Citation Nr: 21021197 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-43 795 DATE: April 12, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service from August 1965 to October 1968. He served in the Republic of Vietnam. The issues of entitlement to service connection for obstructive sleep apnea, bilateral pes planus, and calcaneal spurs of the feet are the subjects of a separate Board of Veterans’ Appeals (Board) decision and will not be addressed below. Entitlement to service connection for hypertension is remanded. The Veteran asserts that service connection for hypertension is warranted as the claimed disability was manifested as the result of his presumed herbicide agent exposure while in the Republic of Vietnam or, in the alternative, secondary to the service connected posttraumatic stress disorder (PTSD). Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for PTSD, right total knee replacement residuals, left total knee replacement residuals, lumbosacral strain, right hip osteoarthritis, left hip osteoarthritis, infectious hepatitis, and knee and lower extremity scars. In its October 2019 Remand instructions, the Board requested that a Department of Veterans Affairs (VA) hypertension evaluation be obtained to determine the etiology of the diagnosed hypertension. A November 2019 VA hypertension evaluation was incorporated into the record. The VA examiner concluded that: “the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness;” “benign essential hypertension is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness to include presumed exposure to Agent Orange/herbicide or high blood pressure;” “less likely than not (less than 50 percent probability) proximately due to or the result of PTSD;” “less likely than not permanently aggravated beyond its natural progression by PTSD;” and “is at least as likely as not (50 percent or greater probability) caused by an unknown post service etiology.” The VA physician commented that “elevated blood pressure is a nonspecific sign which is not pathognomonic for hypertension.” The Board observes that “pathognomonic” is defined as “characteristic for a particular disease.” Hypertension denotes persistently high arterial blood pressure with various thresholds. Dorland’s Illustrated Medical Dictionary, 896 (32nd ed. 2012). Given that the November 2019 VA hypertension evaluation was expressly based upon the examiner’s stated erroneous belief the elevated blood pressure is not a symptom of or otherwise characteristic of hypertension, the Board finds that the evaluation is of essentially no probative value. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Agency of Original Jurisdiction’s compliance with the Board’s remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, the Board finds that further VA hypertension examination is needed. This matter is REMANDED for the following action: Schedule the Veteran for a VA hypertension examination conducted by a medical doctor, other than the physician who prepared November 2019 VA hypertension evaluation, to assist in determining the current nature of any identified hypertensive disability and its relationship, if any, to active service and/or the service connected disabilities. The examiner must review the record, including the National Academies of Sciences, Engineering, and Medicine’s Veterans and Agent Orange Update 11 (2018) and all other submitted medical articles, and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hypertensive disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability had its onset during active service or is related to any incident of service, including the documented in service October 1968 blood pressure reading of 128/98 and the Veteran’s presumed exposure to herbicide agents while in the Republic of Vietnam. The examiner should specifically discuss the National Academies of Sciences, Engineering, and Medicine’s Veterans and Agent Orange Update 11 (2018) (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability is due to PTSD and the other service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any hypertensive disability has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by PTSD and the other service connected disabilities. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ware, 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.