Citation Nr: 21013457
Decision Date: 03/09/21	Archive Date: 03/09/21

DOCKET NO. 16-59 523
DATE: March 9, 2021

REMANDED

Entitlement to service connection for hypertension, to include as due to exposure to herbicides, is remanded.

REASONS FOR REMAND

The Veteran had active duty service in the United States Air Force from March 1960 to August 1972 and again from February 1973 to September 1980.  His duty included service in the Republic of Vietnam from February 1966 to January 1967.  His exposure to herbicides has been conceded.

Entitlement to service connection for hypertension.

The Board most recently remanded the Veteran’s claim in July 2020.  Consistent with the Board’s remand directives, he was afforded additional VA examination in January 2021.  The January 2021 VA examiner opined that the Veteran did not have a current heart disability but that he did have a diagnosis of hypertension.  She opined that the Veteran’s hypertension was less likely than not due to service.  However, a sufficient rationale was not provided.  The examiner did not address the medical literature which states there is “sufficient” evidence of a relationship between hypertension and herbicide exposure.

Specifically, the updates from the National Academy of Sciences (NAS), in 2006 and 2008, concluded that there was “limited or suggestive evidence of an association” between hypertension and herbicide exposure.  See 75 Fed. Reg. 32,540, 32,549 (June 8, 2010); 75 Fed. Reg. 81,332, 81,333 (December 27, 2010).  However, more recently, hypertension was moved from the “limited or suggestive” category to the category of “sufficient” evidence of an association.  See National Academies of Sciences, Engineering, and Medicine. 2018. Veterans and Agent Orange: Update 11 (2018).  This medical literature was not considered by the January 2020 VA examiner.  Therefore, remand is necessary. 

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from the January 2021 VA examiner addressing the nature and etiology of the Veteran’s hypertension. 

The examiner must consider and discuss the 2018 NAS Institute of Medicine Update which states that there is “sufficient” evidence of an association between hypertension and herbicide exposure.  

If the examiner determines the Veteran’s hypertension was more likely caused by other factors, she should state as much.

After considering the NAS report, the examiner is again asked to opine whether the Veteran’s hypertension is at least as likely as not directly related to service to include his conceded exposure to herbicides.

The examiner is again reminded that although a Veteran may not be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis.

A complete rationale for any medical opinion must be provided. 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Martha R. Luboch, 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.