Citation Nr: 21023356 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-12 064 DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to November 1971, followed by service in the Army Reserves. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in September 2018 and July 2020 and was remanded for additional development. The case is once again before the Board. The Board regrets the delay associated with this remand, especially considering that this matter was the subject of two previous remands. However, another remand is necessary to ensure that the Veteran is afforded full compliance with the statutory duty to assist. In November 2019, a VA examiner found the Veteran’s hypertension less likely than not related to the Veteran’s service or his service-connected posttraumatic stress disorder (PTSD). However, the examiner did not provide sufficient rationale to support his conclusion that hypertension was not directly related to the Veteran’s service. While hypertension is not a presumptive disease related to tactical herbicide exposure, service connection may nonetheless be established by evidence demonstrating that the disease was in fact incurred in service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Pursuant to the July 2020 Board remand, an opinion was obtained in December 2020. It appears that the December 2020 VA examiner’s opinion may have been based, at least in part, on an inaccurate factual premise. In this regard, the Veteran’s claim’s file included misfiled service treatment records for a different Veteran. In addition to the Veteran’s medical history, the examiner noted medical history related to the misfiled medical records. A medical opinion based upon an inaccurate factual premise has no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). As the December 2020 examiner’s opinion appears to be based, in part, on inaccurate information, another opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The November 2019 examiner does not appear to have relied on the misfiled documents, but out of an abundance of caution, a new opinion regarding whether the Veteran’s hypertension is related to his service-connected PTSD is requested. The undersigned has taken steps to remove these misfiled documents from the Veteran’s claims file. This matter is REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion on the following: (a) whether it is as likely as not that hypertension had its onset during service or within one year of the Veteran’s discharge from service. (b) whether the hypertension is at least as likely as not casually or etiologically due to his time in service, to include exposure to herbicides, taking into consideration the November 2018 National Academy of Sciences publication conclusion that hypertension has been upgraded from its previous classification in the category of “limited or suggestive” evidence of an association to the category of “sufficient” evidence of an association to exposure to herbicide. (c) Is it at least as likely as not, (50 percent probability or greater), that the hypertension was (A) caused or (B) aggravated beyond its normal progression by the service-connected PTSD. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. (Continued on the next page)   A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. B. G. LeMoine Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.V. Palatt, 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.