Citation Nr: 21073092 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-03 926 DATE: December 7, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1965 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in September 2017 and September 2021 for additional development and has now returned for further appellate review. Entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. The Veteran is seeking service connection for hypertension which he contends is etiologically related to herbicide exposure during active duty service. Pursuant to the September 2021 Board remand decision, the Veteran received a VA examination regarding the nature and etiology of his claimed hypertension. The examiner was directed to opine on the relationship between hypertension and exposure to herbicide agents. In a September 2021 examination report, the examiner provided a negative nexus opinion based solely on the fact that hypertension is not listed as a presumptive condition of herbicide exposure under 38 C.F.R. § 3.309 (e). This rationale is inadequate because service connection for a disease can be established on a direct basis as related to Agent Orange and is not precluded solely because the disease is not listed as a presumptive condition associated with herbicide exposure. Accordingly, on remand, an opinion must be obtained addressing whether the Veteran's hypertension is related to his exposure to herbicides during service. The matters are REMANDED for the following action: 1. Obtain an opinion from a physician of appropriate expertise, addressing the etiology of the Veteran's hypertension. The examiner must be provided access to the electronic claims file and indicate review of the file in the opinion report. The examiner is requested to provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is related to his exposure to herbicide agents during service? The clinician is requested to consider and discuss as necessary the National Academy of Science's Agent Orange: Update 11 (2018), which upgrades hypertension from the category of "limited or suggestive" evidence of an association with herbicide exposure to the category of "sufficient" evidence. The examiner is advised that service connection for a disease can be established on a direct basis as related to Agent Orange and that service connection is not precluded solely because the disease is not listed as a presumptive condition associated with herbicide exposure. Thus, the opinion and associated rationale must address the likelihood that this Veteran's hypertension is related to herbicide agent exposure given his individual medical history, family history, risk factors, etc. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Gorum, 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.