteran’s hypertension had its onset in service, was manifest within one year of separation, or was related to an injury or disease incurred in service, including his presumed exposure to herbicide agents. In reaching his or her conclusions, the examiner should review and consider the findings of the Veterans and Agent Orange: Update 11, released on November 15, 2018, and the determination of the NAS to upgrade hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with herbicide exposure, to the category of “sufficient” evidence of an association. Complete rationale for all opinions expressed should be provided. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.