Citation Nr: 21077395 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 19-17 417 DATE: December 29, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran had active-duty service in the United States Marine Corps from November 1968 to October 1970, including service in the Republic of Vietnam. In the February 2020 decision, the Board denied the issue of entitlement to service connection for hypertension. The Veteran appealed the case to the United States Court of Appeals for Veterans Claims (Court). In August 2021 the Court granted the parties' Joint Motion for Partial Remand (JMPR) and remanded this issue to the Board for action consistent with the terms of the JMPR. The Board also denied the issues of entitlement to an effective date prior to August 9, 2017 for the award of service connection for prostate cancer; entitlement to service connection for peripheral neuropathy, left upper extremity, to include as due to Agent Orange exposure; entitlement to service connection for peripheral neuropathy, right upper extremity, to include as due to Agent Orange exposure; and entitlement to service connection for peripheral neuropathy, left lower extremity, to include as due to Agent Orange exposure. However, the Veteran did not challenge the Board findings and the parties requested that the Court dismiss the appeals of these claims. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents, is remanded. The Veteran is seeking service connection for hypertension. The JMPR found that the Board erred when it failed to discuss whether it had constructive possession of the National Academy of Sciences, Engineering, and Medicine's (NAS) report Veterans and Agent Orange: Update 2012. 79 Fed. Reg. 20,308 (Apr. 11, 2014). Specifically, the JMPR noted that the 2012 Update shows that there is limited or suggestive evidence of an association between hypertension and exposure to Agent Orange, which is relevant to Veteran's claim to entitlement for service connection for hypertension. Importantly, although VA has not conceded a relationship between hypertension and herbicides, more recently, the NAS released Update 2018, which upgraded hypertension from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to Agent Orange to the category of "sufficient" evidence of an association. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. Further, service treatment record show that his blood pressure was slightly elevated at 120/82 at his October 1970 discharge examination. The Veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Considering the above, the Board finds that a VA examination with etiological opinion is necessary to address the etiology of the Veteran's hypertension. In light of the need to remand, additional VA clinical records should also be obtained. The matters are REMANDED for the following action: 1. Obtain VA clinical records dated from February 2019 to the present. 2. Schedule the Veteran for a VA examination with an appropriate clinician for his hypertension. The claims file must be reviewed. The examiner must opine whether it is at least as likely as not that the hypertension (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) related to service, including exposure to herbicide agents. A detailed rationale must be provided. The examiner must address the slightly elevated blood pressure reading of 120/82 upon discharge. The examiner is advised that a negative opinion cannot be based solely on the fact that hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Moreover, the examiner should consider Update 11 (2018) from NAS Institute of Medicine that upgraded hypertension from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to Agent Orange to the category of "sufficient" evidence of an association. Specifically, according to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.N. Moats 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.