Citation Nr: 21001088 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 09-25 152 DATE: January 7, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1968 to November 1969. 1. Entitlement to service connection for hypertension is remanded. The Veteran seeks entitlement to service connection for hypertension. He contends that his hypertension is a result of his presumed exposure to herbicide agents during his Vietnam service. In the alternative, he contends that his hypertension is secondary to his service-connected diabetes mellitus disability. In an April 2019 decision, the Board denied the Veteran’s claim for entitlement to service connection for hypertension. The Veteran appealed the denial of his claim to the Court of Appeals of Veteran’s Claims (Court). In an April 2020 Order, the Court endorsed the parties’ findings in a Joint Motion for Remand (JMR) and vacated the April 2019 Board decision and remanded for compliance with JMR instructions. The parties to the JMR agreed that the Board failed to provide adequate reasons and bases when it relied on an October 2018 VA medical opinion that the Veteran’s hypertension was not result of his presumed exposure to herbicide agents. Although the October 2018 VA medical examiner noted consideration of extensive medical research, the VA examiner did not specifically discuss the findings of the National Academies of Science, Engineering and Medicine (NAS) Institute of Medicine’s (IOM) potential association between Agent Orange and hypertension as directed in the March 2018 remand instructions. Notably, the more recent IOM’s Agent Orange Update 11 (2018) 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 such an association. A remand is needed to obtain a new VA medical opinion that specifically considers the IOM’s report. In addition, the parties to the JMR agreed that the Board failed to provide adequate reasons and bases when it relied on an October 2018 VA medical opinion in determining that the Veteran’s hypertension was not secondary to his service-connected diabetes mellitus. Specifically, the parties noted that the October 2018 VA medical opinion used the incorrect standard regarding secondary aggravation by concluding the Veteran’s hypertension was not “permanently aggravated” by his diabetes mellitus disability. See Ward v. Wilkie, 31, Vet. App. 233, 340 (2019) (holding that “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation). A remand is needed to obtain new VA medical opinion that properly addresses whether the Veteran’s hypertension was proximately aggravated by his service-connected diabetes mellitus. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding whether the Veteran’s hypertension is at least as likely as not related to his presumed exposure to herbicide agents. The examiner must specifically reference, in the opinion rationale, the National Academy of Sciences (NAS) Institute of Medicine’s (IOM) Veterans and Agent Orange Updates, to include in 2018, which stated that there was “sufficient” evidence of an association between hypertension and herbicide exposure. 2. Obtain an addendum opinion regarding whether the Veteran’s hypertension is at least as likely as not proximately aggravated beyond its by service-connected diabetes mellitus disability. The opinion must address whether the Veteran’s hypertension increased in severity beyond its natural progression (i.e., was aggravated) by his service-connected diabetes mellitus. If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Murray 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.