Citation Nr: 21002330 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 16-43 257 DATE: January 13, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus or due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1961 to December 1967, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran and his wife testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This matter was previously before the Board in September 2020, when it was remanded for further development. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). 1. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus or due to Agent Orange exposure Regrettably, the Board finds a new VA opinion addressing direct service connection is needed prior to adjudicating the claim. The Board previously remanded the claim in September 2020 to obtain a VA addendum opinion addressing whether the Veteran’s current hypertension is at least as likely as not related to service, to include related to his presumed Agent Orange exposure. While a negative VA opinion was provided in September 2020, the opinion is not fully responsive to the remand directives. Specifically, the examiner did not adequately explain the relationship, if any, between the high blood pressure readings during service and currently diagnosed hypertension; did not adequately address the fact that the National Academies of Science, Engineering and Medicine (NAS) determined there is “sufficient” evidence of a relationship between herbicide exposure and the development of hypertension; and did not adequately address whether the current hypertension is directly related to the Veteran’s presumed exposure to Agent Orange, notwithstanding that hypertension is not a condition presumptively linked to herbicide exposure. Thus, another VA opinion is needed. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion, preferably provided by an examiner other than the individual who provided the June 2020 and September 2020 medical opinions, on the issue of direct service connection for hypertension. After reviewing the claims file, the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was incurred in or is otherwise related to service, to include his presumed Agent Orange exposure? The examiner must explain why or why not, to include addressing the significance, if any, between the Veteran’s current hypertension and his blood pressure readings during service (specifically, 140/85 and 130/78 in December 1965, 138/86 in January 1967 and 130/84 in November 1967); and the fact that the National Academies of Science, Engineering and Medicine (NAS) previously determined there was “limited/suggestive evidence of a relationship” between hypertension and herbicide exposure, but recently changed it to “sufficient” evidence of a relationship between herbicide exposure and the development of hypertension. The examiner must provide a complete rationale for the opinions and conclusions expressed. The Board advises the examiner that it needs an opinion addressing the likelihood that the Veteran’s hypertension is directly related to his Agent Orange exposure, without regard to the conditions VA recognizes as being presumptively due to Agent Orange. 2. If the claim remains denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. C. Birder 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.