Citation Nr: 21026084 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 10-38 573 DATE: April 29, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus and/or as due to in-service herbicide exposure, is remanded. Entitlement to service connection for arthritis and/or polymyositis is remanded. REASONS FOR REMAND The Veteran had active duty service from April 1971 to April 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2008 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) in November 2017. The hearing transcript is of record. The Board remanded the claims in April 2018 and September 2020 for further development. The case has been returned to the Board for appellate review. Unfortunately, the Board finds that another remand is required for additional development. The Veteran was afforded VA examinations in November 2020 for his hypertension and arthritis claims and the VA examiner found, in part, that the disorders were less likely related to service. Instead, he opined that obesity was a cause of both disorders. In an April 2021 brief, the Veteran’s representative raised, for the first time, an additional theory of entitlement; that the Veteran’s obesity is due to his service-connected disorders. In support of that opinion, the representative stated that the Veteran’s service connected disorders impede the Veteran’s ability to exercise and cited to a medical article linking obesity and diabetes. As such, the Board finds that medical opinions are required for this newly raised theory of entitlement. The Board also finds that another VA medical opinion should be obtained for the Veteran’s hypertension claim. In that regard, the Veteran has claimed that the medications he takes for his diabetes mellitus have caused or contributed to his hypertension. The November 2020 VA examination failed to address these contentions. As a result, the AOJ then requested an addendum opinion; however, the VA examiner’s addendum opinion noted only that “[l]ay statements from the veteran were reviewed but did not change the opinion rendered.” As the claim is being remanded for a VA medical opinion, the Board finds that the VA examiner should also more clearly address whether the Veteran’s medication prescribed for his service-connected diabetes mellitus has caused or aggravated his current hypertension. Finally, the Veteran’s representative has cited to several medical articles in the April 2021 brief, to include medical articles “suggesting association between herbicide exposure and hypertension” and noting that diabetes and hypertension are interrelated diseases. As the Veteran’s claims are being remanded, the Board finds that the VA examiner should comment on these articles submitted by the Veteran and his representative. Accordingly, the case is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, The Veteran should be afforded a VA medical opinion as to the nature and etiology of any hypertension that may be present. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that any current hypertension is either caused by or aggravated by the Veteran’s service connected disorders, including (a) as a result of any medication prescribed for his diabetes mellitus and (b) any obesity resulting from the Veteran’s service connected disorder(s), to include impediment of physical activity/exercise caused by the disorders. The examiner should also opine whether it is at least as likely as not that any current hypertension is related to in-service herbicide exposure. The examiner is asked to specifically comment on the medical articles submitted by the Veteran’s representative in the April 2021 brief in his or her opinions. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) 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. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing directive #1, the Veteran should be afforded a VA medical opinion as to the nature and etiology of any arthritis and/or polymyositis that may be present. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that any current arthritis and/or polymyositis is either caused by or aggravated by any obesity resulting from the Veteran’s service connected disorder(s), to include impediment of physical activity/exercise caused by the disorder(s). The examiner is asked to specifically comment on the medical articles submitted by the Veteran’s representative in the April 2021 brief in his or her opinions. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) 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. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Rideout-Davidson, 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.