Citation Nr: 21003359 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-19 707 DATE: January 21, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus type II and exposure to herbicide agents, is remanded. Entitlement to a rating in excess of 30 percent for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1960 to July 1964, and from July 1966 to August 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA), and has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107. The Veteran testified during a hearing before the undersigned Veterans Law Judge in April 2019. A transcript of the hearing is associated with the claims file. In November 2019, the Board remanded claims of entitlement to service connection for right ear hearing loss, service connection for hypertension, and a compensable rating for left ear hearing loss for further development. After performing additional development, the agency of original jurisdiction (AOJ) granted service connection for bilateral hearing loss, assigned a 30 percent rating from December 6, 2012, and indicated that it constituted a full grant of the appeal. However, the Board observes that the Veteran was not granted the maximum schedular rating for hearing loss, so his claim remains pending. See AB v. Brown, 6 Vet. App. 35 (1993). The AOJ has yet to issue a Supplemental Statement of the Case (SSOC) as to an increased rating for bilateral hearing loss; therefore, the Board will assume jurisdiction for the limited purpose of remanding the matter for issuance of a SSOC. Regarding the claim for service connection for hypertension, the AOJ was asked to obtain a medical opinion discussing whether hypertension was directly related to exposure to herbicide agents and whether it is proximately due to, a result of, or aggravated by service-connected diabetes mellitus. The Veteran appeared for an examination in October 2020. After reviewing the report, the Board finds that it does not comply with the remand directives, and further clarification is necessary. The October 2020 examiner concluded that the Veteran’s hypertension “could not have been caused or aggravated by his [service-connected diabetes mellitus type II], a clear nexus is not established.” However, he did not provide any rationale or further explanation for his conclusions. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Moreover, despite the Board’s directive to do so, the examiner did not address the study in the National Academy of Sciences dated November 2018, concluding that hypertension was moved from the “limited or suggestive” to the “sufficient” category for association with herbicide agents. Thus, an addendum medical opinion is necessary. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) The matters are REMANDED for the following actions: 1. Please obtain a medical opinion from a suitably qualified clinician regarding the etiology of the Veteran’s hypertension. ONLY IF the clinician determines that a VA examination is necessary to answer the questions below should one be scheduled. The clinician is asked to review the claims file and opine on the following: (a) Is it at least as likely as not that the Veteran’s hypertension had its onset during or is etiologically related to active military service, to include exposure to herbicide agents? (b) Is it at least as likely as not that the Veteran’s hypertension is proximately due to, a result of, or aggravated by, a service-connected disorder to include diabetes mellitus type II? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: • The November 2018 study from the National Academy of Sciences moving hypertension from the “limited or suggestive” to the “sufficient” category for exposure to herbicide agents • The article from WebMD titled “Diabetes and High Blood Pressure” located at the following link: https://www.webmd.com/diabetes/high-blood-pressure#:~:text=Diabetes%20damages%20arteries%20and%20makes%20them%20targets%20for,pressure%20readings%2C%20people%20with%20hypertension%20more%20often%20have%3A • The Veteran’s lay statements, to include contentions that he was diagnosed with hypertension during military service and that his hypertension is related to diabetes mellitus type II and exposure to herbicide agents The clinician is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the clinician’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. 2. After performing any necessary development, readjudicate the Veteran’s claim of entitlement to a rating in excess of 30 percent for bilateral hearing loss in a Supplemental Statement of the Case. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.