Citation Nr: 22018228 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 19-14 884A DATE: March 28, 2022 ORDER New and material evidence has been submitted and the claim to reopen service connection for bilateral hearing loss is granted. New and material evidence has been submitted and the claim to reopen service connection for tinnitus is granted. New and material evidence has been submitted and the claim to reopen service connection for diabetes mellitus, type 2 (type 2 diabetes) is granted. New and material evidence has been submitted and the claim to reopen service connection for hypertension is granted. New and material evidence has been submitted and the claim to reopen service connection for peripheral neuropathy of the right lower extremity (RLE peripheral neuropathy) is granted. New and material evidence has been submitted and the claim to reopen service connection for peripheral neuropathy of the left lower extremity (LLE peripheral neuropathy) is granted. Service connection for tinnitus is granted. Service connection for a right eye disability is denied. Service connection for spinal stenosis is denied. Service connection for type 2 diabetes, as secondary to an in-service exposure to Agent Orange is granted. Service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to an in-service exposure to Agent Orange is denied. REMANDED The service connection claim for bilateral hearing loss is remanded. The service connection claim for hypertension, to include as secondary to an in-service exposure to Agent Orange, or as secondary to service-connected type 2 diabetes is remanded. The service connection claim for RLE peripheral neuropathy, to include as secondary to service-connected type 2 diabetes is remanded. The service connection claim for LLE peripheral neuropathy, to include as secondary to service-connected type 2 diabetes is remanded. FINDINGS OF FACT 1. Since the last, final November 2012 rating decision which denied service connection for bilateral hearing loss, tinnitus, type 2 diabetes, and hypertension, and bilateral lower extremity peripheral neuropathy, VA received additional, probative evidence, including and not limited to, photographs and lay statements from the Veteran about the nature of his work while building an airport in Korat, Thailand, as well as a medical opinion from a private physician. 2. By resolving all reasonable doubt in the appellant's favor, the Veteran's tinnitus was the result of noise exposure during his active military service. 3. The evidence does not show that the Veteran's pre-existing, eye disability aggravated, beyond natural progression, during his active service. 4. There evidence does not show that the Veteran's spinal stenosis was incurred in, or was the result of his active military service. 5. By resolving all reasonable doubt in the appellant's favor, the Veteran's type 2 diabetes was presumptively due to his exposure to herbicide agents, including Agent Orange, during his active service in Thailand. 6. While the Veteran was presumptively exposed to herbicide agents, including Agent Orange during his active service in Thailand, the weight of the probative evidence does not show that the Veteran's COPD was due to said exposure; nor does it show that his COPD was otherwise related to or the result of his active military service. CONCLUSIONS OF LAW 1. The criteria for reopening service connection for bilateral hearing loss have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 2. The criteria for reopening service connection for tinnitus have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 3. The criteria for reopening service connection for type 2 diabetes have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 4. The criteria for reopening service connection for hypertension have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 5. The criteria for reopening service connection for RLE peripheral neuropathy have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 6. The criteria for reopening service connection for LLE peripheral neuropathy have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.156. 7. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a right eye disability have not been met. 38 U.S.C. §§ 1110, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. 9. The criteria for service connection for spinal stenosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for type 2 diabetes, as secondary to an in-service exposure to herbicide agents, including Agent Orange have been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 11. The criteria for service connection for COPD, to include as secondary to an in-service exposure to herbicide agents, including Agent Orange have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 1962 to December 1963, with additional periods of service, including active duty for training, in the United States Army Reserve. He died in August 2020. This matter comes before the Board of Veterans' Appeals (Board) from November 2016 and September 2017 rating decisions of the Department of Veterans Affairs, Veterans Benefits Administrative (VA) Regional Office in Detroit, Michigan. Although the Veteran filed a claim for the above-mentioned issues in February 2016 and September 2017, he passed away while this appeal was still pending, before the Board. The appellant, V.G. is his surviving spouse, who, after his death, duly filed a September 2020 VA Form 21P-534EZ ("Application for DIC, Survivors Pension, and/or Accrued Benefits" form), as well as March 2021 VA Form 21P-0847 ("Request for Substitution of a Claimant Upon Death of a Claimant" form). As either application allows for a substitution as a claimant for this appeal, see 38 C.F.R. § 3.1010, the Regional Office granted the appellant's request for substitution in September 2021. Thus, accordingly, V.G. is substituted as the claimant (appellant) for the purpose of processing this appeal to completion. 