Citation Nr: 21076031 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 16-32 687 DATE: December 22, 2021 REMANDED Service connection for hypertension is remanded. REASONS FOR REMAND Hypertension The Veteran served on active duty in the United States Army from July 1968 to June 1970, including service in the Republic of Vietnam and decorations include Combat infantry Badge. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in May 2021 and remanded for additional development. The Veteran seeks service connection for his hypertension condition. In support, he reports that his condition is related to his Agent Orange exposure in service and his service-connected conditions. The Board remanded this in case in May 2021. Subsequently, on November 2021, the Veteran was afforded a VA examination and the examiner stated that his hypertension was less likely than not related to service or his diabetes mellitus. The rationale was that his hypertension was diagnosed before his diabetes and the condition is not attributable to Agent Orange exposure. However, the Board finds that the instructions in the May 2021 Board remand were not followed since the examiner did discuss the NAS study mentioned in the Board's decision. Additionally, the Board finds that the latest VA examination was not adequate and did not provide a complete rationale regarding the onset and nature of the Veteran's hypertension. See VA medical examination (November 2021). Thus, the Veteran should be afforded a complete examination to determine the onset, etiology and nature of his hypertension condition. Also, the examiner must opine if his hypertension is aggravated or caused by his service-connected conditions. Further, the examiner should consider the credible lay statements regarding the onset of his hypertension condition. Indeed, the record shows treatment and a diagnosis of hypertension. Thus, the Board must remand these matters for compliance with the instructions in this decision and the May 2021 Board's remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, although hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e), the National Academy of Sciences Institute of Medicine the (NAS) has upgraded hypertension to the "sufficient" category from "limited or suggestive," indicating that "there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137. On remand, the VA examiner must acknowledge and discuss the NAS findings. As there is no adequate examination to determine the cause, onset, etiology of his hypertension, as well, if is aggravated or proximately due by his service-connected disabilities, a remand is necessary to have the Veteran examined and for an examiner to provide opinions necessary to adjudicate this appeal. The matter is REMANDED for the following action: 1. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). Whether an in-person examination is necessary should be determined by the examiner. Also, the examiner must opine as to whether it is at least as likely as not that the Veteran's hypertension is related to or had its onset in service. In offering this opinion, the examiner must acknowledge and discuss the NAS study cited above. Additionally, the examiner must opine if his hypertension is related to service or aggravated by service or his service-connected conditions, and in particular his diabetic nephropathy. The examiner should provide a complete rationale or explanation for all opinions reached. In offering this opinion, the examiner must acknowledge and discuss the Veteran's competent and lay statements of his condition and any lay evidence regarding the onset of his disability. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.