Citation Nr: 21073529
Decision Date: 12/09/21	Archive Date: 12/09/21

DOCKET NO. 16-43 535
DATE: December 9, 2021

REMANDED

Service connection for hypertension is remanded.

REASONS FOR REMAND

In the November 2021 Appellate Brief, the Veteran's representative raised the issue of entitlement to service connection for hypertension as due to his presumed exposure to herbicides during his active service in the Republic of Vietnam.

The National Academy of Sciences, Engineering, and Medicine (NAS) recently published updated information about the relationship between a person's exposure to Agent Orange and subsequent development of hypertension.  It upgraded the relationship between hypertension and Agent Orange exposure from "limited or suggestive" to "sufficient," indicating that "there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure.  See National Academies of Sciences, Engineering, and Medicine 2018, Veterans and Agent Orange: Update 11 (2018) at 10, 487-498.

Also, in formulating a negative etiological opinion with regard to a relationship between hypertension and coronary artery disease, the September 2021 C&P examiner noted that there is a study that shows an increased risk for hypertension in veterans that were exposed to pesticides.

Considering there is evidence of a current disability of hypertension and the NAS findings suggesting that there may be an association between hypertension and herbicide exposure, remand is required for a medical opinion.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).  

The matter is REMANDED for the following action:

1. Request that the September 2021 C&P examiner (or another qualified examiner if the September 2021 examiner is unavailable) review the claims folder and provide an opinion as to whether hypertension is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, to include presumed exposure to herbicides?

In formulating the opinion, the physician should consider the recent change in status of hypertension in Veterans and Agent Orange.  See National Academies of Sciences, Engineering, and Medicine 2018, Veterans and Agent Orange: Update 11 (2018) at 10, 487-498.

The examiner must provide a comprehensive rationale for all opinions proffered, and consideration should be given to the lay and medical evidence of record. 

An examination should be scheduled if deemed necessary by the examiner.  

 

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.W. Kreindler, 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.