Citation Nr: 21066149 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 14-10 625A DATE: October 28, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had continuous active military service from November 1968 to June 1974, including service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (the Board) on appeal from a May 2013 rating decision in which the Agency of Original Jurisdiction (AOJ) denied entitlement to service connection for hypertension. The Veteran participated in a hearing with the undersigned Veterans Law Judge in December 2016. A transcript of this hearing is of record. Subsequently, the Board denied the Veteran's claim for entitlement to service connection for hypertension in a January 2020 decision, concluding that the Veteran's hypertension did not have its onset during service, nor was it etiologically related to service. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (the Court). In a July 2021 Order, the Court entered a Joint Motion for Partial Remand (JMPR) of the parties. This Order vacated and remanded the portion of the Board's January 2020 decision that denied entitlement to service connection for hypertension. In the JMPR, the parties agreed that the Board erred in relying on an inadequate Department of Veterans Affairs (VA) examination, conducted in April 2019. The JMPR concluded that the April 2019 VA examination was inadequate for three reasons. First, the examiner who proffered the April 2019 VA medical opinion stated that the Veteran only had one in-service blood pressure reading of 138/90 that met the diagnostic criteria for hypertension. The examiner noted other in-service blood pressure readings of 120/82 to 138/88, but she concluded that these were not indicative of hypertension because they did not meet the diagnostic criteria. However, the JMPR identified a March 2007 VA medical note indicating that hypertension is evidenced by systolic blood pressure greater than 130 or diastolic blood pressure greater than 80. As the Veteran had multiple in-service blood pressure readings demonstrating diastolic blood pressure over 80, the examiner's rationale is inadequate. Upon remand, the examiner must address the standard for hypertension discussed in the March 2007 medical note and consider whether service connection for hypertension is warranted based on the Veteran's in-service readings showing diastolic blood pressure greater than 80. Second, the VA examiner opined that the Veteran's hypertension was more likely than not due to comorbidities, including a history of smoking. However, the JMPR noted that VA treatment records from March 2007 demonstrate that the Veteran stopped smoking 25 years prior. The VA examiner did not reconcile her finding that the Veteran's history of smoking contributed to his hypertension with the fact that he quit smoking decades prior to his diagnosis. As such, the Veteran's statement that he quit smoking many years before he was diagnosed with hypertension must be considered upon remand. Third, the April 2019 VA examiner referenced a study from the National Academy of Sciences Institute of Medicine (IOM), as well as a November 2016 article in the Journal of Occupational and Environmental Medicine, regarding the relationship between exposure to herbicide agents and hypertension. However, the examiner did not address the 2018 IOM report update that recognized "sufficient evidence of an association" between exposure to herbicide agents and hypertension. Accordingly, the 2018 IOM update must be addressed upon remand. When VA provides an examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). To be adequate, a medical examination report must contain clear conclusions, supporting data, and a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). It should be based upon consideration of the Veteran's prior medical history and describe the disability and symptoms in sufficient detail to allow the Board to make a fully informed decision. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). As the April 2019 VA examination is insufficient to allow the Board to make a fully informed decision on the matter of entitlement to service connection for hypertension, a remand is required to obtain an adequate medical opinion that complies with the JMPR. The matters are REMANDED for the following action: Obtain an addendum opinion from the examiner who conducted the April 2019 VA examination. If the same examiner is not available, the request should be forwarded to an appropriate clinician. The Veteran's claims file should be made available to the examiner. After review of the claims file, with any necessary examination and testing, the examiner should address the following: (a.) Is it at least as likely as not that the Veteran's hypertension had its onset during or within one year of service or is otherwise etiologically related to service, to include in-service elevated blood pressure readings and exposure to herbicide agents? In rendering this opinion, the examiner must discuss the following: 1. The Veteran's in-service blood pressure readings showing a blood pressure of 138/90 at the time of the June 1974 separation examination, as well as other blood pressure readings ranging from 120/82 to 138/88. The examiner must address the March 2007 medical note indicating that the standard for hypertension is systolic blood pressure greater than 130 or diastolic blood pressure greater than 80; 2. The March 2007 VA treatment record indicating that the Veteran quit smoking 25 years prior; and 3. The 2018 IOM report update that recognized "sufficient evidence of an association" between the exposure to herbicide agents and hypertension. The examiner must provide a rationale for any opinion proffered. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.