Citation Nr: 21023512 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 09-00 120A DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for joint pains is remanded. Entitlement to service connection for residuals of cerebrovascular accident is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1968 to July 1970, and from November 1970 to November 1971. He died in August 2016. The appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office in Montgomery, Alabama (RO). In August 2010, the Veteran and his spouse testified at a personal hearing before a Veterans Law Judge. A transcript of that hearing has been associated with the claims file. That Veterans Law Judge is no longer with the Board. In January 2021, the appellant was sent a letter offering her another hearing before a current Veterans Law Judge. The appellant’s representative responded in February 2021, stating the appellant did not desire another such hearing. In February 2011, September 2014, and November 2019, the Board remanded this appeal to the RO for additional development. As noted above, the Veteran died in August 2016. The appellant was granted substitution by the RO in August 2016. A substitute has the same rights regarding hearings, representation, appeals, and the submission of evidence as would have applied to the claimant had the claimant not died; however, a substitute may not add an issue to or expand the claim. 38 C.F.R. § 3.1010(f). 1. Entitlement to service connection for hypertension, joint pains, and residuals of a cerebrovascular accident. As noted in the prior November 2019 remand order, the primary contention made by the Veteran and later the appellant is that these claimed disabilities were the result of diabetes mellitus, which itself was the result of the Veteran’s herbicide exposure in service. While service connection for diabetes mellitus was not awarded prior to the Veteran’s death, this disease is nevertheless recognized by VA to be among the disabilities for which service connection is presumed in veterans with confirmed herbicide exposure. See 38 U.S.C. § 1116, 38 C.F.R. § 3.309(e). As such, the Board requested in November 2019 that medical opinions be obtained which, among other things, addressed whether the claimed hypertension, joint pain, and residuals of a cerebrovascular accident were related to herbicide exposure in service, and/or diabetes mellitus. A remand order by the Board confers on the appellant the right to substantial compliance with the Board’s remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). While various medical opinions were obtained in May 2020, these failed to address all aspects of the November 2019 remand order. Regarding the Veteran’s claimed joint pain, the VA examiner merely stated that a diagnosis of arthralgia could not be confirmed in the record. The examiner did not, however, address the contention that the Veteran’s diabetes mellitus resulted in diabetic peripheral neuropathy of the upper and lower extremities, resulting in joint pain. Regarding the question of the etiologies of the Veteran’s hypertension and cerebrovascular accident, the examiner stated the Veteran’s hypertension was essential hypertension, with onset in the 1990’s, many years after service. The examiner did not, however, address the question of whether hypertension was due to or aggravated by diabetes mellitus, as requested by the Board. The examiner further stated the cerebrovascular accident was related to hypertension, suggesting these issues are inextricably intertwined. Based on the above, remand is required to ensure full compliance with the Board’s remand order. The matters are REMANDED for the following action: 1. Obtain an opinion addressing the etiology of the Veteran's residuals of a stroke, hypertension, and joint pains. The examiner must opine as to the following: (a) Is it at least as likely as not (a fifty percent probability or greater) that a service connected disability caused the Veteran’s: 1) Residuals of a stroke? 2) Hypertension? 3) Joint pain? (b) If not, is it at least as likely as not (a fifty percent probability or greater) that a service-connected disability aggravated (worsened) the Veteran’s: 1) Residuals of a stroke? 2) Hypertension? 3) Joint pain? (c) Is it at least as likely as not (a fifty percent probability or greater) that the residuals of a stroke are related to any conceded herbicide exposure in service? (d) Is it at least as likely as not (a fifty percent probability or greater) that the hypertension is related to any conceded herbicide exposure in service? (e) Is it at least as likely as not (a fifty percent probability or greater) that the joint pain is related to any conceded herbicide exposure in service? The examiner is requested to provide a complete rationale for any opinion provided. If the examiner cannot provide any requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. CHRISTOPHER A. WENDELL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Thomas D. Jones, 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.