Citation Nr: 21070841 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 18-46 668 DATE: November 26, 2021 ORDER Entitlement to service connection for hypertension is granted. REMANDED Entitlement to service connection for gall bladder stone is remanded. Entitlement to service connection for chronic kidney disease (CKD) is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for benign prostatic hyperplasia (BPH), status post transurethral resection of the prostate (TURP) is remanded. FINDING OF FACT Affording the Veteran the benefit of the doubt, his hypertension is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1968 to December 1969 in the United States Army. In September 2021, the Board remanded the claims for additional development. There has been substantial compliance with the remand in connection with claim decided here and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Entitlement to service connection for hypertension, including as the result of exposure to herbicides. The Veteran contends that his current hypertension is etiologically related to in-service herbicide exposure. The Board concludes that the Veteran has a current disability that is related to herbicide exposure during active-duty service in the Republic of Vietnam. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records show the Veteran has a current diagnosis of hypertension. Thus, the question becomes whether the current disability is related to service. The Veteran served in Vietnam and is presumed to be exposed to herbicides. See 38 C.F.R. § 3.307(a)(6)(iii). VA regulations do not list hypertension as a presumptive disability associated with herbicide agent exposure. See 38 C.F.R. § 3.309(e). This however does not preclude him from establishing entitlement on a direct incurrence or other basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Evidence against the claim are the inadequate VA medical opinions concluding that the Veteran's hypertension is not related to service, to include exposure to herbicide agents. Although hypertension is not among the diseases presumed to be associated with herbicide exposure, the National Academy of Sciences (NAS), in 2006 and 2008 updates, concluded that there was limited or suggestive evidence of an association between hypertension and herbicide exposure. See 75 Fed. Reg. 32,540, 32,549 (June 8, 2010); 75 Fed. Reg. 81,332, 81,333 (December 27, 2010). However, in November 2018, the NAS upgraded the relationship between hypertension and herbicide exposure from limited/suggestive to sufficient, indicating that there is enough epidemiologic evidence to conclude that there is a possible association between hypertension and herbicide exposure. See National Academies of Sciences, Engineering, and Medicine. 2018. Veterans and Agent Orange: Update 11 (2018). The Board notes that the NAS serves as an advisor on scientific matters and is comprised of experts in the given field. The Board finds the NAS upgrade highly probative. The Board finds the evidence to be in relative equipoise, that the Veteran's hypertension is causally related to his service, to include as due to herbicide exposure. Service connection is granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Unfortunately, there has not been substantial compliance with the previous remand directives regarding these issues and another remand is required. Stegall, 11 Vet. App. at 271. 1. Service connection for a gall bladder disorder, as the result of herbicide exposure is remanded. 2. Service connection for a kidney disorder, including as the result of herbicide exposure is remanded. 3. Service connection for erectile dysfunction, including as the result of exposure to herbicides is remanded. 4. Service connection for prostate disorder, including as the result of exposure to herbicide is remanded. The claims are remanded because the October 2021 VA opinions are inadequate. The examiner relied on the fact that the disabilities are not presumptively related to herbicide exposure and a conclusory statement that there is no published evidence that supports a connection between the diagnosed disabilities and herbicide exposure. The examiner did not explain why the absence of published evidence supports a conclusion that such a connection is precluded; lack of published evidence could be indication of uncertainty. Therefore, addendum opinions are necessary. The matters are REMANDED for the following action: 1. Obtain addendum opinions from an appropriate clinician regarding the etiology of the Veteran's following conditions, specifically providing a response to the following: (A) Whether any diagnosed gallbladder disorder is at least as likely as not related to service, including presumed herbicide exposure in service? (B) Whether any diagnosed kidney disorder is at least as likely as not related to service, including presumed herbicide exposure in service? (C) Whether any diagnosed erectile dysfunction is at least as likely as not related to service, including presumed herbicide exposure in service? (D) Whether any diagnosed prostate disorder is at least as likely as not related to service, including presumed herbicide exposure in service? A complete rationale should be provided for all opinions rendered. The fact that the claimed disabilities are not specifically listed as presumptively due to herbicide exposure CANNOT be the basis of a negative opinion. In providing the requested opinions, consider the Veteran's contentions, to include the absence of a family history for these disorders. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.