Citation Nr: 21005570 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 13-14 761 DATE: February 2, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to March 1970. In March 2020, the Board remanded the Veteran’s claim for service connection for hypertension for further action consistent with the Board’s remand directives. The claim is back before the Board for further appellate proceedings. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran has hypertension. See July 2020 VA examination report. Since the prior Board remand in March 2020, VA conceded that the Veteran was exposed to herbicides based on his nautical service in the eligible offshore waters of the Republic of Vietnam pursuant to the Blue Water Navy Vietnam Veterans Act of 2019. See July 2020 Rating Decision. The Veteran was afforded a VA examination regarding the nature and etiology of his hypertension in 2017, and an additional VA medical opinion was requested in July 2020 regarding his hypertension as it relates to his now service-connected coronary artery disease (CAD). However, neither opinion addressed the Veteran’s recently conceded herbicide exposure as it relates to his diagnosis of hypertension. Hypertension is not a disease listed under 38 C.F.R. § 3.309 (e) for which a presumption of service connection based on herbicide agent exposure applies. In November 2018, the National Academy of Sciences (NAS) issued an update on Veterans and Agent Orange that moved hypertension from the “limited or suggestive evidence” category to the “sufficient evidence of an association” category. See Nat’l Acad. of Sci., Inst. of Med., Veterans and Agent Orange: Update 11 (2018), available at https://www.nap.edu/resource/25137/111318_VAO_2018_highlights.pdf (accessed on February 1, 2021). Given the 2018 NAS update, there is an indication that the Veteran’s diagnosed hypertension may be associated with his herbicide agent exposure, thus triggering VA’s duty to obtain a medical opinion. See McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006). Absent a medical opinion, the record is insufficient for the Board to decide the Veteran’s claim. The Board will remand for a medical opinion as to the likelihood that the Veteran’s hypertension is related to his in-service herbicide agent exposure. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records relevant to treatment the Veteran received for his hypertension. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from an appropriately qualified VA clinician to determine the nature and etiology of the Veteran’s hypertension. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinions must include a notation that this record review took place. It is up to the discretion of the reviewing clinician whether a physical examination of the Veteran is needed to answer the questions below. The reviewing clinician should answer the following: Is it at least as likely as not that the Veteran’s hypertension was incurred in, or is otherwise related, to his time on active service, to include his conceded herbicide agent exposure? The reviewing clinician should specifically consider the Veterans and Agent Orange: Update 11 (2018) from the National Academies of Science, Engineering and Medicine. Is it at least as likely as not that the Veteran’s hypertension was caused OR aggravated by his service-connected coronary artery disease and/or diabetes? In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question. 3. After the above has been completed to the extent possible, readjudicate the claim. If the benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Katie Poe, 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.