Citation Nr: 21014380 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 17-19 798 DATE: March 12, 2021 REMANDED Service connection for hypertension, to include as secondary to in-service herbicide exposure and/or as secondary to the service-connected coronary artery disease (CAD) and the service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1967 to September 1971. A February 2020 Board of Veterans’ Appeals (Board) decision remanded this matter for further evidentiary development. Pursuant to the February 2020 Board remand, the Veteran was accorded a VA examination for his hypertension later that same month. The February 2020 examiner confirmed the diagnosis of hypertension but opined against its relationship to the Veteran’s active service (to include as a result of in-service exposure to herbicides) and to his service-connected CAD and PTSD. The Board, however, finds the examiner’s medical opinion to be inadequate. Specifically, the examiner stated that, because hypertension is not currently on the list of Agent Orange related pathologies, no reasonable association could be found. Further, the examiner stated that, per the Veteran’s history and service treatment records, his hypertension was not diagnosed until eight years after service and, therefore, could not be directly associated with his active service. Unfortunately, this opinion conclusory and inadequate. The February 2020 remand directives asked the examiner to address the likelihood that the Veteran’s hypertension is related to his in-service herbicide exposure. An adequate opinion on that matter was not provided. (Simply stating that the Veteran’s hypertension is not on the list of disorders presumed to be associated with herbicide exposure is not enough.) Also, in rendering the conclusions that were included in the report, the examiner did not discuss the Veteran’s medical history, family history, or risk factors associated with his conceded in-service herbicide exposure. As the Board cannot adequately adjudicate this claim based on the provided medical opinion and current evidence of record, a remand is necessary to procure another (adequate) medical opinion. Accordingly, this matter is REMANDED for the following action: Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his hypertension. After reviewing the entire claims file, completion of any necessary tests and studies, and an examination of the Veteran, the examiner should opine as to whether: (a.) It is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s hypertension onset during his active duty—or was otherwise related to such military service, to include as a result of his conceded exposure to herbicide agents therein? The examiner is advised that there is no VA presumption of service connection for hypertension as due to herbicide exposure. The Agent Orange Updates speak to associations between exposure to chemicals and health outcomes in human populations, and not to the likelihood that any individual’s health problem is associated with or caused by the herbicides in question. Thus, the question here becomes what is the likelihood that this Veteran’s hypertension is related to his in-service herbicide exposure, given his medical history, family history, risk factors, etc. (b.) It is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s hypertension was aggravated (i.e., made worse) by his service-connected CAD? If so, the examiner should identify the degree of impairment that is due to such aggravation. If aggravation is found, the examiner should identify a baseline level of severity of hypertension by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the hypertension. If such cannot be done, it should be explained why. (c.) It is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s hypertension was aggravated (i.e., made worse) by his service-connected PTSD? If so, the examiner should identify the degree of impairment that is due to such aggravation. If aggravation is found, the examiner should identify a baseline level of severity of hypertension by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the hypertension. If such cannot be done, it should be explained why. A complete rationale for all opinions expressed must be provided. An examiner’s report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that. 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 a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is 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 J. R. Bobb, 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.