Citation Nr: 21074791 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-46 764A DATE: December 16, 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 from January 1968 to November 1971. Entitlement to service connection for hypertension, claimed due herbicide agent exposure, is remanded. In its July 2021 Remand instructions, the Board requested that the Veteran be afforded further Department of Veterans Affairs (VA) hypertension evaluation. The examiner was directed to advance an opinion as to "whether it at least as likely as not (i.e. a probability of 50 percent or greater) that the hypertension is related to his acknowledged in-service exposure to herbicide agents and whether the hypertension was aggravated by the service connected diabetes mellitus with express consideration of the "NAS IOM's Veterans and Agent Orange: Update 11 (2018) ... and the medical treatise cited by the Veteran's representative in the May 2021 Appellate Brief for the proposition that diabetic nephropathy may not necessarily precede hypertension." A September 2021 hypertension evaluation conducted for VA concluded that "the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness." The examiner commented that: "in order for hypertension to be considered due to Agent Orange exposure it must be linked to diabetes;" "to be linked to diabetes, there has to be evidence that diabetes is affecting kidneys;" "with a high functioning kidney, hypertension is not due to kidney, and kidney is not due to diabetes;" "further evidence shows hypertension predating diabetes, and diagnosed in 2002;" and "with no evidence of kidney dysfunction, a cause for aggravation is also not found." The physician assistant did not note or otherwise address the "NAS IOM's Veterans and Agent Orange: Update 11 (2018) ... and the medical treatise cited by the Veteran's representative in the May 2021 Appellate Brief for the proposition that diabetic nephropathy may not necessarily precede hypertension." The Agency of Original Jurisdiction's compliance with the Board of Veterans' Appeals (Board) remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, further VA hypertension evaluation is needed. Clinical documentation dated after February 2021 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for any hypertensive disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records dated after February 2021. 3. Schedule the Veteran for a VA hypertension examination conducted by a medical doctor to assist in determining the current nature of any identified hypertensive disability and its relationship, if any, to active service and/or service connected disability. The examiner must review the record, including the "NAS IOM's Veterans and Agent Orange: Update 11 (2018) and the medical treatise cited by the Veteran's representative in the May 2021 Appellate Brief for the proposition that diabetic nephropathy may not necessarily precede hypertension, 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 the diagnosed hypertension had its onset during active service or is related to any incident of service, including presumed exposure to herbicide agents. The examiner must specifically address the NAS IOM's Veterans and Agent Orange: Update 11 (2018). (Continued on the next page) (c) Opine whether it is at least as likely as not (50 percent probability or greater) that the diagnosed hypertension is due to the diabetes mellitus, atherosclerotic cardiovascular disease, and the other service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that the diagnosed hypertension has been aggravated (increased in severity beyond the natural progress of the disorder) by the diabetes mellitus, atherosclerotic cardiovascular disease, and the other service connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Macek, M. A. 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.