Citation Nr: 22002016 Decision Date: 01/13/22 Archive Date: 01/13/22 DOCKET NO. 20-12 478 DATE: January 13, 2022 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to May 1968, including in the Republic of Vietnam. These issues are before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. Entitlement to service connection for hypertension is remanded. The Board cannot make a fully informed decision on the issue of entitlement to service connection for hypertension because no VA examiner has opined whether the Veteran's hypertension is related to a service-connected disability. The Veterans Claims Assistance Act, as part of the duty to assist, requires VA to obtain an exam or opinion in certain circumstances. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). A VA examination or opinion must be obtained in conjunction with a claim if there is: competent evidence of a current disability; evidence of an in-service event, injury, or disease; an indication that the current disability may be associated with the veteran's service or another service-connected disability; and there is otherwise insufficient competent medical evidence to decide on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, September 2011 private treatment records show a diagnosis of hypertension. As recently as September 2019, VA treatment records also listed hypertension as an active problem. The Veteran is service connected for diabetes mellitus II. The Veteran has contended and, in March 2020, submitted evidence and that there may be a relationship between these two disabilities. The Board cannot, in making its decisions, assert its own medical opinion about the cause of the Veteran's hypertension. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). A VA examination of the Veteran's hypertension and a nexus opinion is warranted. The matter is REMANDED for the following action: The Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand order. Schedule the Veteran for an examination by an appropriately qualified health care professional to determine the etiology of the hypertension. The examiner must review the claims file. The examiner is asked to provide a response to the following: (1.) Is the current hypertension at least as likely as not related to service? (2.) Is the hypertension at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. (3.) Is the hypertension at least as likely as not proximately due to diabetes mellitus II? In answering this question, the examiner should address the document submitted by the Veteran "Diabetes and High Blood Pressure." (4.) Is hypertension at least as likely as not aggravated, i.e., worsened beyond its natural progression, by diabetes mellitus II? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. (Continued on the next page) "Aggravation" means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. Provide a rationale to support the opinions. If the examiner cannot provide a requested opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.