Citation Nr: 21041340 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 14-14 260 DATE: July 8, 2021 REMANDED Entitlement to service connection for a heart disorder, to include as due to in-service exposure to herbicide agents and as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for hypertension (HTN), to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for bilateral foot disorder, to include pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1967 to May 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claims in May 2018 to the agency of original jurisdiction (AOJ) for additional development. While the Board regrets the additional delay, a remand is necessary to ensure that the Veteran is afforded due process. The Veteran was initially represented by an attorney. However, pursuant to 38 C.F.R. § 20.6, the attorney withdrew his representation. See May 2016 correspondence. Thus, the Veteran is currently proceeding with his appeal pro se. To more accurately reflect the scope of the Veteran's claim, the issue of entitlement to service connection for a heart disorder has been recharacterized as shown on the title page. 1. Entitlement to service connection for a heart disorder, to include as due to in-service exposure to herbicide agents and as secondary to service-connected PTSD. The May 2018 Board Remand instructed the AOJ to afford the Veteran a VA examination for his claimed heart disorder. Upon review of the April 2020 VA opinion report, the Board finds that an addendum VA opinion is needed to fully address the Veteran's claims. In this regard, the April 2020 VA examiner opined that the Veteran's heart condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner based this opinion on the fact that the onset was many years post service. The Board finds this opinion inadequate because the examiner did not discuss the Veteran's statements related to his heart condition and did not provide an etiology for his heart disorder. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one). In November 2020, the Veteran's former representative also submitted an article regarding a link between gout medication and heart disorders. Thus, the Board finds that a remand is required for an addendum VA opinion that discusses the etiology of the Veteran's heart disorder, considers his statements, and submitted article. Further, the evidence of record shows that the Veteran has been experiencing heart palpitations and increased heart rate due to his service-connected PTSD panic symptoms. See May 2016 VA treatment record. In light of this evidence suggesting that the Veteran's heart disorder may be related to his service-connected PTSD, the Board finds that a remand is necessary to obtain an opinion addressing service connection on a secondary basis. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). 2. Entitlement to service connection for HTN, to include as due to in-service exposure to herbicide agents. The Veteran underwent a VA examination for his HTN in April 2020. The VA examiner provided a negative nexus opinion based on the fact that the Veteran was not diagnosed with HTN until many years post service. The examiner noted that a general medical community opinion is that association or correlation is not causation. The Board again finds this opinion inadequate because the examiner did not discuss the Veteran's statements related to his HTN and did not provide an etiology for his HTN, other than a general medical community opinion. See Nieves-Rodriguez, supra; Barr, supra. In addition, the Board notes that the Veteran's service treatment records (STRs) show that his May 1969 separation examination blood pressure readings were elevated. As such, an addendum VA opinion is needed to address the etiology of the Veteran's HTN, his statements, and his elevated blood pressure readings in-service. The Board also notes that the Veteran's claim includes as due to in-service exposure to herbicide agents and in October 2020 he submitted a research article regarding hypertension and a potential link to Agent Orange exposure. Additionally, the National Academy of Sciences has concluded that there is sufficient evidence of an association between exposure to Agent Orange and hypertension, even though this condition is not on the list of diseases presumed to be related to herbicide agent exposure in 38 C.F.R. § 3.309(e). See Nat'l Acad. of Sci., Inst. of Med., Veterans & Agent Orange: Update 2018 (2018)). However, there is no medical opinion currently of record which addresses whether there is any relationship between the Veteran's current hypertension and his conceded in-service herbicide exposure. Accordingly, the VA examiner must provide an opinion that addresses in-service exposure to herbicide agents and discuss the conflicting evidence submitted by the Veteran as well as the NAS update. 3. Entitlement to service connection for bilateral foot disorder, to include pes planus. The Veteran underwent a VA examination for his bilateral foot disorder in April 2020. The VA examiner provided a negative nexus opinion based on the lack of in-service injury. The Board finds this opinion inadequate because the examiner did not discuss the Veteran's statements related to his bilateral foot disorder and did not provide an etiology for his condition. See Nieves-Rodriguez, supra; Barr, supra. The Board notes that the Veteran is competent to report his symptoms of pain and treatment received. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Thus, the Board finds that a remand is required for an addendum VA opinion that discusses the etiology of the Veteran's bilateral foot disorder and considers his statements. The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to a VA examiner to provide an addendum medical opinion addressing the nature and etiology of the Veteran's heart disorder, HTN and bilateral foot disorder. A full examination should not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file, including a copy of this Remand and should note so in the report. Thereafter, the examiner is asked to provide an opinion with respect to the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's heart disorder had its onset during active service or is related to any in-service disease, event, or injury, to include exposure to herbicide agents in service? (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's heart disorder was caused or aggravated by his service-connected PTSD. The term "aggravation" means any incremental increase - any additional impairment of earning capacity - regardless of permanence. In providing this opinion, the examiner must address all of the evidence of record, to include an article regarding a link between gout medication and heart disorders. (c) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's HTN had its onset during active service or is related to any in-service disease, event, or injury, to include exposure to herbicide agents in service? In providing this opinion, the examiner must address all of the evidence of record, to include an article regarding a potential link between HTN and Agent Orange exposure and the Veteran's elevated blood pressure readings in-service, as well as the NAS update. (d) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension was caused or aggravated by his service-connected PTSD. The term "aggravation" means any incremental increase - any additional impairment of earning capacity - regardless of permanence. (e) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral foot disorder had its onset during active service or is related to any in-service disease, event, or injury? The examiner must address the Veteran's lay contentions, as well as set forth a complete rationale for any conclusion reached, citing to the examiner's own expertise, medical literature, and/or evidence in the Veteran's claims file as necessary. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuzniar, 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.