Citation Nr: 21073232 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 13-31 108 DATE: December 7, 2021 REMANDED Entitlement to service connection for essential hypertension, to include as secondary to the service-connected type II diabetes mellitus and/or ISHD is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to November 1967. His personnel records reflect he served in the Republic of Vietnam from November 1966 to November 1967; therefore, he is presumed to have been exposed to herbicide agents, such as Agent Orange, during that time. This matter is before the Board of Veterans' Appeals (Board) on appeal of the June 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In the December 2020 decision, the Board denied the Veteran's claim for entitlement to service connection for hypertension. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In July 2021, the parties filed a Joint Motion for Partial Remand (JMPR) moving for vacatur of the December 2020 decision's denial of entitlement to service connection for hypertension. On August 26, 2021, the Court issued an Order granting the JMPR and remanding the matter to the Board for further development and proceedings pursuant to 38 U.S.C. § 7252(a). In the JMPR, the parties agreed that the January 2020 VA medical opinion, which the Board relied on in denying the Veteran's claim, was inadequate in addressing whether the Veteran's hypertension was aggravated by the Veteran's service connected IHD and/or type II diabetes mellitus. A medical opinion as to secondary service connection is inadequate for the Board's decision as to aggravation if the issue of aggravation is not sufficiently addressed by the examiner. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). An examiner's determination that the disease or injury at issue is not "related to" the service-connected condition is not sufficient to address the aggravation issue. Id. Thus, this medical opinion is inadequate, because it only addresses the causation prong of secondary service connection. Therefore, a remand is necessary to secure a new medical opinion that sufficiently addresses whether the Veteran's hypertension was aggravated by his service connected IHD and/or type II diabetes mellitus. The matter is REMANDED for the following action: 1. If possible, return the Veteran's claims file to the VA examiner who conducted the January 2020 hypertension examination for clarification of the previous medical opinion. If it is not possible to obtain clarification from the January 2020 VA examiner, then forward the Veteran's claims file to a VA examiner who has the requisite expertise to render the requested medical opinion. The examiner should provide the following medical opinions: (a.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran's hypertension is proximately due to the or the result of his service-connected diabetes mellitus, type II? (b.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran's hypertension was aggravated beyond its natural progression by his service-connected diabetes mellitus, type II? (Does not need to permanently worsen). (c.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran's hypertension is proximately due to the or the result of his service connected IHD? (d.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran's hypertension was aggravated beyond its natural progression by his service connected IHD? (Does not need to permanently worsen). (e.) Is it at least as likely as not (at least a 50 percent probability) that the Veteran's hypertension is directly related to military service, to include as a result of exposure to herbicides while he was in Vietnam? The examiner should consider that in November 2018, hypertension was moved by National Academies of Sciences to the category of "sufficient" evidence of an association from its previous classification in the "limited or suggestive" category. https://www.nationalacademies.org/news/2018/11/vietnam-veterans-and-agent-orange-exposure-new-report The examiner should give a detailed explanation for the reasons for the opinion(s) provided. The medical reasons for accepting or rejecting the Veteran's theories of entitlement should be set forth in detail. If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. Jones v. Shinseki, 23 Vet. App. 382, 289 (2010). (The agency of original jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained). 2. The AOJ must review this opinion to ensure it is adequate and complies with the Board's specific remand directives herein. If deficient in any manner, corrective action must be taken at once. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that AOJ compliance with Board remand directives is not discretionary or optional). (Continued on the next page) 3. Then, the Veteran's claim must be readjudicated. If the benefit sought on appeal is not granted to the Veteran's satisfaction, the Veteran and his representative must be provided a Supplemental Statement of the Case and be given an adequate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist 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.