Citation Nr: 21064485 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 17-48 170 DATE: October 20, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1968. In June 2021, a videoconference hearing was held before the undersigned Veterans Law Judge. Following the hearing, also in June 2021, the Board of Veterans' Appeal (Board) remanded this case for additional development. In October 2021, the Veteran's representative submitted an appellate brief, that in addition to submitting arguments in favor of service connection for hypertension, sought service connection for chronic lymphocytic leukemia and sleep apnea. The Board notes that entitlement to service connection for chronic lymphocytic leukemia and sleep apnea is not currently on appeal; therefore, this analysis will focus on whether service connection for hypertension is warranted. Entitlement to service connection for hypertension, to include as secondary to herbicide agents exposure, is remanded. In June 2021, the Board remanded the Veteran's claim for service connection for hypertension to obtain a VA medical opinion. The Board instructed the VA examiner to opine whether the Veteran's hypertension was at least as likely as not related to an in-service injury, event, or disease, including as due to herbicide agents exposure. Additionally, the Board specifically instructed the VA examiner to address the research articles submitted in April 2015. See June 2021 Board Decision. In attempt to comply with the Board's June 2021 remand instructions, the Agency of Original Jurisdiction (AOJ) obtained an August 2021 VA medical opinion. The August 2021 VA examiner diagnosed hypertension and opined that the condition was less likely than not incurred or caused by the claimed in-service injury, event or illness. Significantly, however, the examiner did not address the medical research articles regarding the potential relationship between herbicide agents exposure and hypertension, as instructed above. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Moreover, in the examiner's rationale, she defined hypertension and subsequently stated, "hypertension has a clear etiology and it is not due to herbicide agent." The Board finds this statement to be conclusory as the examiner did not otherwise explain the etiology of the Veteran's hypertension, nor did she explain why it is not related to service, to include as secondary to herbicide agents exposure. Accordingly, the Board finds the August 2021 VA medical opinion insufficient for rating purposes. Additionally, in the Veteran's October 2021 appellate brief, the Veteran's representative submitted new evidence that has not been considered by VA examiners. First, the representative held that the National Academy of Sciences Engineering and Medicine (NAS) "Veteran's and Agent Orange: Update 11" (2018)) states that there is now "sufficient" evidence of an association between hypertension and herbicide agent exposure. Second, the representative contended that the Veteran's hypertension may be related to his service-connected posttraumatic stress disorder (PTSD). See October 2021 Appellate Brief. Based on the foregoing, the Board finds that remand is warranted to obtain a new VA medical opinion consistent with the directives herein. The matter is REMANDED for the following action: Obtain a VA medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran's hypertension. The claims folder (including a copy of this remand) must be provided to and reviewed by the VA examiner. All indicated tests should be accomplished and all clinical findings reported in detail. (a.) The examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hypertension had its onset in, or is otherwise related to the Veteran's active duty service, to include as due to herbicide agents exposure. In rendering the above opinion, the examiner is instructed to consider and discuss the medical research articles submitted in April 2015, which indicate that a relationship between herbicide agents exposure and hypertension may exist. Additionally, the examiner must consider and discuss the evidence identified in the October 2021 appellate brief, which indicates that the "Veteran's and Agent Orange Update: 11" (2018)" has held that there is now "sufficient" evidence of an association between hypertension and herbicide agent exposure. (b.) The examiner must also provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hypertension was caused or aggravated by his service-connected PTSD. Aggravation in this context is defined as any increase in disability. In rendering the above opinion, the examiner must consider and discuss the medical treatise evidence included in the October 2021 appellate brief, wherein the Veteran's representative argued that PTSD may increase blood pressure. Additionally, the examiner must consider and discuss the evidence included in the October 2021 appellate brief that indicates PTSD may have led to "negative coping", which may in turn have caused or aggravated the Veteran's hypertension. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. (Continued on the next page) A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Talton, John H. 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.