Citation Nr: 21066528 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 14-29 273 DATE: November 1, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to herbicide exposure and/or as secondary to service-connected prostate cancer and diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1964 to October 1967, to include service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) regional office (RO) in Waco, Texas, which, in pertinent part, denied the Veteran's claim of entitlement to service connection for hypertension, to include as secondary to herbicide exposure and/or as secondary to service-connected prostate cancer and diabetes mellitus, type II. The Veteran timely appealed the rating decision. In October 2020, the Board remanded the matter on appeal for additional evidentiary development. The Board notes that a claimant has the right to substantial compliance with remand directives. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the United States Court of Appeals for Veterans Claims Court (Court) or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders). In this case, the remand directives requested that a VA examiner concede a 1975 diagnosis date for hypertension and address the Veteran's presumed exposure to herbicide agents without reliance on the lack of availability of presumptive service connection for hypertension and with discussion of the National Academy of Sciences Institute of Medicine's conclusion that there is "sufficient evidence of an association" between herbicide exposure and hypertension. See NAS, Veterans & Agent Orange: Update 11 (2018). While the September 2021 addendum medical opinion was responsive to the directives in that the examiner rely on the lack of availability of presumptive service connection for hypertension, the examiner did not concede the 1975 diagnosis date or discuss the NAS report at all. The Board finds that substantial compliance has not been established, thus an additional remand is required. The matter is REMANDED for the following action: Obtain an addendum medical opinion from an appropriate clinician regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed hypertension had its onset in service or is otherwise related to service, to include as a result of conceded exposure to herbicide agents therein (please concede the Veteran's reported diagnosis of hypertension in 1975). In addressing this question, please address the Veteran's presumed exposure to herbicide agents, do not rely on the lack of availability of presumptive service connection for hypertension, and please discuss the National Academy of Sciences Institute of Medicine's conclusion that there is "sufficient evidence of an association" between herbicide exposure and hypertension. See NAS, Veterans & Agent Orange: Update 11 (2018). A complete rationale must be provided for all opinions expressed. If for any reason the examiner is unable to provide a medical opinion, he or she should provide a rationale for that conclusion (e.g., whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bush 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.