Citation Nr: 21013769 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-31 450A DATE: March 10, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to in-service exposure to herbicide agents, or as secondary to a service-connected disability, including anxiety disorder and arteriosclerotic cardiovascular disease, is remanded. REASONS FOR REMAND The Veteran had active service from May 1967 to February 1971. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2009 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In November 2017, a videoconference Board hearing was held before a Veterans Law Judge (VLJ). A transcript of that hearing is of record. In June 2020, the Board notified the Veteran that the VLJ who presided over his November 2017 hearing had retired. In that same communication from the Board, the Veteran was asked to respond within 30 days if he desired another Board hearing. The Veteran subsequently responded, in correspondence obtained in August 2020, that he does not wish to appear at another Board hearing. As such, the Board will proceed with consideration of the Veteran’s claim. The Board also notes that this case was remanded for additional development in June 2018 and August 2020. Although the remand directives have mostly been satisfied, the Board will regrettably have to remand this case again, for reasons indicated below. The Board finds that the September 2020 VA medical opinion is inconclusive and cannot be used to decide the Veteran’s claim. Specifically, after indicating that he reviewed the medical journal articles submitted by the Veteran, and acknowledging that both articles suggest significant findings and show some correlation between Agent Orange exposure and increased risk for hypertension, the examiner concluded that he could not state with certainty whether the Veteran’s hypertension is more likely attributable to Agent Orange exposure as opposed to underlying cardiovascular disease, family history, advanced age, or the Veteran’s lifestyle. As service connection for arteriosclerotic cardiovascular disease is in effect, this opinion leaves open the possibility that the Veteran’s hypertension could be proximately due to, or caused by, his arteriosclerotic cardiovascular disease. The record does not include any other medical opinion regarding the relationship between these two disabilities. In addition, without elaborating further, the examiner noted that people who are anxious or stressed are more likely to engage in unhealthy habits that raise blood pressure. He did not specify which of the Veteran’s unhealthy habits, if any, may have aggravated or caused his high blood pressure. Further, the examiner merely listed various risk factors for hypertension, but he did not explain how those risk factors specifically relate to the Veteran’s case. Generally, when VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the Board finds that the September 2020 medical opinion is inadequate because it is inconclusive and is not supported by adequate rationale. Thus, due to the noted deficiencies in the September 2020 medical opinion, a remand is necessary for the RO to obtain an addendum medical opinion regarding the etiology of the Veteran’s hypertension. Accordingly, this matter is REMANDED for the following action: Forward the Veteran’s claims file to an appropriate VA clinician to obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s hypertension. A VA examination should be scheduled if the clinician believes that one is necessary to answer the questions below. The clinician is asked to review the claims file, including relevant medical journal articles submitted by the Veteran, and to opine on the following: a. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension onset during service or is etiologically related to service, to include his presumed exposure to herbicide agents? b. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s hypertension was caused by, aggravated by (made worse), or proximately due to, a service-connected disability, to include his anxiety disorder and arteriosclerotic cardiovascular disease? In answering this question, the examiner is asked to address the September 2020 VA examiner’s opinion, which raised the possibility that the Veteran’s hypertension was proximately due to service-connected arteriosclerotic cardiovascular disease. The examiner is also asked to address the September 2020 VA examiner’s statement that “people who are anxious or stressed are more likely to engage in unhealthy habits that raise blood pressure.” Specifically, the examiner is asked to explain how this relates to the Veteran’s case—i.e., that his anxiety disorder caused, or aggravated, his hypertension. A rationale should be provided for all opinions expressed. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for any VA medical examination, if requested, may impact the determination made. 38 C.F.R. § 3.655. The Veteran is also advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Trowers, 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.