Citation Nr: 22016579 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 18-42 084 DATE: March 22, 2022 REMANDED Entitlement to service connection for hypertension, to include as secondary to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to October 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a March 2021 videoconference hearing. A transcript of that hearing is associated with the claims file. This case was most recently before the Board in August 2021 when it was remanded for additional development. The issue of entitlement to service connection for erectile dysfunction was granted in a November 2021 rating decision. As this represents a full grant of the entitlement sought on appeal, that issue is no longer before the Board. Entitlement to service connection for hypertension, to include as secondary to herbicide agent exposure, is remanded. A remand confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board previously remanded this claim for an opinion on whether the Veteran's hypertension is etiologically related to his presumed in-service exposure to herbicide agents. The Board explained that although hypertension is not listed as a disease associated with such exposure in the VA regulations, the Veteran is not precluded from establishing service connection with proof of direct causation. The August 2021 remand directed the examiner that although there is not an evidentiary presumption, actual causation must be considered. An October 2021 VA examiner opined that the Veteran's hypertension was less likely than not incurred in or caused by service because "there are no records of hypertension in service" and according to VA, "there is no service connection for hypertension related to exposure to herbicide agent during service." The opinion does not respond to the inquiry of whether hypertension manifested to a compensable degree within a year of service discharge and contains no other rationale. The Board finds the October 2021 VA opinion inadequate to adjudicate the claim. Specifically, the examiner did not provide a reasoned medical explanation for the opinion, instead relying solely on a lack of a presumptive finding by VA and the absence of an in-service diagnosis of hypertension, reasons that were already identified as not dispositive of the issue. The Board thus finds that an additional opinion should be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum opinion on the etiology of the Veteran's hypertension. A review of the claims file, including a copy of this remand, should be completed. The examiner must provide thorough, well-reasoned opinions as to each of the following: (a.) Is it at least as likely as not that hypertension was incurred in service or is otherwise related to service, to include his presumed in-service exposure to herbicide agents? Notably, the mere fact that an evidentiary presumption has not been established for a diagnosed disorder based on herbicide agent exposure is not dispositive of the issue of a nexus between a current disorder and service. Consideration must be given to the likelihood of actual causation by the herbicide agent exposure based on relevant supporting data, such as the Veteran's reported history and pertinent medical literature. (b.) Is it at least as likely as not that hypertension manifested to a compensable degree within one year of separation from service? A complete rationale should be provided for all opinions offered. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.