Citation Nr: 21006682 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 15-20 691 DATE: February 4, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for stroke is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1969 to December 1971, and from November 1973 to August 1975. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in July 2013 and February 2016 issued by a VA Regional Office (RO). These claims were previously before the Board in September 2018 and were remanded for further development to determine whether the Veteran’s active duty service included service near shore or in an inland waterway during the Vietnam war. A review of the claims file now shows that there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). However, as will be discussed in greater detail below, the Board finds that a further remand is warranted to properly develop the Veteran’s claims. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for stroke is remanded. The Veteran contends his hypertension and stroke are related to service during the Vietnam era. Specifically, the Veteran has alleged his conditions are related to herbicide exposure. The Board notes, the Veteran’s exposure to herbicide agents has been conceded according to the Blue Water Navy Vietnam Veterans Act of 2019. See March 2020 VA Memorandum. The Board further notes, that since the Board’s prior remand in September 2018, the Veteran is now service connected for diabetes type II as well as coronary artery disease as a result of presumed herbicide agent exposure during service. The evidence of record is currently insufficient for the Board to render a decision and, therefore, remands are warranted to afford the Veteran appropriate VA examinations. In particular, the Board notes that the Veteran’s service treatment records (STRs) contain a physical reevaluation form dated in July 1978 that indicates the Veteran was disqualified from service due to “unacceptable blood pressure/pulse” readings. Post-service medical records confirm diagnoses for both hypertension and history of a past stroke. Indeed, medical records indicate that the Veteran suffered a stroke in April 2010 and a primary care note, dated in July 2012, indicates the Veteran’s stroke in 2010 occurred “when his diabetes was not controlled”. The Veteran’s conditions of stroke and hypertension are not presumptive diseases listed under 38 C.F.R. § 3.309 (e). Service connection, however, may still be established on a direct basis or secondary basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). To that effect, the Veteran has never been afforded a VA examination to determine the etiology of his stroke and hypertension. As mentioned above, the Veteran is now service connected for diabetes type II as well as for coronary artery disease. The evidentiary record reasonably raises the theory that the Veteran’s stroke and/or hypertension were incurred in service or, alternatively, are secondary to service-connected disabilities, such as diabetes and coronary artery disease. In light of the above, the Board finds a VA examination is warranted and the evidence is currently insufficient to render a decision on the claim. See McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate VA clinician regarding the etiology of the Veteran's claimed stroke and hypertension conditions. The clinician is asked to review the claims file and note that such review took place. The need for an examination is left to the discretion of the clinician selected to write the opinion. The clinician is asked to address the following: (a.) Whether it is at least as likely as not (probability of 50 percent or better) that the Veteran's hypertension and/or stroke had its onset in or is otherwise related to his active service. The examiner should specifically address the service treatment record (STR) dated in July 1978 that the Veteran was disqualified from service due to “unacceptable blood pressure/pulse”. (b). If not incurred in or otherwise due directly to service, whether it is at least as likely as not (probability of 50 percent or better) that the Veteran’s hypertension and/or stroke (and residuals thereof) was caused or aggravated (i.e., worsened beyond natural progression) by a service-connected disability, including diabetes type II and coronary artery disease. In determining whether his claimed conditions are aggravated by any service-connected disability, discuss a baseline level of severity of the claimed condition established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. The examiner is specifically asked to address the following piece of evidence: July 2012 Primary Care Note indicating the Veteran suffered a stroke in April 2010 “when his diabetes was not controlled”. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.