Citation Nr: 21075900 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-65 257 DATE: December 21, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service with the Army from November 1968 to July 1970. This matter is before the Board of Veterans' Appeals (the Board) on appeal from July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified in a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the evidence of record. The Veteran's claims were remanded in April 2020 and June 2021 for additional development. The Board regrets the delay but finds additional development is necessary prior to final adjudication of his claim. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; if they manifested to a compensable degree within a presumptive period following separation from service; or if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 C.F.R. § 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In the absence of presumptive service connection, the right to compensation for a present disability on a direct basis should be considered. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Direct service connection can be established if the Veteran shows (1) the existence of a present disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 U.S.C. § 1110; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Initially, the Veteran contended that while his hypertension was diagnosed prior to his service-connected diabetes mellitus there was a link or relationship between them. In the October 2020 appellate brief, the Veteran's representative raised another theory of entitlement. The representative noted that the National Academy of Sciences Institute of Medicine's "Veterans and Agent Orange: Update 2010" had concluded there was evidence suggesting an association between agent orange exposure and hypertension. Since the RO conceded the Veteran's exposure to agent orange in service, the Veteran should be afforded an examination to determine whether his hypertension was related to his herbicide exposure. While the Board notes the Veteran underwent VA examinations for diabetes and/or hypertension in June 2016, June 2017, June 2020, and June 2021, these examinations did not address whether his current hypertension was related to his in-service herbicide agent exposure. The July 2016 rating decision conceded exposure to an herbicide agent in service. Hypertension is not a condition currently recognized as presumptively linked to herbicide exposure. 38 C.F.R. §§ 3.307, 3.309. However, the threshold for finding a link between current disability and disease or injury in service is low. In this case, given that the Veteran's exposure to an herbicide is conceded, the Board finds it necessary to now obtain an addendum medical opinion regarding whether the Veteran's current hypertension was related to his in-service herbicide agent exposure prior to final adjudication. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the June 2021 examiner regarding service connection for hypertension. If the June 2021 examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical examination is needed, one should be scheduled. The examiner is asked to opine on the following: If it is at least as likely as not that the Veteran's hypertension had its onset in service or was otherwise etiologically related to any event or circumstance of his service, to include his exposure to an herbicide agent. The complete record, including a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. 2. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and be afforded the opportunity to response. Thereafter, the case should be returned to the Board for further consideration. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Byers 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.