Citation Nr: 22014807
Decision Date: 03/15/22	Archive Date: 03/15/22

DOCKET NO. 17-47 017
DATE: March 15, 2022

REMANDED

Entitlement to service connection for hypertension is remanded.  

REASONS FOR REMAND

The Veteran had active service from January 1978 to April 1981; from September to October 2002; and from January 2004 to January 2005.  He served in Southwest Asia.  

Entitlement to service connection for hypertension is remanded.  

In its September 2021 Remand instructions, the Board of Veterans' Appeals (Board) requested that the Veteran be afforded a Department of Veterans Affairs (VA) hypertension evaluation.  The examiner was directed, if he did not "find that the Veteran's hypertension was aggravated as a result of his third period of active service, to provide an opinion as to whether it is at least as likely as not that any current hypertension is casually related to a prior period of service" and to specifically "consider the Veteran's reported history of environmental exposures (e.g., smoke from oil fire, smoke from burning trash or feces, and vehicle or truck exhaust fumes, etc.) and many symptoms (e.g., chronic cough, runny nose, fever, weakness, headaches, swollen/stiff/painful joints, muscle aches, skin diseases or rashes, redness of eyes with tearing) during deployment to Southwest Asia from January 2004 to January 2005."  

An October 2021 hypertension evaluation conducted for VA states that the examiner concluded that "the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in service injury, event, or illness."  The examiner commented that; "the pathogenesis of primary hypertension (formerly called 'essential' hypertension) is poorly understood but is most likely the result of numerous genetic and environmental factors that have multiple compounding effects on cardiovascular and renal structure and function;" "risk factors include advancing age, family history, race ( African-American) excessive alcohol consumption, obesity;" and "as such, there is nothing in the medical records or literature to suggest that the timing and nature of onset of this disease process occurred in a manner differently than in the general population of the same age, gender, and other demographic factors without regard to a history of military service."  The physician did not note or otherwise address "the Veteran's reported history of environmental exposures (e.g., smoke from oil fire, smoke from burning trash or feces, and vehicle or truck exhaust fumes, etc.) and many symptoms (e.g., chronic cough, runny nose, fever, weakness, headaches, swollen/stiff/painful joints, muscle aches, skin diseases or rashes, redness of eyes with tearing) during deployment to Southwest Asia from January 2004 to January 2005."  

The Agency of Original Jurisdiction's compliance with the Board's remand instructions is neither optional nor discretionary.  Stegall v. West, 11 Vet. App. 268 (1998).  

The matters are REMANDED for the following action:

Schedule the Veteran for a VA hypertension examination conducted by a medical doctor, other than the physician which conducted the October 2021 hypertension evaluation, to assist in determining the nature and etiology of the claimed hypertension and any relationship to active service.  The examiner must review the record and should note that review in the report.  A rationale for all opinions should be provided.  The examiner should: 

(a)  Diagnose all hypertension disabilities found.

(b)  Opine whether it is at least as likely as not (50 percent probability or greater) that any hypertension had its onset during active service or is related to any incident of service, including "the Veteran's reported history of environmental exposures (e.g., smoke from oil fire, smoke from burning trash or feces, and vehicle or truck exhaust fumes, etc.) and many symptoms (e.g., chronic cough, runny nose, fever, weakness, headaches, swollen/stiff/painful joints, muscle aches, skin diseases or rashes, redness of eyes with tearing) during deployment to Southwest Asia from January 2004 to January 2005."  

 

 

J. T. HUTCHESON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Smith, 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.