Citation Nr: 21071153 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-22 361A DATE: November 29, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) with insomnia, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1970 to February 1972, which includes service in the Republic of Vietnam. His awards include the Army Commendation Medal. This matter initially came before the Board of Veterans' Appeals (Board) from a December 2016 rating decision. In March 2019, the Board remanded this matter for further development. The Veteran requested a Board hearing before a Veterans Law Judge (VLJ) on an April 2020 VA Form 9. He withdrew his Board hearing request in September 2020 (see a September 2020 "Statement in Support of Claim" form (VA Form 21-4138)). As a final preliminary matter, the Board points out that the Veteran had also perfected an appeal with regard to the issue of entitlement to service connection for psychiatric disability, and the Board remanded this issue in March 2019 for further development. The agency of original jurisdiction (AOJ) awarded service connection for PTSD in a December 2019 rating decision, and thereby resolved the appeal as to this issue. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD with insomnia, is remanded. The Veteran was afforded a VA examination in October 2019 and was diagnosed as having hypertension. The nurse practitioner who conducted the examination opined that the Veteran's hypertension was not likely incurred in or caused by service. The examiner reasoned, in pertinent part, that although the National Academy of Sciences (NAS) indicated that there is now sufficient evidence of an association between hypertension and herbicide agent exposure, presumptive service connection for hypertension due to Agent Orange exposure has not been established. The October 2019 opinion is insufficient because the sole rationale for why the Veteran's hypertension is not related to his presumed herbicide agent exposure in Vietnam is essentially that hypertension is not recognized as a disability that is presumed to be related to Agent Orange exposure. The Board points out, however, that the fact that a disability is not on the list of disabilities presumed to be associated with exposure to herbicide agents (including Agent Orange) cannot be the sole basis for finding a lack of nexus between the disability and herbicide agent exposure. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). Moreover, as noted above, the Veteran has been awarded service connection for PTSD. VA's own regulatory documents have indicated a possible association between psychiatric disorders and cardiovascular disease. See Presumptions of Service Connection for Diseases Associated with Service Involving Detention or Internment as a Prisoner of War, 70 Fed. Reg. 37040 (June 28, 2005); Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 69 Fed. Reg. 60083 (Oct. 7, 2004) (association between PTSD and cardiovascular disease in prisoners of war). See also VA National Center for PTSD, Kay Jankowski, PTSD and Physical Health ("A number of studies have found an association between PTSD and poor cardiovascular health"). A medical opinion has not been obtained as to whether there is an association between the Veteran's hypertension and his service-connected psychiatric disability. In light of the above, a remand is necessary to obtain an appropriate medical opinion as to whether the Veteran's hypertension is related to service or is caused or aggravated by his service-connected PTSD with insomnia. Also, a November 2020 psychiatric examination report from K.R. Schneider, Ph.D. suggests that the Veteran may have been in receipt of Social Security Administration (SSA) disability and/or supplemental security income benefits for unspecified disability. Any outstanding records pertaining to the Veteran's claim(s) for SSA benefits may be relevant to the issue on appeal. Hence, the AOJ should attempt to obtain any such relevant records upon remand. Lastly, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the Jackson Vista electronic records system and are dated to July 2021. Any VA treatment records are within VA's constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. The matter is REMANDED for the following action: 1. Ask the Veteran to identify the location and name of any VA or private medical facility where he has received treatment for hypertension, to include the dates of any such treatment. Ask the Veteran to complete a VA Form 21-4142 for all records of his treatment for hypertension from any sufficiently identified private treatment provider from whom records have not already been obtained. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's outstanding VA treatment records from the Jackson Vista electronic records system for the period since July 2021; and all such relevant records from any other sufficiently identified VA facility. 3. Contact the SSA and request a copy of that agency's decision(s) for disability and/or supplemental security income benefits and all relevant records pertaining to the Veteran's claim(s). Document all requests for information as well as all responses in the claims file. 4. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, obtain an addendum opinion from an appropriate clinician regarding whether any hypertension experienced by the Veteran since approximately September 2016 at least as likely as not (1) began during service; (2) manifested within one year after separation from service; (3) is related to an injury or disease during service, including his presumed exposure to herbicide agents (including Agent Orange); (4) is caused by service-connected PTSD with insomnia; OR (5) is aggravated by service-connected PTSD with insomnia. (CONTINUED ON NEXT PAGE) The clinician must provide reasons for each opinion given. In this regard, the clinician should address the NAS's determination that there is now sufficient evidence of an association between hypertension and Agent Orange exposure (See Veterans and Agent Orange: Update 11 (2018)). The fact that hypertension is not yet on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.