Citation Nr: 22018076 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-49 455 DATE: March 28, 2022 REMANDED Entitlement to service connection for hypertension (claimed as high blood pressure) is remanded. REASONS FOR REMAND The Appellant is the surviving spouse of the Veteran who had active military service from December 1968 to December 1970. The Veteran died in February 2019. In April 2020, the Veteran's surviving spouse was substituted as the appellant for the appeal. This matter comes to the Board of Veterans' Appeals (the Board) following an October 2015 rating decision in which the Agency of Original Jurisdiction (AOJ) denied the Veteran's claim for entitlement to service connection for hypertension (claimed as high blood pressure). The Board previously remanded this appeal in December 2021, instructing the AOJ to obtain a Department of Veterans Affairs (VA) medical opinion regarding the etiology of the Veteran's hypertension. The examiner was asked to opine on whether the Veteran's hypertension (1) had its onset in or was otherwise related to his active service or (2) was caused or aggravated by any of his service-connected disabilities, to include coronary artery disease. 1. Entitlement to Service Connection for Hypertension On remand, the AOJ obtained a VA medical opinion in January 2022. The examiner opined that the Veteran's hypertension was less likely than not incurred in or caused by his active military service, as the Veteran's December 1970 separation examination was silent for a diagnosis of hypertension and showed a normal blood pressure reading. The examiner also determined that it was less likely than not that the Veteran's hypertension was proximately due to, the result of, or aggravated by any of his service-connected conditions. The examiner linked the Veteran's hypertension to obesity and lifestyle choices. Yet, prior to his death, the Veteran contended that he was entitled to service connection for hypertension due to exposure to herbicide agents during his active military service in the Republic of Vietnam. Exposure to herbicide agents has been conceded, as the AOJ previously granted entitlement to service connection for coronary artery disease as presumptively associated with exposure to herbicide agents. See 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Hypertension is not among the list of diseases presumptively associated with exposure to herbicide agents under 38 U.S.C. § 3.309(e). However, service connection on a direct basis can still be established. The Board notes that in the National Academies of Sciences (NAS), Engineering and Medicine Veterans and Agent Orange: Update 11 (2018), the NAS found sufficient evidence of an association for hypertension and exposure to herbicide agents used during the Vietnam War. Hypertension was thereby upgraded from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to herbicide agents to the category of "sufficient" evidence of an association with exposure to herbicide agents. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide agent exposure. This NAS report is constructively before the Board. See Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021). The January 2022 medical opinion did not sufficiently address the question of whether the Veteran's hypertension was caused by his exposure to herbicide agents; as such, it is inadequate. See Miller v. Wilkie, 32 Vet. App. 249, 257 (2020). Accordingly, the Veteran's appeal must be remanded to obtain a new VA medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether there it least as likely as not, or an approximate balance of the evidence, that the Veteran's hypertension related to in-service exposure to herbicide agents (Agent Orange) during his service in the Republic of Vietnam. The examiner must address the National Academies of Sciences (NAS), Engineering and Medicine Veterans and Agent Orange: Update 11 (2018), wherein the NAS found sufficient evidence of an association for hypertension and exposure to herbicide agents used during the Vietnam War and hypertension was upgraded from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to herbicide agents to the category of "sufficient" evidence of an association with exposure to herbicide agents. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.