Citation Nr: 21069960 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 18-28 405A DATE: November 22, 2021 ORDER 1. Entitlement to service connection for hypothyroidism is granted. REMANDED 2. Entitlement to service connection for hypertension is remanded. FINDING OF FACT The Veteran has aa diagnosis of hypothyroidism (which is presumed to be related to his exposure to herbicide agents while serving in Vietnam). CONCLUSION OF LAW Service connection for hypothyroidism is warranted. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from November 1965 to September 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2017 rating decision. In April 2021, a virtual hearing was held before the undersigned; a transcript is in the record. 1. Entitlement to service connection for hypothyroidism is granted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. To substantiate a claim of service connection there must be evidence of: (1) a current disability for which service connection is sought; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). Those diseases now include hypothyroidism. 38 C.F.R. § 3.309(e). A Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to Agent Orange. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). The Veteran's military personnel records reflect that he served in Vietnam from April 1967 to April 1968; thus, he is presumed to have been exposed to Agent Orange during active service (and such is not in dispute). Pursuant to the William M. Thornberry National Defense Authorization Act for Fiscal Year 2021 (P.L. 116-283), hypothyroidism was added as a disease associated with exposure to herbicide agents. See Public Law 116-283; 38 U.S.C. § 1116(a)(2). The Veteran's private treatment records show a diagnosis of hypothyroidism. The Board finds that service connection for hypothyroidism based on a legal presumption that it is due to his exposure to Agent Orange is warranted. REASONS FOR REMAND 2. Entitlement to service connection for hypertension. The Veteran's primary theory of entitlement for hypertension is one of secondary service connection. He asserts that his hypertension is secondary to his hypothyroidism. On January 2017 VA examination, the examiner opined that it was less likely than not that the Veteran's hypertension was related to his service. She explained that hypertension was still not a presumptive disorder related to Agent Orange exposure, the Veteran was not diagnosed with hypertension during his service, and hypertension was not diagnosed until several years after his discharge from service. In May 2018, a VA provider declined to opine regarding whether or not the Veteran's hypertension was caused or aggravated by his hypothyroidism because in a separate opinion, he opined that it was less likely than not that his hypothyroidism was related to his service. Since service connection for hypothyroidism is established no VA opinion has adequately addressed whether the hypothyroidism may have caused or aggravated the Veteran's hypertension, remand for an adequate medical advisory opinion is necessary. The matter is REMANDED for the following: Arrange for the Veteran's record to be forwarded to an appropriate clinician for review and an addendum medical advisory opinion. [If further examination of the Veteran is deemed necessary for the opinion sought, such should be arranged.] The consulting provider should provide responses to the following: (a) Identify the likely etiology for the Veteran's hypertension, indicating whether it is at least as likely as not that it was incurred in service or was caused or aggravated (the opinion must address aggravation) by his (now) service-connected hypothyroidism. (b) If the opinion is to the effect that the Veteran's service-connected hypothyroidism did not cause, but aggravated, his hypertension, specify, to the extent possible, the degree of disability (symptoms/impairment) that has resulted from such aggravation. (c) If the hypertension is determined to be unrelated to the Veteran's service and his service-connected hypothyroidism, identify the etiology for the hypertension that is considered more likely. The examiner should include rationale with all opinions, and the rationale must encompass consideration of all medical journal articles the Veteran has submitted into evidence, to specifically include the articles submitted in May 2021 that discuss a possible link between hypothyroidism and an increase in blood pressure. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.