Citation Nr: 21040165 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 16-09 457 DATE: July 2, 2021 REMANDED Service connection for hypertension is remanded. Service connection for epilepsy is remanded. Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to June 1971. He is the recipient of the Bronze Star and Vietnam Iron Cross. Hypertension Epilepsy Bilateral Hearing Loss In December 2018, the Board remanded these matters for VA examinations and examination opinions. These examinations did not take place as the Veteran had declined examinations. There is no indication why the examination opinions were not obtained. In May 2021, the Board clarified that the Veteran does wish to proceed with his appeals and finds that good cause has been shown as to why the Veteran did not attend previously scheduled examinations, and that new examinations should be scheduled. The matters are REMANDED for the following action: 1. Obtain a VA examination opinion from a physician (M.D.) regarding the etiology of the Veteran's hypertension. The Veteran's claims file (to include this decision) must be reviewed by the examiner providing the opinion. Should the examiner find an in-person examination is necessary, one should be scheduled accordingly. Upon review of the claims file, pertinent medical history, and the relevant medical literature, the examiner should provide an opinion responding to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is causally or etiologically related to conceded in-service herbicide exposure? The Board is cognizant that there is no VA presumption of service connection for hypertension as due to herbicide exposure. The question here is, considering the NAS elevation of hypertension to the "Sufficient Evidence" category, what is the likelihood that this Veteran's hypertension is related to his herbicide exposure given his medical history, family history, absence of other risk factors, etc. See Veterans and Agent Orange: Update 11 (2018), NAS. (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is caused by, the result of, or otherwise related to, taking daily salt tablets as required by the Army during his one-year tour of duty in Vietnam? In rendering these opinions, the examiner should assume that the Veteran was exposed to herbicides in service. Additionally, while the examiner is free to cite to studies by the National Academy of Sciences or any other medical treatises in rendering the opinion, the examiner may not rely solely on the fact that the Veteran's conditions are not on the presumptive list of diseases associated with herbicide exposure. Rather, the opinion should explain why any statistical or medical studies are found to be persuasive or unpersuasive and should address whether there are other risk factors that might be the cause of the Veteran's conditions or whether they manifested in an unusual manner. The examiner's report must reflect consideration of the Veteran's entire documented medical history and assertions and all lay evidence. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner must provide a thorough rationale for each opinion given. 2. Obtain a VA examination opinion from a physician (M.D.) to determine the nature and etiology of the Veteran's epilepsy condition. The claims file, including a copy of this remand, must be made available to and be reviewed. Should the examiner find an in-person examination is necessary, one should be scheduled accordingly. Upon review of the claims file, pertinent medical history, and the relevant medical literature, the examiner should provide an opinion responding to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's epilepsy is causally or etiologically related to conceded in-service herbicide exposure? (b) Is it at least as likely as not (50 percent or better probability) that the Veteran's epilepsy is either proximately due to OR aggravated by his claimed hypertension. In rendering these opinions, the examiner should assume that the Veteran was exposed to herbicides in service. The examiner's report must reflect consideration of the Veteran's entire documented medical history and assertions and all lay evidence. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner must provide a thorough rationale for each opinion given 3. Schedule a VA examination to determine the current severity of the Veteran's bilateral hearing loss disability. The results of audiological testing must include, in numeric decibels, the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz and must provide the speech recognition scores using the Maryland CNC test. The audiologist must also describe the effect of the Veteran's hearing loss on his occupational functioning and daily activities. (Continued on the next page) The Veteran and his representative must be notified in writing at his correct, current address of record that he is being scheduled for a VA examination and of the potential consequences that may result from his failure to attend a VA examination pursuant to 38 C.F.R. § 3.655 . The AOJ is specifically instructed to document such notification in the Veteran's claims file. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish, 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.