Citation Nr: 21014068 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 10-31 214 DATE: March 11, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected persistent depressive disorder, to include as due to exposure to herbicide agents, is remanded. Entitlement to a total disability evaluation based on individual unemployability is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1970 to December 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2008 and November 2014 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In relevant part, the September 2008 rating decision denied the service connection for hypertension. The November 2014 rating decision denied entitlement to a total disability rating based on individual unemployability (TDIU). As pertinent to this appeal, these matters were previously remanded by the Board in June 2016 and January 2019 for further development. 1. Entitlement to service connection for hypertension, to include as secondary to service-connected persistent depressive disorder, to include as due to exposure to herbicide agents While the Board regrets further delay, a remand is necessary in order to fully adjudicate the Veteran’s claim for entitlement to service connection for hypertension. In September 2019, a VA examiner found that the Veteran did not have and had not had hypertension. It appears as though the opinion was based on a review of the record, including an April 2015 VA treatment record under the heading “Physical Disorders,” which revealed incorrect and inconsistent findings. A June 2020 addendum opinion essentially reiterated the same. However, an August 2020 VA treatment note shows a blood pressure reading of 164/91, with a note for the Veteran to follow-up with his primary care physician in two months for hypertension, among other things. Because the most recent VA treatment records of record are dated in August 2020 and the Veteran is noted to follow up in approximately October 2020 for hypertension, the Board finds that a remand is warranted to obtain VA treatment records from August 2020 to ascertain whether the Veteran has since been diagnosed with hypertension and, if so, to obtain an etiology opinion. 2. Entitlement to a TDIU The Veteran contends that his service-connected disabilities impact his ability to work. Specifically, the Veteran reported that he was no longer able to deal with current and potential customers working as a self-employed painter, which led to a lack of work which, in turn, led to the end of his business operations. See October 2012 VA Mental Disorders Examination Report. The Veteran’s claim for entitlement to a TDIU is intertwined with the remanded service connection claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Board also notes that after the Board’s January 2019 remand, the RO advised the Veteran that it was working on his TDIU claim and asked him to complete a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability. The Veteran was also asked to submit, if possible, a VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefit, which was to be completed by the employer(s) identified in the VA Form 21-8940. The Veteran has not responded. The Veteran is encouraged to complete and submit the aforementioned forms on remand. The matters are REMANDED for the following action: 1. Obtain all VA treatment records pertinent to the Veteran’s claim for service connection for hypertension dated from August 2020 and associate them to the claims file. 2. Thereafter, provide the claims file to an appropriate VA examiner, to include a copy of this Remand. The examiner should indicate that the claims file was reviewed. The need for a new VA examination to provide an addendum opinion regarding the nature and etiology of the Veteran’s claimed hypertension is left to the discretion of the VA examiner. Following review of the claims file and re-examination of the Veteran, if necessary, the examiner is asked to address the following: a. Does the Veteran have hypertension for VA compensation purposes as defined by 38 C.F.R. § 4.104, Diagnostic Code 7101 (meaning the diastolic blood pressure is predominantly 90mm. or greater confirmed by readings taken two or more times on at least three different days)? b. If the Veteran has hypertension, is it at least as likely as not (50 percent probability or greater) that his hypertension is related to service, to include exposure to herbicide agents while serving in Vietnam? The examiner should consider the Veterans and Agent Orange: Update 11 (2018), where NAS upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association to the category of “sufficient” evidence of an association. 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. c. If the answer to part (b) above is “no,” is it at least as likely as not (50 percent probability or more) that the Veteran’s hypertension is (i) proximately due to or the result of the Veteran’s service-connected disabilities, including medication prescribed for treatment of his service-connected disabilities, to include persistent depressive disorder and benign prostate hypertrophy with erectile dysfunction, or (ii) aggravated by his service-connected disabilities, including medication prescribed for treatment of his service-connected disabilities? If the examiner finds that one of the Veteran’s service-connected disabilities aggravates his hypertension, the examiner is asked to state whether the medical evidence created prior to the aggravation, or at any time between the time of aggravation and the current level of disability, shows a baseline for hypertension prior to aggravation and a current level of disability for hypertension. If the examiner is unable to establish a baseline for hypertension prior to the aggravation, he or she should state such and explain why a baseline cannot be determined. For aggravation, a permanent worsening or permanent increase in severity of the claimed disability is not required. All opinions are to be accompanied by a rationale consistent with the evidence of record. If the examiner cannot provide an opinion without resorting to speculation, he or she must provide complete explanations stating why this is so. In so doing, the examiner must explain whether any 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). 3. Thereafter, complete any additional development deemed appropriate, to include any development needed for the Veteran’s TDIU claim. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Battaile 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.