Citation Nr: 21072168 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-43 795 DATE: December 2, 2021 REMANDED Entitlement to service connection for hypertension, claimed as the result of herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran had active service from August 1965 to October 1968. He served in the Republic of Vietnam. In October 2021, the Board of Veterans' Appeals (Board) remanded the issue of service connection for obstructive sleep apnea to the Agency of Original Jurisdiction for additional development. The issue has not yet been returned and recertified to the Board. Therefore, it is not before the Board and will not be addressed below. Entitlement to service connection for hypertension, claimed as due to herbicide agent exposure, is remanded. In its April 2021 Remand instructions, the Board requested that the Veteran be scheduled for a "VA hypertension examination conducted by a medical doctor, other than the physician who prepared November 2019 VA hypertension evaluation." The report of an April 2021 VA hypertension examination and an April 2021 addendum thereto state that the examiner was a physician assistant. The examiner noted that she had reviewed the claims record. Nevertheless, the physician assistant indicated that "this examiner needs sufficient detail as to the specific 'other service-connected conditions' in question to" determined the relationship, if any, between the diagnosed hypertension and the service connected disabilities. Given the physician assistant's failure to review the claims record in order to determine the service connected disabilities, the Board finds that the examination report and the addendum thereto are of essentially no probative value. In August 2021, the Board again remanded the Veteran's appeal to the Agency of Original Jurisdiction to schedule the Veteran for a VA hypertension examination which complied with the Remand instructions. The report of a September VA hypertension examination states that the examiner was a nurse practitioner and the negative opinion rendered as to the relationship between the diagnosed hypertension and the service connected disabilities was specifically based upon the deficient April 2021 VA examination report and addendum. In the November 2021 Appellant's Post-Remand Brief, the accredited representative notes that the VA clinical documentation reflects that the Veteran was found to be obese. The accredited representative contends that the diagnosed hypertension is due to the diagnosed obesity related to the service-connected posttraumatic stress disorder (PTSD). VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Agency of Original Jurisdiction's compliance with the Board's remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, further VA hypertension evaluation is needed. The matters are REMANDED for the following action: Schedule the Veteran for a VA hypertension examination conducted by a medical doctor, other than the physician who prepared November 2019 VA hypertension evaluation, to assist in determining the current nature of any identified hypertensive disability and its relationship, if any, to active service, the service-connected disabilities, and/or any obesity found to be associated with the service connected disabilities. The examiner must review the record, including the National Academies of Sciences, Engineering, and Medicine's Veterans and Agent Orange Update 11 (2018) and all other submitted medical articles, and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hypertensive disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability had its onset during active service or is related to any incident of service, including the documented in-service October 1968 blood pressure reading of 128/98 and the Veteran's presumed exposure to herbicide agents while in the Republic of Vietnam. The examiner should specifically discuss the National Academies of Sciences, Engineering, and Medicine's Veterans and Agent Orange Update 11 (2018). (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability is due to the PTSD, the other service-connected disabilities, and/or any obesity associated with the service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any hypertensive disability has been aggravated (increased in severity beyond the natural progress of the disorder) by the PTSD, the other service-connected disabilities, and/or any obesity associated with the service connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Casula 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.