Citation Nr: 21021483 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 10-07 691 DATE: April 13, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to the service-connected posttraumatic stress disorder (PTSD), service-connected coronary artery disease (CAD), herbicide agents exposure, and/or asbestos exposure, is remanded. Entitlement to service connection for transient ischemic attacks (TIAs), to include as secondary to the service-connected PTSD, service-connected CAD, and/or herbicide agents exposure, is remanded. REASONS FOR REMAND The Veteran had active military service from March 1966 to June 1970. These issues are on appeal from an April 2007 rating decision. The Veteran testified before the undersigned Veterans Law Judge during a November 2015 hearing. These issues were remanded by the Board of Veterans’ Appeals (Board) in June 2016, January 2018, and April 2020. In April 2020, the Board remanded the issue of entitlement to service connection for an acquired psychiatric disorder, to include PTSD, to include as secondary to service-connected disabilities, prior to March 17, 2015, for further development. In the Introduction, the Board acknowledged that a February 2020 rating decision granted service connection for major depressive disorder, effective March 17, 2015. The Board noted that the Veteran filed his service connection claim for a psychiatric disorder in February 2006, and thus the March 2015 grant was only a partial grant. Upon remand, in an August 2020 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for PTSD with major depressive disorder (previously rated as major depressive disorder), effective February 6, 2006. To date, the Veteran has not appealed this decision. The Board finds that this rating decision is a full grant of the benefits sought, as the Veteran received service connection for a psychiatric disorder back to the date of his service connection claim. The August 2020 rating decision also informed the Veteran that this was a full grant of the benefits sought. This issue is no longer on appeal before the Board. In April 2020, the Board remanded the issue of entitlement to service connection for erectile dysfunction for further development. In January 2021, the AOJ granted service connection for erectile dysfunction. To date, the Veteran has not appealed this decision. This issue is no longer on appeal before the Board. 1. Entitlement to service connection for hypertension, to include as secondary to the service-connected PTSD, service-connected CAD, herbicide agents exposure, and/or asbestos exposure, is remanded. The Veteran asserts, in pertinent part, that his hypertension is related to his in-service asbestos exposure. The M21-1MR requires that VA undertake certain development in claims based on asbestos exposure. See M21-1MR, Part IV, Subpart ii, Chap. 1, Sec. H, Para. 29; Part IV, Subpart ii, Chap. 2, Sec. C, Para. 9. In this case, the record shows that the AOJ has not complied with the M21-1MR procedures. The AOJ sent the Veteran a letter in July 2016, asking him to explain the details of his asbestos exposure. The Veteran has not been sent the appropriate questionnaire regarding a claim of asbestos exposure. Additionally, the AOJ requested records of asbestos exposure in service or jobs the Veteran performed from the Joint Services Records Research Center (JSRRC). In October 2006, the JSRRC responded that there are no records at “Code 13 for this person” and to make the request to “Code 11.” In the same request, the same response was given in response to the request for the Veteran’s personnel records. The Veteran’s personnel records were later obtained by the AOJ. However, it does not appear that the AOJ made any further attempts to obtain the Veteran’s asbestos records. Upon remand, the AOJ must send the Veteran an asbestos questionnaire, obtain his asbestos records, and make a formal determination on whether the Veteran was exposed to asbestos during his active military service. Further, in a December 2020 medical opinion, the VA examiner mentions asbestos exposure; however, the rationale only pertains to secondary service connection. Upon remand, an adequate medical opinion regarding the Veteran’s hypertension and his asbestos exposure must be obtained. The Veteran also contends that his hypertension is related to his active military service. The Veteran is presumed to have been exposed to herbicide agents during his active service due to his service in the Republic of Vietnam. The National Academy of Sciences (NAS) Institute of Medicine's Veterans and Agent Orange: Update 2010, concluded that there is "limited or suggestive" evidence of an association between exposure to herbicide agents and hypertension. In November 2018, hypertension was moved by NAS to the category of "sufficient" evidence of an association from its previous classification in the "limited or suggestive" category. The NAS's conclusions indicate that the Veteran's hypertension could be directly related to his active service. To date, a VA medical opinion addressing whether hypertension is related to the Veteran’s presumed herbicide agent exposure has not been obtained. As such, the issue must be remanded so that an opinion may be obtained. 2. Entitlement to service connection for TIAs, to include as secondary to the service-connected PTSD, service-connected CAD, and/or herbicide agents exposure, is remanded. A February 2021 VA medical opinion determined that hypertension is a risk factor for TIAs. Thus, a decision on the remanded issue of service connection for hypertension could significantly impact a decision on the TIAs issue, and the issues are inextricably intertwined. A remand of the TIAs claim is required. The matters are REMANDED for the following actions: 1. Send the Veteran the appropriate asbestos exposure questionnaire for him to fill out. 2. Attempt to verify the Veteran’s in-service exposure to asbestos, to include submitting a request using “Code 11” if available for this Veteran. 3. The AOJ should make a specific written determination as to whether the Veteran was exposed to asbestos before, during, or after his military service. This determination should be provided to the VA examiner. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertension is at least as likely as not related to an in-service injury, event, or disease, including his conceded herbicide exposure and his in-service asbestos exposure. The examiner should review the November 2018 NAS conclusion possibly linking hypertension and herbicide agent exposure. The examiner should also review the AOJ’s asbestos determination. The examiner must provide a rationale for all opinion(s) provided. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to service connection for TIAs, to include as secondary to the service-connected PTSD, service-connected CAD, and/or herbicide agents   exposure. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shauna M. Watkins, 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.