Citation Nr: 21063927 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 12-00 988 DATE: October 18, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to herbicide exposure or a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to March 1971, to include service in the Republic of Vietnam. The Board of Veterans' Appeals (Board) remanded this matter for further evidentiary development in March 2018, June 2019, October 2020, and March 2021. The case has returned to the Board for appellate review. The Board notes that the issues of entitlement to service connection for a cervical spine disability and service connection for hypothyroidism were also remanded by the Board in March 2021. The agency of original jurisdiction (AOJ) granted service connection for these matters in April 2021 and August 2021 rating decisions. As these claims for service connection have been granted in full, they are not before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for hypertension, to include as secondary to herbicide exposure or a service-connected disability is remanded. While the Board sincerely regrets additional delay, the Board finds that the claim must be remanded to assure the Veteran is afforded a full and fair adjudication of his claim. As previously mentioned, this claim has been remanded by the Board for evidentiary development to assist in adjudication of the Veteran's claim. Most recently, in March 2021, this matter was remanded to the AOJ with directives to obtain a new VA medical opinion to address the nature and etiology of the Veteran's hypertension. Specifically, the examiner was asked to provide an opinion on whether the Veteran's hypertension was directly related to his conceded in-service herbicide exposure. The examiner was requested to address whether the Veteran's hypertension was proximately due to or aggravated by his service-connected diabetes. The Board notes that at a March 2021 VA examination for the Veteran's diabetes, the examiner indicated the Veteran's diabetes did not aggravate his hypertension. However, no rationale was provided, particularly with regard to a February 2020 VA diabetes examination indicating the Veteran's diabetes permanently aggravated his hypertension; however, a rationale was not provided with this opinion either. Pursuant to the Board remand, a VA medical opinion was obtained in April 2021. The April 2021 examiner provided a negative nexus opinion with the rationale that there is insufficient data to conclude that it is as likely as not that there is sufficient evidence of an association between hypertension and Agent Orange without resorting to speculation. In his rationale, the examiner acknowledged the November 15, 2018 National Academy of Sciences (NAS) news release that upgrades hypertension from the category of "limited or suggestive" evidence of an association with herbicide agent exposure to the category of "suggestive" evidence. The examiner also cited to 2017 guidelines from the American College of Cardiology that placed 46 percent of United States population under category of hypertension and a January 8, 2020 edition of Military Times where the VA cited significant concerns and limitations by studies reviewed by the NAS. The Board finds the April 2021 medical opinion to be inadequate for the purposes of determining service connection. See generally Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The examiner did not provide an adequate rationale for direct service connection and he failed to provide an opinion regarding secondary service connection. The examiner based his negative nexus opinion on the fact that a large percentage of the United States population is hypertensive, and that the VA has addressed concerns regarding past NAS updates. Additionally, the examiner does not appear to consider the Veteran's lay statements. Thus, the Board finds an addendum VA medical opinion is necessary to make a fully informed decision on the Veteran's claim. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from a VA examiner of appropriate expertise to ascertain the etiology of the Veteran's current hypertension disability. (If it is determined that additional examination is needed, it should be scheduled in accordance with applicable procedures.) The claims file should be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should address the following: (a.) Offer an opinion as to whether it is at least as likely as not (50 percent or greater likelihood) that any current hypertension had its onset in service or is otherwise related to active service, specifically to include herbicide agents in the Republic of Vietnam. This should include a discussion of whether any hypertension disability found is proximately due to, the result of, or aggravated by the Veteran's service-connected disability, specifically to include diabetes. (b.) The examiner should provide a detailed rationale for the opinion, including a discussion of the evidence of record and medical principles which led to the conclusions reached. If an opinion cannot be provided without resort to speculation, the examiner should explain why it is not possible to provide an opinion. (c.) It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. 2. After the development requested has been completed, the AOJ should review the expanded record to ensure complete compliance with the directives of this REMAND. If any report is deficient in any manner, implement corrective procedures at once. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Frazier, Associate Attorney 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.