Citation Nr: 21062788 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-34 222 DATE: October 12, 2021 REMANDED Entitlement to service connection for a disability manifested by hardened arteries, to include as due to exposure to herbicide agents and/or as secondary to service-connected diabetes mellitus type II and/or hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1965 to May 1995, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2013 by a Department of Veterans Affairs (VA) Regional Office. In November 2016, the Veteran testified at a hearing before a Decision Review Officer (DRO). A transcript of the hearing is associated with the record. Additionally, while he was informed that his requested Board hearing was scheduled for September 2019, he failed to report for it. Thus, such request is deemed withdrawn. 38 C.F.R. § 20.704(d). In April 2019 and March 2021, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for a disability manifested by hardened arteries, to include as due to exposure to herbicide agents and/or as secondary to service-connected diabetes mellitus type II and/or hypertension. In the March 2021 remand, the Board determined that, while a January 2020 VA examiner found that the Veteran did not have a diagnosis of coronary arteriosclerosis (hardening of arteries), additional evidence reflected the possible presence of non-coronary arteriosclerosis, and thus remanded the claim in order to afford the Veteran a VA examination so as to determine the nature and etiology of such disorder, to include whether such was related to his military service, to include his acknowledged in-service exposure to herbicide agents, or caused or aggravated by his service-connected diabetes mellitus, type II, and/or hypertension. Thereafter, at a June 2021 VA examination, a diagnosis of peripheral vascular disease (PVD) was rendered. However, the examiner opined that such disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, he noted that the Veteran was diagnosed with PVD in 2010 with risk factors of diabetes and hypertension, which was reflected by a May 25, 2010, Consultation Report from McLeod Regional Medical Center. The examiner further found that the Veteran's service treatment records (STRs) did not show PVD and such was not a disease acknowledged to be presumptively related to exposure to herbicide agents. However, as the examiner based his opinion that the Veteran's PVD was less likely than not related to his acknowledged in-service exposure to herbicide agents solely on the fact that such disease has not been recognized by VA to be presumptively related to such exposure, the Board finds that such is inadequate to decide the claim. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). Thus, a remand is necessary in order to obtain an addendum opinion addressing such matter. The examiner also opined that it was less likely than not that the Veteran's PVD was caused by his service-connected diabetes mellitus, type II, and/or hypertension. In support thereof, he explained that PVD was caused by atherosclerosis and plaque formation inside the artery wall reducing blood flow, which was due to hyperlipidemia/cholesterol. The examiner further opined that the Veteran's PVD was at least as likely as not aggravated beyond its natural progression by his service-connected diabetes mellitus, type II, and/or hypertension, but also concluded that he could find no event, exposure, or evidence that such disorder was aggravated by his service-connected disabilities. However, as the examiner offered a conflicting opinion regarding whether the Veteran's PVD was aggravated by his diabetes mellitus, type II, and hypertension, and did not consider the relevancy that such were noted risk factors for the development of his PVD in the May 25, 2010, Consultation Report from McLeod Regional Medical Center, the Board finds that a remand is necessary in order to obtain an addendum opinion addressing such matters. The matter is REMANDED for the following action: Return the record, to include a copy of this Remand, to the June 2021 VA examiner who offered an opinion addressing the etiology of the Veteran's disability manifested by hardened arteries, currently diagnosed as PVD. If the VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's currently diagnosed PVD is related to his acknowledged in-service exposure to herbicide agents? The examiner is advised that his/her rationale cannot be based solely on the fact that VA has not included PVD on the list of diseases acknowledged to be presumptively related to herbicide agents. In other words, the Board needs an opinion as to the likelihood that the Veteran's PVD is related to his in-service exposure to herbicide agents despite the fact such is not included on the presumptive list. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's currently diagnosed PVD is caused or aggravated by his service-connected diabetes mellitus type II and/or hypertension? For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In offering such opinion, the examiner should consider the May 25, 2010, Consultation Report from McLeod Regional Medical Center reflecting a diagnosis of PVD with risk factors of diabetes and hypertension. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark 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.