Citation Nr: 21032314 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 17-07 872 DATE: May 26, 2021 REMANDED Entitlement to service connection for hypertension, to include as due to in-service tactical herbicide exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1965 to November 1968 with service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing conducted by the undersigned Veterans Law Judge in October 2019. A transcript of the hearing has been associated with the Veteran's VA claims file. The Board remanded the Veteran's claim for additional development in January 2020 and November 2020. This case is once again before the Board. The Board notes that the Veteran attempted to opt-in to the Appeals Modernization Act (AMA) framework from the legacy SSOC appeals process when he filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in January 2021. However, the form does not contain a valid signature. The error was explained in a March 2021 AMA notification letter, which also explained how to cure the defect. The Veteran has not submitted a properly executed VA Form 10182 to date. Therefore, the Board will consider his claim under the legacy appeals process. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). 1. Entitlement to service connection for hypertension, to include as due to herbicide agent exposure is remanded. The Veteran contends his hypertension is related to active duty service, to include as due to exposure to tactical herbicide agents in Vietnam. The February 2020 VA examiner provided a diagnosis of hypertension and the record reflects the Veteran served in the Republic of Vietnam during the Vietnam era. As such, he is presumed to have been exposed to herbicides while in service. Considering the evidence of a current disability and the Veteran's herbicide agent exposure, the Board remanded the claim in January 2020 for a VA examination and opinion to address whether the Veteran's hypertension is related to his herbicide agent exposure during service. In accordance with the January 2020 directives, a new VA examination and opinion was obtained in February 2020. The VA examiner opined the Veteran has a diagnosis of hypertension that is at least as likely as not incurred in or caused by hypertension during service. However, as rationale, he stated there is no objective evidence of diagnosis for hypertension found documented on available active duty records. A March 2020 addendum opinion was provided to correct the inconsistent statements made. Here, the VA examiner opined the Veteran has a diagnosis of hypertension that is not at least as likely as not incurred in or caused by hypertension during service. He stated benign essential hypertension by definition has unknown cause. No further rationale was provided. Additionally, the examiner did not opine as to whether the Veteran's hypertension is related to in-service herbicide agent exposure. In November 2020, the Board remanded the claim again, finding the February 2020 opinion and March 2020 addendum opinion inadequate, as well as finding there had not been substantial compliance with the January 2020 remand directives. Specifically, the Board noted the VA examiner did not address whether the Veteran's hypertension is related to his herbicide agent exposure. A subsequent addendum/clarification was provided in December 2020. However, the Board finds that opinion is not fully responsive to the remand directives and is internally inconsistent. The VA examiner opined it is less likely as not the Veteran's hypertension had its clinical onset in service or due to an event in service to include presumed herbicide exposure. As rationale, he stated the Veteran's current problem list does not list a diagnosis of hypertension, the Veteran is not taking blood pressure medication, his blood pressure is variable ranging from 122-144 to 68-85 over the past year. Notwithstanding the apparent finding that the Veteran does not have hypertension, the examiner then stated that the Veteran has other comorbidities which can contribute to hypertension and has been diagnosed with benign essential hypertension. With regards to hypertension as due to herbicide agent exposure, the VA examiner stated, "there is no incidence of herbicide exposure and hypertension correlation in the medical literature." He did not provide an any further rationale or comment on the Agent Orange: Update 11 (2018), the National Academies of Sciences, Engineering and Medicine (NAS) which found sufficient evidence of an association for hypertension and monoclonal gammopathy of undetermined significance (MGUS) and exposure to Agent Orange and other herbicides used during the Vietnam War. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and tactical herbicide exposure. Because the examiner's opinion is inadequate, a new medical opinion must be obtained. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran's claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hypertension had its clinical onset during service or is due to an event or incident of the Veteran's period of active service to include his presumed exposure to herbicides. The examiner is asked to respond to the following question: (a.) It is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension began during active service; is related to an incident of service; began within one year of separation from service; or is related to his presumed in-service tactical herbicide agent exposure. The examiner should address the Veteran's and Agent Orange: Update 11 (2018) by the National Academies of Sciences, Engineering and Medicine (NAS) indicating that there is sufficient evidence of an association between hypertension and herbicide exposure. If the examiner finds that the Veteran has not had hypertension at any point during the appeal period, an opinion describing the reasoning behind this finding should be provided. 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. 2. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Aston, 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.