Citation Nr: 21031370 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 19-18 990 DATE: May 21, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected coronary artery disease (CAD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1963 to March 1966, including service in the Republic of Vietnam from February 1964 to February 1965 and from September 1965 to March 1966. This case comes before the Board of Veterans' Appeals (Board) on appeal of a June 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in September 2019, it was remanded for additional development. The case has now been returned to the Board for further appellate consideration. The Veteran was afforded a VA examination in December 2019 with an addendum opinion obtained in April 2021. The examiner was asked to opine if the Veteran's hypertension was at least as likely as not related to an in-service event, to include his presumed herbicide exposure. The April 2021 examiner opined that the Veteran's hypertension was less likely than not due to an in-service event or injury, to include exposure to herbicide agents. The examiner reasoned that the Veteran's military occupational specialty did not have long-term direct skin contact with herbicide agents, and incidental exposure under field conditions where herbicide agents were sprayed was less likely to cause hypertension than direct contact pursuant to recent studies. In the informal hearing presentation, the Veteran's representative argues an additional opinion is necessary in order to consider his assertions that his hypertension could be due to exposure to herbicide agents through the local water sources, which have been shown to concentrate herbicide and not filter it out. Furthermore, the Veteran stated that his hypertension was secondary to his heart condition. See Notice of Disagreement (NOD) received in February 2018. The Veteran was granted service connection for CAD in June 2019. Although the evidence suggests that the hypertension was diagnosed prior to the CAD, this does not preclude a theory of aggravation. Thus, as a theory of secondary service connection has been raised, the claim should also be addressed on this basis, to include obtaining a VA opinion addressing this theory of entitlement. In light of the above, a remand is necessary to obtain a new medical opinion as to whether the Veteran's hypertension was related to service or was caused or aggravated by his service-connected CAD. This matter is REMANDED for the following action: Obtain a VA opinion from an appropriate clinician regarding the Veteran's hypertension. The claims file, including a copy of this remand, must be made available to and reviewed by the clinician. After review of the claims file, the clinician is asked to provide a response to the following: (a.) Is it at least as likely as not that the Veteran's hypertension (1) began during service; (2) manifested within one year after discharge from service; OR (3) was related to an in-service injury or disease, including herbicide exposure through local water sources? Specifically, the examiner should address the correlation between hypertension and herbicide exposure identified in the NAS report, Veterans and Agent Orange: Update 2018. (b.) Is it at least as likely as not that the Veteran's hypertension was proximately due to or the result of his service-connected CAD? (c.) Is it at least as likely as not that the Veteran's hypertension was aggravated (i.e., worsened beyond its natural progression) by his service-connected CAD? Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The clinician is advised that a finding that the Veteran's hypertension was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. (Continued on the next page) A complete rationale should be provided for all opinions. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Townsend, 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.