Citation Nr: 21021862 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 12-01 150 DATE: April 14, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and/or as secondary to service-connected diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to December 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2009 by a Department of Veterans Affairs (VA) Regional Office. In July 2016, the Board denied the instant claim, and the Veteran appealed such decision to the U.S. Court of Appeals for Veterans Claims (Court). In September 2017, the Court granted the Veteran’s and the Secretary of VA’s Joint Motion for Partial Remand (JMPR), which vacated and remanded such decision. In April 2018 and August 2018, medical opinions were obtained from the Veterans Health Administration, and the case was remanded in May 2020 and December 2020 for additional development. It now returns for further appellate review. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and/or as secondary to service-connected diabetes mellitus, type II. Pursuant to the December 2020 remand, an addendum opinion addressing the etiology of the Veteran’s hypertension was obtained in February 2021. At such time, the examiner opined, as relevant, that it was less likely than not that the Veteran’s hypertension was caused by, or related to, his in-service exposure to herbicide agents. In this regard, while she noted that the National Academy of Science (NAS) Institute of Medicine (IOM) most recent Update 11 (2018) upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with exposure to Agent Orange to the category of “sufficient” evidence of an association, she found that the report was not conclusive so as to allow her to provide a favorable opinion that the Veteran’s hypertension was caused by Agent Orange or herbicide exposure without resorting to speculation. However, her reasoning was based on the previous classification of hypertension in the category of “limited or suggestive” as she cited that such a finding means that epidemiologic research results suggest an association between exposure to herbicides and a particular outcome, but a firm conclusion is limited because chance, bias, and confounding factors could not be ruled out with confidence. Thus, the Board finds that a remand is warranted to obtain another addendum opinion that addresses the upgraded classification of hypertension to the category of “sufficient” evidence of an association. The matter is REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate VA examiner other than the February 2021 examiner in order to obtain an opinion addressing the etiology of the Veteran’s hypertension. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hypertension is related to his acknowledged in-service herbicide exposure. In offering such opinion, the examiner should consider and discuss NAS IOM’s Veterans and Agent Orange: Update 11 (2018) that upgraded hypertension from its previous classification in the category of “limited or suggestive” evidence of an association with exposure to Agent Orange 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. A rationale for any opinion offered should be provided. If the examiner is unable to provide an opinion without resorting to speculation, he or she must make clear that he or she has considered all procurable data, but any member of the medical community at large could not provide such an opinion without resorting to speculation. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Clark, 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.