Citation Nr: 21006811 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 08-23 897 DATE: February 5, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1970 to December 1971. This appeal has been remanded by the Board in June 2017, June 2018, and June 2019. 1. Entitlement to service connection for hypertension is remanded. The Veteran contends his hypertension is related to his military service, including herbicide exposure, or one of his service-connected disabilities, to include post-traumatic stress disorder (PTSD) or coronary artery disease (CAD). The June 2019 Board remand requested an opinion from an appropriate specialist pursuant to 38 U.S.C.§ 5109 due to the complexity and controversy of the claim. The examiner was directed to consider the 2011 National Academy of Sciences study between herbicide agent exposure and hypertension as the March 2019 VA examiner provided conclusory statements. In January 2020 an addendum opinion was obtained. This examiner did not provide an analysis of the 2011 NAS study or the 2018 study, which indicates, “…exposure to Agent Orange and other herbicides used during the Vietnam War found sufficient evidence of an association for hypertension.” NATIONAL ACADEMY OF SCIENCES, Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War (Nov. 15, 2018), available at: http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137. The Board also finds the examiner’s opinion as to whether the Veteran’s hypertension was proximately due to or aggravated by his service-connected post-traumatic stress disorder to be insufficient. The examiner appears to rely on the lack of service treatment records indicated a correlation between the Veteran’s mental health and his blood pressure. There is no explanation as to why a correlation would be present in the service treatment records as the Veteran was not diagnosed with either condition until after his separation. The remand instructions were not fully complied with, and as such, a remand is appropriate. See Stegall v. West, 11 Vet. App. 268 (1998). The Board is obligated by law to ensure that the RO complies with its directives; where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. See Stegall, 11 Vet. App. 268. A remand is again warranted. The matters are REMANDED for the following action: 1. Obtain another addendum opinion from an appropriate clinician, pursuant to 38 U.S.C.§ 5109, to determine the nature and etiology of the Veteran’s hypertension. After reviewing the claims file, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran’s hypertension: (a.) had its onset in service or is otherwise etiologically related to active service, to include herbicide agent exposure. The examiner should address (1) the 2018 NAS update indicating sufficient evidence for a correlation between Agent Orange exposure and hypertension and (2) the fact that the Veteran’s blood pressure was 162/84 upon separation from service. (b.) was proximately due to the Veteran’s service-connected PTSD. (c.) underwent any incremental increase in disability, regardless of its permanence, due to the service-connected PTSD. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. Joshua Castillo Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Rekowski 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.