Citation Nr: 21023530 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-33 973 DATE: April 20, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus or herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1965 to July 1967. This matter comes before the Board of Veterans Appeals (Board) on appeal from a July 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue was previously remanded by the Board in November 2017 and denied in June 2019. In a March 2020 Joint Motion for Remand (JMR), VA’s Office of General Counsel and the Veteran agreed that the standard used in the VA’s November 2017 negative aggravation opinion was inadequate under Ward v. Wilkie. 31 Vet. App. 233, 240 (2019) (a “permanent worsening” of a nonservice-connected disability is not required to establish secondary service connection on the basis of aggravation). Accordingly, in an October 2020 decision, the Board remanded the issue in order to obtain a new VA opinion that addressed secondary service connection. The requested development was partially completed; however, the Board finds an additional remand is necessary. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus or herbicide agent exposure, is remanded. In this post-remand case, the Veteran seeks service connection for hypertension to include as secondary to his service-connected diabetes mellitus or herbicide agent exposure. The Board notes the Veteran was granted service connection for diabetes mellitus type II associated with herbicide exposure in an October 2013 rating decision. By way of history, after a March 2020 JMR, this issue was remanded by the Board in October 2020 to obtain an additional VA medical opinion. Pursuant to the remand directives, an opinion was obtained in November 2020. The VA examiner stated that the examiner was 1) unable to determine a baseline level of severity of his hypertension based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by diabetes; and, 2) regardless of an established baseline, the Veteran’s hypertension was not at least as likely as not aggravated by his diabetes mellitus. The examiner provided the rationale that there is no documentation in the Veteran’s medical records that indicate any change in treatment for his pre-existing hypertension that worsened, aggravated, or altered the natural progression of his condition due to his service-connected diabetes type II. The examiner concluded that it is less likely than not that the Veteran’s hypertension was aggravated beyond its natural progression due to his service-connected diabetes. The Board finds this opinion to be of little probative value. The examiner solely relied upon the lack of documentation as support for a negative nexus opinion. The examiner did not explain whether diabetes mellitus can aggravate his hypertension or worsen his symptoms beyond the natural progression of the disability. Therefore, a remand is necessary in order to obtain an additional VA etiological opinion. Additionally, the Veteran seeks service connection for hypertension to include as secondary to herbicide exposure. The last opinion regarding herbicide agents causing hypertension was provided in November 2017. The November 2017 examiner relied on the National Academy of Sciences (NAS) Institute of Medicine “Veterans and Agent Orange” 2010 update. However, the Veteran’s representative noted in their brief a NAS “Veterans and Agent Orange” update from 2018 wherein it was discussed that there is sufficient evidence of an association between the chemicals of interest and hypertension. Therefore, an additional opinion addressing this 2018 NAS update is also necessary. The matters are REMANDED for the following actions: Obtain an additional VA etiological opinion from another qualified examiner regarding the possible aggravation of the Veteran’s hypertension by his service-connected diabetes. Specifically, the examiner should opine on whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension was aggravated or worsened beyond its natural progression by his service-connected diabetes mellitus. Also obtain an opinion regarding direct service connection and specifically, whether it is at least as likely as not (50 percent or greater) that the Veteran’s hypertension was caused by exposure to herbicides agents. The examiner should provide an opinion regarding the NAS “Veterans and Agent Orange” update from 2018. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. DeBoer, 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.