Citation Nr: 21077495 Decision Date: 12/30/21 Archive Date: 12/29/21 DOCKET NO. 14-44 056A DATE: December 30, 2021 REMANDED Service connection for hypertension, to include as due to exposure to herbicide agents and/or lead-based paint and/or asbestos, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1962 to June 1966. In July 2018, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. The Veteran's claim for entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and/or lead-based paint and/or asbestos, was denied in a July 2020 Board of Veterans' Appeals (Board) decision. The Veteran appealed to the Court of Appeals for Veterans Claims (Court). In an August 2021 Joint Motion for Remand (JMR), the parties agreed that the Board failed to ensure substantial compliance with the September 2018 remand order. At that time, the Board remanded the Veteran's claim for a new examination to address whether the Veteran's hypertension was related to any in-service disease or injury, to include exposure to herbicide agents during service in Vietnam, lead-based paint, solvents, or other chemicals. The examiner was directed to consider and address the medical opinions of record, medical treatise evidence, and lay statements. However, the April 2020 addendum medical opinion did not address the private medical opinion, medical treatise evidence, or lay statements. In the April 2020 addendum opinion, the VA examiner noted that there was limited or suggestive evidence of an association between hypertension and herbicide agent exposure, but that the noted literature did not conclude that herbicide agent exposure was a causative factor of hypertension. The examiner did note that that low levels of lead and other chemical exposure are known to cause organ damage over time but concluded that because there was no evidence of kidney damage, a nexus could not be established. Since the Court's August 2021 decision, an updated October 2021 medical opinion by the same private provider was added to the file, indicating that chronic exposure to modest levels of lead, too low to trigger symptoms, can increase risk for hypertension and can accelerate future cognitive and renal decline in adults. In accordance with the JMR, an addendum medical opinion that considers the medical opinions of record, medical treatise evidence, and lay statements is required. The matters are REMANDED for the following action: 1. Provide the Veteran's claims file to an appropriate VA clinician. The clinician should provide an opinion addressing whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is related to any in-service disease or injury, to include exposure to herbicide agent, lead-based paint, solvents, asbestos, or other chemicals as the Veteran has described. The examiner must specifically comment on the private medical opinions of record, medical treatise evidence submitted by the Veteran, and the lay statements of record. 2. The examiner should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 3. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Geer, 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.