Citation Nr: 21061405 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 13-20 905 DATE: October 4, 2021 REMANDED Service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to October 1969, to include service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (Board) from a June 2012 rating decision which denied service connection for hypertension as secondary to service-connected PTSD. In June 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In November 2017, July 2020, and May 2021, the Board remanded this matter for further development. Service connection for hypertension is remanded. The Veteran contends that service connection is warranted for hypertension as secondary to service-connected PTSD and as due to exposure to herbicide agents. The Veteran also asserts that he was diagnosed with hypertension shortly after service in the early 1970s. In June 2021, a VA examiner provided an addendum opinion. The examiner stated that, in the absence of records demonstrating an onset of hypertension within one year of service or at least proximate to service, it is more likely than not that this disability arose well after service and likely between 2000 and 2009. The examiner also stated that, while the National Academy of Sciences (NAS) 2018 update suggested an association between hypertension and exposure to herbicide agents, a review of medical literature did not show any articles confirming remote exposure to herbicide agents as a cause of hypertension. The Board unfortunately cannot make an informed decision at this time because the June 2021 VA addendum opinion is inadequate. While the examiner stated that the Veteran's hypertension likely began after 2000, the examiner did not consider an October 1977 treatment record that appears to indicate a prescription for blood pressure medications. Similarly, while the examiner discounted the NAS 2018 update, the examiner did not identify any other factors that were more likely to be the cause of the Veteran's hypertension, or indicate why other factors could not be identified. The agency of original jurisdiction (AOJ) should also provide the Veteran with a VA Form 21-4142 to obtain relevant private treatment records, to include from O.F. since 1972. In March 2018, the AOJ indicated that records could not be obtained from O.F. because this facility required a fee. See 38 C.F.R. § 3.159(c) (stating that the AOJ will not pay fees to obtain private records). It is not clear if the AOJ informed the Veteran that records could not be obtained from O.F. In light of the October 1977 treatment record, the AOJ should make another attempt to see if these records can be obtained without a fee. Because the AOJ may not be able to obtain these records on remand, the Veteran is informed that he can independently submit these records for consideration. The matter is REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records for the period from December 2020 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment for hypertension, to include from O.F. since 1972. Make two requests for the authorized records from each facility, unless it is clear after the first request that a second request would be futile. If records cannot be obtained from a facility, the AOJ should inform the Veteran that records could not be obtained and provide the Veteran with 30 days to obtain such records. 3. Following this development, obtain an addendum opinion from an appropriate clinician on whether it is at least as likely as not that the Veteran's hypertension (1) began during, or is related to, active service, to include as due to exposure to herbicide agents; (2) manifested within one year after discharge from service; or (3) was noted during service with continuity of the same symptomatology since service. (Continued on the next page.) The examiner is advised that a negative opinion regarding exposure to herbicide agents cannot be based solely on the fact that the National Academy of Sciences 2018 update identified only a positive association between hypertension and exposure to herbicide agents. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, 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.