Citation Nr: 20063333 Decision Date: 09/28/20 Archive Date: 09/28/20 DOCKET NO. 10-06 751 DATE: September 28, 2020 REMANDED Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II, and/or due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to February 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2016, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In March 2016 and April 2019, the Board remanded the claims of entitlement to service connection for hypertension and an acquired psychiatric disorder for additional development, While most recently on remand, a July 2020 rating decision granted service connection for posttraumatic stress disorder. As such is a fully grant of the benefit sought on appeal with regard to such claim, it is no longer before the Board. The remaining issue now returns for further appellate review. The Board notes that the Veteran was previously represented by the Maryland Department of Veterans Affairs; however, in November 2019, such service organization withdrew their representation. Therefore, the Veteran is unrepresented in the current appeal. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II, and/or due to exposure to herbicide agents. In the April 2019 Remand, the Board determined that, while the opinions of record adequately addressed whether the Veteran’s hypertension is directly related to his military service, or caused or aggravated by his diabetes mellitus, type II, such did not address whether his hypertension was related to his acknowledged in-service exposure to herbicide agents or manifested within one year of separation from service. Therefore, the claim was remanded to obtain an addendum opinion addressing such matters. In November 2019, a VA examiner reviewed the record and opined that it was less likely than not that the Veteran’s hypertension manifested within one year of his separation from service in January 1971, due to a lack of complaints or diagnosis until 2000. The VA examiner also opined that it was less likely than not that the Veteran’s hypertension was incurred in service or caused by exposure to herbicide agents. However, as a rationale for such opinion, she only stated that there is no medical data to support the contention that hypertension can be caused by exposure to herbicide agents. In this regard, such opinion failed to consider the potential association found by the National Academy of Science (NAS) Institute of Medicine (IOM) in Update 11 (2018) between hypertension and exposure to herbicide agents as directed in the April 2019 Remand. Consequently, a remand is necessary in order to obtain another addendum opinion to address such matter. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Forward the record and a copy of this remand to an appropriate VA examiner so as to obtain an addendum opinion addressing the etiology of the Veteran’s hypertension. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hypertension is related to his acknowledged in-service exposure to herbicide agents? In offering such opinion, the examiner should address the fact that NAS IOM upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with exposure to Agent Orange to the category of “sufficient” evidence of an association in Update 11 (2018). 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 examiner is advised that a negative nexus opinion cannot be solely based on the fact that hypertension is not on the list of diseases found to be presumptively related to exposure to herbicide agents. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Breckenridge, 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.