Citation Nr: 21074622 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 09-48 730 DATE: December 15, 2021 ORDER Entitlement to service connection for hypertension is granted. REMANDED Entitlement to service connection for an eye disorder resulting in loss of vision (other than refractive error), to include as secondary to service-connected diabetic retinopathy with macular edema is remanded. FINDING OF FACT The Veteran's hypertension is related to conceded herbicide exposure during service. CONCLUSION OF LAW The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1968 to September 1972 in the United States Navy. In July 2021, the Board remanded the claims for additional development. There has been substantial compliance with the remand in connection with claim decided herein and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Entitlement to service connection for hypertension, to include as secondary to the service-connected diabetes mellitus, and/or as a result of in-service exposure to herbicide agents The Veteran contends that his hypertension is etiologically due to herbicide exposure during active-duty service. The Board concludes that the Veteran has a current disability that is related to his conceded in-service herbicide exposure during active-duty service in the Republic of Vietnam. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). February 2005 private treatment records show the Veteran has a current diagnosis of hypertension. Thus, the question becomes whether the current disability is related to service. On this question there is essentially only one probative opinion, which is in favor of the claim. The evidence against the claim includes multiple VA medical opinions. However, these opinions have been deemed inadequate in subsequent Board decisions. The evidence in favor of the claim includes a September 2021 addendum medical opinion finding that the Veteran's hypertension is at least as likely as not due to his conceded in-service herbicide exposure. As rationale the examiner clarified that "agent orange exposure is an established primary etiology of HTN in the medical literature (based on the 2018 update from the National Academy of Sciences)." The Board notes that the AOJ determined that this opinion lacks any factual information, "is not consistent with the evidence of record," and "therefore does not satisfactorily prove your claim." However, as the Board has stated, the remaining VA medical opinions of record are inadequate with respect to this question, undercutting any reliance on the evidence of record as having more probative value than the September 2021 opinion. Furthermore, the Veteran's time and manner of herbicide exposure are conceded facts in this case and the examiner's opinion specifically cited literature that the Board requested be addressed, in support of his opinion. Therefore, the Board finds this medical opinion, and the examiner's interpretation of the cited medical literature, to be probative. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypertension is related to herbicide exposure during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for an eye disorder resulting in loss of vision, other than refractive error and diabetic retinopathy with macular edema vision loss due to conditions other than diabetic retinopathy is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of entitlement to service connection for vision loss. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board cannot make a fully-informed decision on the issue of entitlement to service connection for vision loss because no VA examiner has opined whether the Veteran's various eye conditions, other than diabetic retinopathy, are aggravated by service-connected diabetic retinopathy with macular edema. In July 2021 an addendum opinion was provided addressing the aggravation theory of secondary service connection. However, the examiner cites the incorrect standard for aggravation by a service-connected disability. Therefore, an additional medical opinion is required. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether each of the Veteran's diagnosed eye conditions (other than diabetic retinopathy with macular edema) are at least as likely as not aggravated by service-connected diabetic retinopathy with macular edema. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.