Citation Nr: 21021851 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 18-12 411 DATE: April 14, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran had active service from May 1961 to February 1985. The Veteran died on September [REDACTED], 2016. The Appellant is the Veteran’s surviving spouse. In January 2021, the Appellant testified before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The Appellant contends that the Veteran’s death was the result of disabilities related to his active service. The Veteran’s death certificate indicates that the Veteran’s cause of death was idiopathic pulmonary fibrosis due to hypertension, chronic kidney disease, coronary heart disease, and diabetes mellitus. Prior to his death, the Veteran was service-connected for pruritis ani, left eye disability, status post kidney stones, left thigh status post cyst removal, and tension headaches. Specifically, the Appellant contends that the Veteran was exposed to herbicides in service while in Thailand, Korat Royal Thai Air Force Base (RTAFB); the Appellant has also pointed out that coronary artery disease and diabetes are presumptive herbicide related diseases due to herbicide exposure. The Board notes that the Veteran’s records confirm that he was a communications electronic and meteorological scheme monitor in Korat RTAFB. In September 2017, the RO received a memorandum indicating that the VA lacked the information the Joint Services Records Research Center (JSRRC) required in order to verify herbicide exposure in the Republic of Vietnam or other areas of military service. The memorandum continued, noting that the RO gave the Appellant the opportunity to provide the missing information and had properly followed all established procedures for obtaining it. A review of the Veteran’s Air Force personnel and service treatment records did not show any assignments or duties that would have exposed the Veteran to Agent Orange. Moreover, a VA letter dated July 26, 2017 was sent to the Appellant requesting additional information on when, where, and how the Veteran may have been exposed to Agent Orange. The response from the Appellant did not contain any specific place or time that met the requirements of a time span of 60 days to submit a request to the JSRRC. Following the Appellant’s January 2021 hearing, she submitted additional evidence regarding the Veteran’s service in Korat RTAFB. The evidence provides more detail on Korat RTAFB and the use of herbicides there. The Appellant also contends that the Veteran was first diagnosed with hypertension during service, and that he could be presumptively service-connected for hypertension as a chronic disease because it was diagnosed during service. In a letter from a Dr. W. submitted by the Appellant in August 2017, Dr. W. indicated that there was documentation as early as 1977 that while on active duty, the Veteran had elevations in blood pressure as high as 157/98. The RO has previously noted receipt of a correspondence from the Department of the Air Force stating that there was a record of elevations in blood pressure while the Veteran was in service. In response, the RO requested a medical opinion to determine if the reading could be related to the Veteran’s cause of death. In a November 2017 opinion, an examiner determined that the Veteran’s hypertension was less likely than not caused by service. The examiner reasoned that the Veteran’s service treatment records dated September 1984 showed the Veteran’s blood pressure as 118 over 80 which was normotensive; any isolated episodes of hypertension in service did not provide a nexus for the claim. The examiner explained that the Veteran was not diagnosed with hypertension in service, and his blood pressure was 120 over 84 in service in a June 1978 physical examination. The Board notes that on several occasions throughout the Veteran’s service treatment records, his blood pressure is noted as high. While the November 2017 examiner noted a September 1984 occasion, and a June 1978 occasion which did not give rise to a hypertensive diagnosis, there are other instances of blood pressure recordings and elevated blood pressure in the Veteran’s records. For example, in July 1977, the Veteran’s blood pressure is noted as 150 over 98, 145 over 96, and 145 over 80. In a 5 day blood pressure check in 1977, the Veteran’s blood pressure was recorded as 144 over 90, 150 over 88, 138 over 80, 140 over 80, 130 over 90, 138 over 86, 138 over 82, 144 over 88, 132 over 82, and 140 over 90. In consideration of the above, the Board finds that the November 2017 opinion is inadequate. The Board notes that the VA examiner did not explicitly consider the above-mentioned pertinent service treatment records, and therefore, based her opinions on an incomplete review of the evidence. As such, the VA examination is inadequate. Reonal v. Brown, 5 Vet. App. 458, 460 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). Once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide one that is adequate for purposes of the determination being made. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Therefore, remand is required to afford the Appellant a new medical opinion before the Board can render an informed decision on the claim. Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009). In addition to obtaining a new VA opinion regarding the Veteran’s hypertension, the Board also points out that the Appellant has provided additional information regarding the Veteran’s potential herbicide exposure while serving at Korat RTAFB. As such, upon remand, the RO should also consider this evidence in determining whether the Veteran was exposed to herbicides during his active service. The matters are REMANDED for the following action: 1. Consider the recent correspondence submitted by the Appellant regarding the Veteran’s service at the Korat RTAFB, and if necessary, contact the JSRRC and request verification of reported herbicide exposure during the Veteran’s service at Korat RTAFB in Thailand. 2. Obtain a VA addendum opinion from an appropriate clinician to determine whether the instances of high blood pressure recorded during the Veteran’s active service were related to his hypertension that was present prior to his death. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the opinion. The examiner should opine as to the following: (a.) Is it at least as likely as not that the Veteran’s hypertension had its onset during service as shown by the high blood pressure readings during service? The examiner should perform a complete review of the Veteran’s medical history, including his blood pressure readings during service noted in this Board remand, as well as his post-service history of symptoms and treatment. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. A clearly stated rationale for any opinion offered should be provided and must not be based solely on the lack of any in-service records. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vosburgh, 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.