Citation Nr: 21064533 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 17-35 063 DATE: October 20, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from June 1965 to January 1969; and the United States Navy Reserve from June 1969 to June 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision dated in December 2015. This issue was previously before the Board in October 2018, at which time, the Board, in pertinent part, denied entitlement to service connection for hypertension as secondary to service-connected diabetes mellitus and non-Hodgkin's lymphoma. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In February 2021, the Court vacated the October 2018 decision and remanded the matter to the Board for action consistent with the decision. 1. Entitlement to service connection for hypertension is remanded. The Veteran seeks service connection for hypertension, which he asserts is related to service, including exposure to herbicide agents, and his service-connected type II diabetes mellitus (diabetes mellitus) and non-Hodgkin's lymphoma. See also March 2009 Veteran's Application for Compensation or Pension; January 2016 Statement in Support of Claim; January 2016 NOD; June 2009 Form 9 Substantive Appeal; April 2018 and September 2018 Appellate Briefs. At the outset, the Board notes that exposure to herbicides during the Veteran's service in Vietnam has been conceded. See August 2009 rating decision. The Veteran states that he was diagnosed with high blood pressure in 1978. See March 2009 Veteran's Application for Compensation or Pension. See also August 2009 VA examination; January 2017 Decision Review Officer (DRO) hearing. As noted, the Veteran served in the United States Navy from June 1965 to January 1969; and the United States Naval Reserve from June 1969 to June 2006. The Board notes that the Veteran's service treatment records from June 1965 to January 1969 are unavailable for review. See August 2009 rating decision. See also May 2009 Request for Information; May 2009 Email Correspondence; June 2009 VA Memo; and June 2009 MAP-D Development Letter. In cases such as this, where the Veteran's service records are unavailable through no fault of the claimant, there is a heightened obligation to carefully consider the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991). The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). Service treatment records reflect findings of elevated blood pressure (BP) from at least September 1974 (BP 132/84); and in April 1980 (BP 136/86); July 1982 (BP 130/84); February 1983 (BP 138/84); January 1984 (BP 134/106); June 1987 (BP 130/86, BP 140/86); April 1990 (BP 122/90); March 1992 (BP 140/90); and April 1993 (BP 132/84, BP 120/96). Post-service treatment records reflect a diagnosis of borderline hypertension from at least October 1997. In August 2013, the Veteran's private treatment provider noted that the Veteran had concurrent health problems, which included hypertension and diabetes mellitus. In July 2015, the private treatment provider noted that the Veteran's multiple medical problems, including his recurrent non-Hodgkin's lymphoma; type II diabetes, made it a necessity that the Veteran use multiple high risk medications. Finally, in January 2016, the private treatment provider opined that the Veteran's hypertension was directly related to his service-connected type II diabetes. The Veteran was afforded a VA examination in August 2009. The VA examiner opined that the Veteran's hypertension was not a complication of diabetes. The examiner noted that the Veteran did not have any evidence of diabetic nephropathy, there was no evidence of worsening of the Veteran's hypertension, and the Veteran was not currently on medication for treatment of his hypertension. The AOJ obtained an addendum opinion in April 2017. The VA examiner opined that the Veteran's hypertension was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected diabetes mellitus. The examiner noted that the Veteran developed hypertension before his diabetes mellitus; and his blood pressure had been well controlled since the Veteran had been diagnosed with diabetes mellitus. The examiner noted that the Veterans renal function had been normal and was without proteinuria; therefore, the examiner opined that the Veteran's hypertension was not caused nor aggravated by his diabetes mellitus. In addition, the examiner noted that the Veteran's blood pressure had been well-controlled and stable throughout the period he underwent chemotherapy for non-Hodgkin's lymphoma. As outlined in the February 2021 Court Remand associated with an appeal of the Board's prior decision to the United States Court of Appeals for Veterans Claims, the April 2017 VA examiner did not provide sufficient rationale to support their opinion that the Veteran's hypertension had been well-controlled; and no VA examiner has considered whether the Veteran's hypertension was related to service, to include exposure to herbicides. In addition, the Board notes that no VA examiner has considered the August 2013 private treatment record which indicated that the Veteran's hypertension and diabetes mellitus was concurrent; and no VA examiner has discussed whether the Veteran's hypertension was related to the medications used to treat the Veteran's diabetes mellitus and non-Hodgkin's lymphoma. The Board finds that a supplemental VA opinion is warranted to determine the nature and etiology of the Veteran's hypertension. The matters are REMANDED for the following action: 1. Obtain a VA addendum opinion from an appropriate examiner to determine the nature and etiology of the Veteran's hypertension. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, including a copy of this Remand, and the examiner should indicate that the record was reviewed in connection with the examination. As noted, the Veteran's service treatment records from June 1965 to January 1969 are unavailable for review. The examiner is advised that the lack of contemporaneous medical records documenting complaints of or treatment for the Veteran's hypertension is insufficient by itself as a rationale to support a medical nexus opinion. Based upon a review of the record, the examiner should address the following: (a.) whether it is at least as likely as not (50 percent or greater likelihood) that hypertension manifested during service, that hypertension was manifest to a compensable degree within one year of active service, or that it is otherwise causally or etiologically related to a period of active duty service, to include exposure to herbicide agents. (b.) whether it is at least as likely as not (50 percent or greater likelihood) that hypertension is proximately due to a service-connected disability to include but not limited to diabetes mellitus and non-Hodgkin's lymphoma. (c.) whether it is at least as likely as not (50 percent or greater likelihood) that hypertension is aggravated (increase in severity beyond the natural progression of the disorder) by a service-connected disability to include but not limited to diabetes mellitus and non-Hodgkin's lymphoma In rendering the opinions, the examiner must consider and discuss the statements of the Veteran regarding the onset and continuity of the symptoms of his hypertension. The examiner must specifically consider and discuss the medications that the Veteran has been prescribed to treat his diabetes mellitus and non-Hodgkin's lymphoma. In addition, the examiner must specifically consider and discuss the August 2013 private treatment record which indicated that the Veteran's hypertension and diabetes mellitus were concurrent. The examiner should provide a complete rationale for all opinions expressed and conclusions reached, including a discussion of the facts and medical principles involved. The examiner should note that "in keeping" with the benefit of the doubt rule, which is the standard of proof for veterans benefits, "Congress has not mandated that a medical principal must have reached the level of scientific consensus to support a claim for veterans benefits." Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). Instead, Congress adopted a "low standard of proof" for VA to employ to "resolve a scientific or medical question in the claimant's favor so long as the evidence for and against that question is in 'approximate balance.'" S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fleury Johnson, Gerline R. 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.