Citation Nr: 21063740 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-23 978 DATE: October 15, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to in-service herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1964 to January 1966. In November 2020, the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) denied the Veteran's claim of entitlement to service connection for hypertension, to include as due to in-service herbicide exposure. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a May 2021 Joint Motion for Remand (JMR) filed by the parties and a June 2021 Court Order, the Court has remanded the claim back to the Board. Entitlement to service connection for hypertension, to include as due to exposure to herbicide exposure, is remanded. The Veteran claims his hypertension is a result of his time in service, due to exposure to herbicides. The evidence confirms that the Veteran served in Vietnam. Service treatment records are negative for any complaints or reports of hypertension. The earliest clinical record of a diagnosis of hypertension is dated in January 2004 private treatment records. The Veteran has a current diagnosis of hypertension and during a May 2019 Disability Benefits Questionnaire (DBQ), he reported being on blood pressure medication since 1972. The examiner concluded the Veteran's hypertension is less likely than not incurred in or caused by exposure to herbicides during service, with the rationale being that hypertension is not a presumed illness related to such exposure. A June 2019 DBQ medical opinion includes the examiner's conclusion that the Veteran's hypertension is less likely than not incurred in or caused by exposure to herbicides during service as his service separation examination was silent for elevated blood pressure, hypertension, or medication, and there was no evidence to connect his hypotension to service. The Board, in its October 2019 remand, discussed that a recent study by National Academy of Sciences (NAS) released on November 15, 2018, indicates that "[t]he latest in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War found sufficient evidence of an association for hypertension." NAS, Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War (Nov. 15, 2018). The Board, in October 2019, determined that a new opinion as to the etiology of the Veteran's hypertension, considering that NAS's latest findings, was warranted. The Board specifically advised the examiner that it was requesting an opinion as to whether this Veteran's hypertension was related to service even though such is not on the list of presumptive diseases due to herbicide exposure and specifically requested that the examiner review the above-mentioned NAS report that finds "sufficient evidence" of an association for hypertension. In a December 2019 DBQ medical opinion, the examiner concluded that the Veteran's hypertension was less likely than not incurred in or caused by exposure to herbicides during service. The examiner reasoned that the Veteran's treatment records revealed a diagnosis of hypertension around 2006, a benign essential hypertension, a type of hypertension where the cause is unknown. The examiner discussed that such hypertension tends to develop as one ages, that medical literature showed that over 63 percent of people over 60 are diagnosed with hypertension, and this Veteran would have been 65 years old at the time of his diagnosis. The examiner reported that there was no current medical evidence that connects the Veteran's hypertension with his service or exposure to herbicides. As the parties to the May 2021 JMR discussed, the December 2019 DBQ medical opinion is inadequate; the examiner did not address the above-mentioned NAS report that finds "sufficient evidence" of an association for hypertension. There is thus no substantial compliance with the Board's October 2019 remand directives and corrective action is warranted. The matters are REMANDED for the following action: Forward the claims file to the examiner who submitted the December 2019 DBQ medical opinion, or a suitable substitute, for an addendum opinion that responds fully to the Board's inquiries below. If any examiner determines that additional physical examination of the Veteran is required, so schedule the Veteran. The examiner must review the claims file. The examiner is asked to provide a response, with a complete rationale, to the following: (a) Is the Veteran's hypertension at least as likely as not (at least 50 percent probability) related to service, specifically, his conceded in-service exposure to herbicides? The examiner is advised that a negative opinion cannot be based solely on the fact that the Veteran's hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. The examiner must consider and discuss the above-mentioned November 15, 2018, NAS report that finds "sufficient evidence" of an association for hypertension. The examiner must consider and discuss the Veteran's lay report that he was placed on hypertensive medication in as early as 1972 when he was in his 30s. (b) Is it at least as likely as not that the Veteran's hypertension: (1) manifested within one year of his discharge from service; or (2) has existed continuously since separation from service, specifically considering that the Veteran has reported that he was placed on hypertensive medication in as early as 1972 when he was in his 30s? P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.