Citation Nr: 21013408 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 18-27 160 DATE: March 9, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II and/or diabetic nephropathy, or herbicide exposure is remanded. Entitlement to service connection for polycythemia, to include as secondary to service-connected diabetes mellitus type II and/or diabetic nephropathy, or herbicide exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to September 1967, including service in the Republic of Vietnam. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in June 2019, when the claims above were remanded for further development. A service connection claim for residuals of bladder cancer was additionally remanded at that time. In June 2020, the RO granted service connection for residuals of bladder cancer, recurrent urinary tract infections. This issue is no longer in appellate status. With respect to his service connection claims for hypertension and polycythemia, a June 2020 supplemental statement of the case was most recently issued, and the case is once again before the Board. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) was raised in a July 2020 statement and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. 1. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II and/or diabetic nephropathy, or herbicide exposure. 2. Entitlement to service connection for polycythemia, to include as secondary to service-connected diabetes mellitus type II and/or diabetic nephropathy, or herbicide exposure. Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. The Veteran was afforded VA examinations and opinions in January 2020. The examiner provided negative nexus opinions regarding hypertension and polycythemia, as secondary to the Veteran’s service-connected diabetes mellitus type II. However, in providing rationale for the negative opinions, the VA examiner appears to relate the Veteran’s claimed disabilities (hypertension and polycythemia) to a kidney disability. The Board notes that the Veteran is service-connected for diabetic nephropathy. Additionally, following a review of the medical opinions provided, the Board finds that the VA examiner did not adequately address whether these claimed disabilities are directly related to service, to include his conceded herbicide exposure. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The Board finds that additional VA medical opinions are needed to adjudicate these claims. The matters are REMANDED for the following actions: 1. Forward the Veteran’s claims folder to an examiner(s) for an addendum opinion regarding the Veteran’s hypertension and polycythemia. Each examiner is requested to review the claims folder, to include this remand. If further examination of the Veteran is found to be necessary, such should be arranged. Following review of the claims file the examiner should provide opinions on the following: Hypertension Whether it is at least as likely as not (a probability of 50 percent or greater) hypertension had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service, to include herbicide exposure. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s hypertension was caused by his service-connected diabetic nephropathy. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s hypertension was aggravated by his service-connected diabetic nephropathy. Polycythemia Whether it is at least as likely as not (a probability of 50 percent or greater) polycythemia had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to his active service, to include herbicide exposure. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s polycythemia was caused by his service-connected diabetic nephropathy. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s polycythemia was aggravated by his service-connected diabetic nephropathy. The term “aggravated” in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. Rationale for all requested opinions must be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall 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 particular question(s). (Continued on the next page)   2. Finally, readjudicate the claims on appeal. If any of the benefits sought on appeal remain denied, then furnish the Veteran and his representative with a supplemental statement of the case and allow them an opportunity to respond. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. M. Clark, 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.