Citation Nr: 21006962
Decision Date: 02/08/21	Archive Date: 02/08/21

DOCKET NO. 14-10 706A
DATE: February 8, 2021

REMANDED

The claim for hypertension, to include as a result of herbicide exposure or as secondary to the Veteran’s service connected diabetes mellitus, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from the United States Marine Corps from May 1970 to April 1972.  This issue comes before the Board of Veterans’ Appeals (Board) on appeal from April 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2018 and March 2020, this issue was remanded for additional development.

In the March 2020 opinion, the examiner wrote that the Veteran’s hypertension was not the result of his presumed herbicide exposure as hypertension was not a presumptive condition.  However, it is worth noting that the National Academies of Sciences, Engineering, and Medicine in its most recent Agent Orange update moved hypertension from limited or suggestive of an association between hypertension and herbicide exposure to sufficient evidence of an association. See Veterans and Agent Orange Update 11 (2018).  The standard for this new category is epidemiologic evidence is sufficient to conclude that there is a positive association. That is, a positive association has been observed between exposure to herbicides and the outcome in studies in which chance, bias, and confounding could be ruled out with reasonable confidence. For example, if several small studies that are free of bias and confounding show an association that is consistent in magnitude and direction, there could be sufficient evidence of an association. There is sufficient evidence of an association between exposure to the chemicals of interest and hypertension.

While this finding does not mandate the grant of service connection, as hypertension is not an Agent Orange presumptive at this time, the findings should nevertheless be considered by a medical professional as they pertain to the specifics of the Veteran’s case.

The matters are REMANDED for the following action:

Obtain a medical opinion to determine the etiology of the Veteran’s hypertension. If the Board’s questions cannot be answered without a physical examination, one should be scheduled.  The examiner should answer the following questions: Is it at least as likely as not (50 percent or greater) that the Veteran’s hypertension was caused by his presumed exposure to herbicide agents during service?  Why or why not? In so doing, the examiner should review Veterans and Agent Orange Update 11 (2018), in which the National Academies of Medicine concluded that there was sufficient evidence of an association between exposure to herbicide agents and hypertension.

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Carole Kammel, 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.