Citation Nr: 21070300 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 16-47 359 DATE: November 23, 2021 REMANDED Service connection for hypertension, to include as due to exposure to herbicides and contaminated water is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from July 1969 to July 1965 and July 1973 to June 1989. This claim is before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision. Although the Veteran originally requested a hearing in this appeal, he withdrew that request by August 2019 correspondence. The Board previously remanded this appeal in November 2019 and June 2021 for medical examinations and opinions. 1. Service connection for hypertension, to include as due to exposure to herbicides and contaminated water is remanded. Unfortunately, there is still no adequate medical opinion of record in this matter. Both the June 2020 and July 2021 VA medical opinions of record fail to address all relevant evidence in the record. While the latter opinion is more thorough in that it does acknowledge the Veteran's argument that his hypertension may be related to herbicide agent or contaminated water exposure in service, the rationale provided fails to fully consider the breadth and detail of those allegations. Specifically, the Veteran provides more than a broad allegation when mentioning contaminated water exposure at Pensacola Naval Air Station (NAS). Rather, he specifically alleges that it was exposure to "lead, heavy metals, and volatile organic compounds, substances proven to cause high blood pressure" that was of particular interest. Basic online research suggests that heavy metals (e.g., arsenic, cadmium, chromium, etc.) and volatile organic compounds (VOCs) were among the contaminants at Pensacola NAS, though which ones specifically remain unclear. Either way, the examiner does not discuss this allegation specifically, and instead found simply that there was no available information connecting contaminated water to hypertension. Moreover, the Veteran also alleged that he began manifesting symptoms of hypertension in service and specifically pointed to service treatment records (STRs) from January 1986 to February 1987 showing "loss of consciousness," "dyspeptic wheezing...sinus tachycardia...difficulty breathing...light headedness and dizziness." He also argued that an April 1986 emergency room record showing difficulty breathing with a blood pressure reading of 148/78 was "Stage I high blood pressure...according to the National Institute of Health." Post-service, the Veteran noted he "continued to suffer from his condition," citing September 2011 records showing "complaints of dizziness associated with his blood pressure issues." Notably, the Veteran's STRs do show his diastolic and systolic blood pressure readings were frequently elevated or consistent with ranges the American Heart Association (AHA) considers suggestive of hypertension. Often, both diastolic and systolic pressures were within such ranges. Nether VA examiner made any attempt to address the Veteran's very specific arguments regarding manifestation of hypertensive symptoms in service, his blood pressure readings therein, or their relevance (or irrelevance) to the claim at hand. Consequently, additional clarification is needed. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal. 2. Conduct exhaustive development to obtain any records or reports shedding light on the kinds of chemicals, metals, or other contaminants found at the Pensacola Naval Air Station (NAS). 3. Forward the record to a cardiologist or other appropriate physician to clarify the likely cause of his hypertension. If an examination or telephonic interview with the Veteran would be helpful (for example, to obtain a detailed account of his pertinent subjective history), one should be arranged. Based on a review of the record and examination or interview of the Veteran (if available), the examiner should opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that the Veteran's hypertension is related to his military service, TO SPECIFICALLY INCLUDE either herbicide exposure OR contaminated water exposure therein. The examiner MUST CONSIDER AND DISCUSS: (a.) the Veteran's potential exposure to heavy metals (such as, but not limited to, arsenic, lead, cadmium, and chromium); (b.) the several, repeated STRs showing elevated or hypertensive readings of diastolic pressure, systolic pressure, or both during the Veteran's active duty periods; (c.) STRs showing symptoms like "loss of consciousness," "dyspeptic wheezing...sinus tachycardia...difficulty breathing...light headedness and dizziness" that the Veteran argues were early manifestations of OR otherwise consistent with later development of hypertension; AND (d.) the Veteran's competent lay reports that he continued to deal with similar symptomsin particular, dizzinessas a result of hypertension post-service and more recently. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yuan, 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.