Citation Nr: 21064354 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 18-23 130A DATE: October 19, 2021 REMANDED Entitlement to service connection for hypertension to include as due to herbicide agent exposure and as secondary to service-connected diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active service from August 1968 to February 1975. He is a Veteran of the Vietnam era. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), the agency of original jurisdiction (AOJ). The rating decision denied service connection for diabetes mellitus and hypertension, among other disorders. This matter was previously before the Board in March 2020 at which time it was remanded for further development. During the course of the appeal, in October 2020, service connection was granted for diabetes mellitus on a presumptive basis as due to exposure to herbicide agents. The issue of entitlement to service connection for diabetes mellitus is no longer before the Board. 1. Entitlement to service connection for hypertension to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus is remanded. In its March 2020 decision, the Board noted that the Veteran is seeking service connection for hypertension due to exposure to herbicide agents during service. Military personnel records reflect the Veteran was stationed aboard the U.S.S. Allagash from December 27, 1968, to December 21, 1970, and the U.S.S. Santa Barbara from January 7, 1971, to July 22, 1972. Public records indicate that the U.S.S. Santa Barbara departed on June 5, 1972, to the western Pacific on an extended deployment in Asian waters. Although the RO was unable to verify the Veteran's exposure to herbicide agents during active service, the Board found it was unclear whether deck logs for the U.S.S. Santa Barbara for the period from June 5, 1972, to July 22, 1972, were researched to determine whether the Veteran had "service in the Republic of Vietnam" under 38 U.S.C. § 1116 and associated exposure to herbicide agents. Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). Therefore, the Board remanded for further development to obtain these deck logs. In March 2020, VA requested the deck logs for the U.S.S. Santa Barbara from January 7, 1971 to July 22, 1972, including all movements and operations conducted during that time period to determine whether the ship came within 12 nautical miles from the shores of the Republic of Vietnam. The deck logs were received in August 2020 at which time VA conceded exposure to herbicides on the Veteran's nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. The Veteran was afforded a VA examination in September 2020. This consisted of a telephone interview and records review; a face-to-face examination could not be conducted due to Covid-19 restrictions. The examiner noted a diagnosis of hypertension in 1990 for which the Veteran takes prescribed medication. Service treatment records do not note hypertension or high blood pressure readings. The examiner opined that it is less likely than not that the Veteran's hypertension was incurred in or caused by the claimed in-service injury, event or illness. The rationale was that there is no evidence of onset, diagnosis or treatment of hypertension while on active duty. The Veteran was not diagnosed with hypertension until 1990 or 1991. The examiner found that the Veteran had multiple risk factors for the development of primary hypertension at the time of his diagnosis - notably age, non-white race, gender, family history and a significant smoking history. The examiner noted that the Veteran was reportedly exposed to Agent Orange during active duty. Hypertension is not recognized as an Agent orange presumed condition. As requested in the remand, the examiner discussed the findings by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides 2010 report "Veterans and Agent Orange: Update 2010" that continued to categorize hypertension as having limited or suggestive evidence of association with herbicide exposure. The examiner also discussed a 2018 report from The National Academies of Sciences, Engineering, and Medicine (NAS) before finding that the additional risk of a possible association from Agent Orange exposure "does not medically rise to meet the accepted VBA criteria of at least 50% likelihood at this time." As noted, in October 2020, service connection was granted for diabetes mellitus based on presumptive herbicide agent exposure. The Veteran submitted a statement in November 2020 noting that he was recently service connected for diabetes based on herbicide agent exposure, which was conceded by VA in October 2020. He asserted that there are complications of diabetes including heart disease and hypertension due to poor circulation, thereby raising a theory of secondary service connection. He further stated that due to his diabetes, he is experiencing problems with his kidneys, with elevated creatine levels, erectile dysfunction, and prickling, tingling and numbness of his toes. The Veteran submitted a statement in March 2021 informing that he and his wife had contracted Covid 19 in January 2021 and that his wife had died in February 2021. He stated that he is receiving treatment at a VAMC for diabetes and peripheral neuropathy, in addition to COPD, major depression and Crohn's Disease, and by a private physician. The Board finds that the September 2020 examination and opinion are inadequate as the examiner did not acknowledge that in November 15, 2018, the National Academies of Sciences, Engineering, and Medicine moved hypertension to the category of "sufficient" evidence of an association from its previous classification in the "limited or suggestive" category," indicating that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and exposure to herbicides, including Agent Orange. See 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); https://www.nationalacademies.org/news/2018/11/vietnam-veterans-and-agent-orange-exposure-new-report. The Board finds that a new examination and opinion are therefore required to address the nature and etiology of the Veteran's hypertension, to include conceded exposure to herbicide agents and whether the Veteran's hypertension is caused by or aggravated by his service-connected diabetes. The matters are REMANDED for the following action: 1. Obtain any outstanding VA medical records pertinent to the Veteran's claim and associate such records with the Veteran's file. 2. With any assistance required from the Veteran, obtain any private medical records pertinent to the Veteran's claim and associate them with the file. 3. Schedule a VA examination to determine the nature and etiology of the Veteran's hypertension. The examiner should provide the following opinions: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is caused by or related to active service to include conceded exposure to herbicide agents. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is caused or aggravated by his service-connected diabetes mellitus. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Debra B. McLoughlin, 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.