Citation Nr: 21010674 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 11-32 383 DATE: February 25, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to herbicide agent exposure and/or as secondary to service-connected diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to April 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision. In October 2016, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. The Veteran’s claim for service connection was remanded by the Board in February 2017 and April 2018 for further development. The Board finds that there has not been substantial compliance with the remand directives. Entitlement to service connection for hypertension, to include as due to herbicide agent exposure and/or as secondary to service-connected diabetes mellitus, type II, is remanded. The Veteran’s claim for service connection was remanded in April 2018, in part, to obtain an addendum medical opinion to determine the nature and etiology of his hypertension. In particular, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain a medical opinion to determine whether the Veteran’s hypertension had its clinical onset during his active service or is related to any incident of service, to include herbicide agent exposure. The Board directed the examiner providing the medical opinion to consider and address a National Academy of Sciences (NAS) report, finding “limited or suggestive evidence of an association between” hypertension and Agent Orange exposure based on a recent statistical study. See Determinations Concerning Illnesses Discussed in National Academy of Sciences Report: Veterans and Agent Orange: Update 2010, 77 Fed. Reg. 47,924, 47,926 (Aug. 10, 2012); Notice on Health Outcomes Not Associated With Exposure to Certain Herbicide Agents, 75 Fed. Reg. 32,540, 32,542 (June 8, 2010). The Board finds that the September 2019 VA medical opinion obtain by the AOJ is inadequate as it is based on an inaccurate factual premise. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); see also Reonal v. Brown, 5 Vet. App. 458 (1993) (a medical opinion based on an inaccurate factual premise is not probative). The medical opinion states that although there is limited or suggestive evidence of an association between hypertension and herbicide agent exposure based on the above NAS report, there is no firm conclusion as to such an association. However, NAS recently upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with exposure to Agent Orange to the category of “sufficient” evidence of an association in Update 11 (2018). According to NAS, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. Therefore, a remand is necessary to obtain an addendum medical opinion. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2020 to the present. 2. Obtain an addendum medical opinion to determine the nature and etiology of the Veteran’s hypertension. The examiner must review the Veteran’s claims folder. The examiner must opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension is related to any incident of service, to include herbicide agent exposure. In addressing the above, the examiner must consider and address the NAS, Veterans and Agent Orange: Update 11 (2018), which reflects that NAS upgraded hypertension to the “sufficient” category from “limited or suggestive,” indicating “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. See http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137. The examiner must provide complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, 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.