Citation Nr: 21063854 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 15-03 710A DATE: October 18, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in August 2018. A transcript is of record. The Board previously remanded the claim in January 2019 and August 2020 for further development. The Board subsequently denied the claim in a December 2020 decision. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In September 2021, the Court granted a joint motion for remand (JMR), and vacated and remanded the appeal for compliance with the JMR. Following the JMR, the Board issued a letter to the Veteran and his representative dated September 14, 2021, notifying them of their ability to submit additional evidence or argument in support of their appeal within 90 days. In a letter dated September 18, 2021, the Veteran's representative waived the 90-day period and indicated he had no new evidence or argument to submit. 1. Entitlement to service connection for hypertension is remanded. In the JMR, the parties agreed that the September 2020 VA medical opinion the Board relied on in denying the claim was inadequate in two respects. The JMR first noted that the September 2020 examiner improperly required scientific consensus to offer a positive nexus opinion when he noted that the medical literature had not established exposure to herbicides as a cause of hypertension. It added that the examiner erroneously discounted the findings of the 2018 National Academies of Science study addressing herbicide exposure and resulting medical problems by stating that the study "suggested an association, without establishing cause." The JMR referenced Wise v. Shinseki, 26 Vet. App. 517, 531 (2014), in which the Court observed that the benefit of the doubt rule does not require that a medical principle to have reached the level of scientific consensus to support a claim for veterans' benefits. The JMR secondly noted that the examiner primarily relied on general medical literature to support the negative nexus opinion, and did not consider the specific facts of the Veteran's claim, including his decades-long treatment for hypertension. The JMR referenced Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018), in which the Court found a medical opinion inadequate because the examiner based the opinion on general medical concepts without discussing the facts of the veteran's case. The parties agreed in the JMR that a new medical opinion was needed that considered the discussion above. Thus, upon remand, a new medical opinion should be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not related to his presumed exposure to herbicide agents while in service. The examiner must review the claims file, to include a copy of this REMAND, in conjunction with authoring the medical opinion. The examiner is advised that the benefit of the doubt rule does not require that a medical principle to have reached the level of scientific consensus to support a claim for veterans' benefits. The examiner should consider and address the specific facts of this particular Veteran's claim, to include his decades-long treatment for hypertension. The examiner should also consider and address the National Academy of Sciences' recent upgrade of hypertension to the "sufficient" category from "limited or suggestive," indicating that "there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide agent exposure. See Veterans and Agent Orange: Update 11 (2018). A complete rationale must be provided. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jake Choi, 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.