Citation Nr: 21042282 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-04 627 DATE: July 12, 2021 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to April 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) regional office (RO). 1. The claim of entitlement to service connection for hypertension is remanded. An addendum VA opinion was provided in April 2021 following the January 2021 Board remand. The examiner had been asked to provide an opinion regarding whether the Veteran's hypertension was related to the Veteran's herbicide exposure in service. The examiner determined that the Veteran's hypertension was less likely than not caused by herbicide exposure in Vietnam. The examiner provided rationale by quoting pieces of the Veteran's claims file. The examiner quoted the Veteran's service dates, pieces of the Veteran's medical record, and a portion of the October 2019 VA direct service connection opinion that the same examiner provided. The examiner then stated that he was unaware of any evidence based medical literature that would support nexus between the Veteran's herbicide exposure or military service and his development of hypertension more than 30 years later. The examiner noted that there was no evidence in the Veteran's medical records or STRs that would support such nexus. The Board finds this opinion is inadequate for lack of sufficient rationale. The examiner supported his negative nexus statement by simply quoting pieces of the Veteran's medical records and the October 2019 VA opinion without explaining how these pieces of evidence spoke against nexus. The examiner then stated that he had no knowledge of medical literature that would support such nexus. In a February 2018 correspondence, the Veteran noted that the Summer 2017 Agent Orange Newsletter from the VA cited a study of 4,000 Vietnam Era Veterans which showed a correlation between the development of hypertension, service in Vietnam, and exposure to herbicides. The Board also notes that, the National Academy of Sciences, Engineering and Medicine (NAS) determined that there is "sufficient" evidence of an association between herbicide exposure and hypertension. See Veterans and Agent Orange: Update 11 (2018) (November 15, 2018). As such, the Board finds that the March 2016 VA examination report is incomplete and remand for additional VA medical opinion is necessary. The matters are REMANDED for the following action: 1. Obtain a VA addendum opinion addressing the etiology of the Veteran's hypertension. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the hypertension had onset in, or is otherwise related to, active military service. In answering this question, address the question of whether hypertension relates to herbicide exposure in Vietnam. Although hypertension may not be presumed service connected based on herbicide exposure, the herbicide exposure must nevertheless be considered when deciding whether hypertension as likely as not relates to service in Vietnam. Please explain in detail any opinion provided. The examiner must address the latest findings from the National Academies of the Sciences, Engineering and Medicine (NAS) Veterans and Agent Orange: Update 11 (2018) regarding whether there is a relationship between the Veteran's hypertensive heart disease and exposure to herbicide agents (i.e. Agent Orange). MARTHA R. LUBOCH Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.