Citation Nr: 21071894 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 14-33 564 DATE: December 1, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to November 1970, including service in the Republic of Vietnam from October 1969 to November 1970. He also had subsequent service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The matter was first before the Board in April 2018, at which time the Board denied the Veteran's claim. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In August 2019, the Court approved the parties' Joint Motion for Remand (JMR), remanding the case for further action consistent with the JMR. In March 2020, the Board remanded the claim for further development. The case has now been returned to the Board. Entitlement to service connection for hypertension is remanded Unfortunately, there has not been substantial compliance with the Board's March 2020 remand directives. The March 2020 remand sought a medical opinion regarding whether the Veteran's hypertension was related to his active duty service, to include consideration of the Veteran's presumed exposure to herbicides and the National Academies of Sciences, Engineering, and Medicine's recent reclassification of the association between herbicide exposure and hypertension. A VA examiner interviewed the Veteran in September 2021 and provided a medical opinion that the Veteran's hypertension is less likely than not due to Agent Orange exposure during service. The examiner's rationale was that the average American male develops hypertension around the age of 55, and as the Veteran developed hypertension at age 55 and not earlier, his hypertension is more likely than not due to normal aging. However, the Board's review of the medical evidence of record reveals an elevated blood pressure reading from as early as May 1984 on an Air National Guard enlistment examination with a reading of 136/92. At that time the Veteran would have been age 35. The first mention of a hypertension diagnosis in the record is in an April 1989 National Guard examination report noting "HTN (uncontrolled)", at which time the Veteran was age 39. Thus, it appears the examiner's opinion is based in part upon an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) ("An opinion based upon an inaccurate factual premise has no probative value."). In addition, the examiner failed to substantively address the National Academies of Sciences, Engineering, and Medicine's reclassification of the association between herbicide exposure and hypertension. Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, another remand is required. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion on whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hypertension is related to his active duty service, to include conceded exposure to herbicides. The opinion should explain why or why not, and address the following: (a) the National Academies of Sciences, Engineering, and Medicine previously determined there was "limited/suggestive evidence of a relationship" between hypertension and herbicide exposure, but recently changed this to "sufficient" evidence of a relationship; (b) the Veteran's medical records show high blood pressure readings beginning in 1984 and first mention hypertension in 1989. 2. If the claim remains denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Jesteadt, Associate 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.