Citation Nr: 20056487 Decision Date: 08/26/20 Archive Date: 08/26/20 DOCKET NO. 15-38 731 DATE: August 26, 2020 REMANDED Entitlement to service connection for hypertension, including as due to herbicide exposure, is remanded. Entitlement to service connection for Bell's Palsy is remanded. REASONS FOR REMAND The Veteran served active duty service from May 1966 to July 1970, including reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). 38 U.S.C. § 7107 (a)(2). 1. Entitlement to service connection for hypertension, including as due to herbicide exposure, is remanded. 2. Entitlement to service connection for Bell's Palsy is remanded. In the November 2018 Board remand, the RO was requested to provide medical opinions and a VA examination for the Veteran’s disabilities listed above. The Veteran was provided two VA examinations in September 2019. First, in the hypertension VA examination, the VA examiner opined that it is less likely than not that the Veteran’s hypertension was incurred in or caused by his active duty service. The VA examiner reasoned that available records are negative for a hypertension diagnosis during active duty service from 1966 to 1970. Also, the VA examiner reasoned that the Veteran’s single elevation documented in 1971 is not sufficient to establish a hypertension diagnosis at that time, and the predominantly normal blood pressure measurements prior to 1978 do no support an onset of hypertension during or within the year after separation from active duty service. Additionally, the VA examiner opined that it is less likely than not that the Veteran’s hypertension is due to herbicide exposure. The VA examiner concluded that herbicide exposure has not been established as a risk factor for the development of hypertension. Second, in the Bell’s Palsy VA examination, the VA examiner opined that it is less likely than not that the Veteran’s Bell’s Palsy was incurred in or caused by his military service. The VA examiner reasoned that the Veteran’s service treatment records (STRs) are negative for a diagnosis or treatment for Bell’s Palsy while on active duty service, including during his reserve service. Further, the VA examiner reasoned that the 1984 STR that references the Veteran’s Bell’s Palsy is not accompanied by medical treatment records to support the actual onset of a Bell’s Palsy diagnosis in relation to his 1983 Active Duty for Training (ACDUTRA) service. The Veteran is entitled to substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Here, the VA examiner’s opinion regarding direct service connection for the Veteran’s hypertension was primarily based no STRs noting a hypertension diagnosis. The VA examiner did not address the Veteran’s lay hypothesis that his current hypertension is due to the stresses of active duty. Similarly, the VA examiner’s opinion regarding the Veteran’s Bell’s Palsy was primarily based on no STR noting treatment for Bell’s Palsy. The VA examiner did not address the Veteran’s lay hypothesis that during ACDUTRA service, he had a bad cold that resulted in a pinched nerve causing his Bell’s Palsy. Therefore, supplemental medical opinions are necessary addressing the etiologies of the Veteran’s disabilities and his lay contentions. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The matters are REMANDED for the following action: 1. Provide the Veteran’s claims file to a suitable examiner to determine the etiology of the Veteran’s hypertension. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the July 2018 Board hearing testimony where the Veteran hypothesized that his hypertension was due to some of the stresses of active duty such as flying. The examiner must provide opinions as to the following: a. Whether the Veteran’s hypertension is at least as likely as not (50 percent or greater probability) began during active service, or is related to an incident of service, including experiences he found to be stressful. b. Whether the Veteran’s hypertension is at least as likely as not (50 percent or greater probability) related herbicide exposure. It is not sufficient to provide a negative opinion solely based on the fact that herbicide exposure has not been established as a risk factor for the development of hypertension. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. 2. Provide the Veteran’s claims file to a qualified examiner to determine the etiology of the Veteran’s Bell’s Palsy. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination(s) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the July 2018 Board hearing testimony where the Veteran hypothesized that during ACDUTRA he had a bad cold that resulted in a pinched nerve causing his Bell’s Palsy. The examiner must opine as to whether the Veteran’s Bell’s Palsy is at least as likely as not (50 percent or greater probability) began during active service, or is related to an incident of service, including his claims of a cold and a pinched nerve. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. (Continued on the next page)   3. If the claims remain denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran an opportunity to respond. The case should then be returned to the Board, if in order, for further review. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Willoughby, 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.