38 U.S.C. § 5121A. In October 2019, the Veteran testified at a personal hearing before a Decision Review Officer (DRO Hearing) at the Detroit, Michigan VA Regional Office. A transcript of this hearing is of record. As the appellant serves as a substitute for the Veteran, for purposes of processing this appeal to completion, the Board construes all of the Veteran's assertions as the adopted assertions of the appellant. New & Material Evidence to Reopen Previously Denied Claims VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). New evidence is evidence not previously submitted to agency decision makers. Material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The last time the Regional Office denied the claims for bilateral hearing loss, tinnitus, type 2 diabetes, hypertension, RLE peripheral neuropathy, and LLE peripheral neuropathy, was in November 2012. The November 2012 rating decision denied these claims because it found that these conditions were not linked to the Veteran's military service or a service-connected disability. Following this rating decision, the Veteran did not perfect an appeal, and thus, the November 2012 rating decisions became final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104. Probative to this claim, evidence received since the last, final, January 2017 rating decision, includes and is not limited to, photographs of ammunition supplies point and Camp Friendship in Korat Thailand, to include airplanes; lay statements in a May 2019 Board Appeal (Form VA 9); and an October 2017 private medical opinion from Dr. L.K. Specifically, in the May 2019 Form VA 9, as lay evidence, the Veteran asserted, among other contentions, that the photographs he submitted served as evidence of the nature of his work while building an airport in Korat, Thailand, and that this involved working with and around heavy equipment and airplanes, spraying the area with herbicide agents, digging up dirt and vegetation previously sprayed, and breathing in an otherwise ingesting the dirt and chemicals. In the October 2017 private medical opinion, Dr. L.K. opined that the Veteran's diabetes, bilateral sensory loss in lower extremities, and hearing loss, among other conditions, are all directly related to his traumatic exposure to Agent Orange, in performance of his multiple duties while stationed in Korat, Thailand during November 1962 to November 1963. These above-mentioned pieces of evidence are new because VA had not previously considered them. Further, they constitute material evidence because they are purported to serve as evidence of a correlation between the Veteran's service and the current disabilities associated with these claims. Although these additional pieces of evidence are presumed to be credible for the purpose of reopening the claim, Justus, 3 Vet. App. at 512 13, the Board acknowledges that these additional pieces of evidence, when considered in conjunction with the record as a whole, raise a reasonable possibility of substantiating the Veteran's claims. Therefore, the Board finds that new and material evidence has been submitted, and the service connection claims for bilateral hearing loss, tinnitus, type 2 diabetes, hypertension, RLE peripheral neuropathy, and LLE peripheral neuropathy are reopened. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 1. Tinnitus Prior to his death, the Veteran asserted that he had ringing in his ears since service, due to loud noise exposure while serving in the Army as a combat engineer, and working with heavy equipment without the use of hearing protection. See e.g. March 2012 Statement in Support of Claim. With respect to his military occupational specialty (MOS), the Veteran clarified that the MOS listed on his DD-214 was not what he did in service, but rather, he was in the 815th Construction Engineer Battalion, in which he provided assistance on all construction sites, and that he was around explosives and heavy equipment that are known to cause hearing loss. Military personnel records corroborate the Veteran's statements, as they confirm that he served as an engineer equipment maintenance helper in the 815th Construction Engineer Battalion as a principal duty. See Record of Assignments, Military Personnel Records. In November 2012, the Veteran was afforded a VA examination for tinnitus. The VA examiner opined that "[having] determined that [it] is less likely [than]. . . the current hearing loss was caused by or the result of military service, it follows that the tinnitus is not caused by noise exposure in service." However, the Board finds that this opinion is limited in scope, as the VA examiner did not opine whether the Veteran's tinnitus was incurred in or the result of his military service, nor did she provide a sufficient rationale for her opinion that the Veteran's tinnitus was not caused by noise exposure. Nonetheless, the Board finds that the Veteran is competent to report the onset and continuity of symptoms, such as ringing in his ears because this only requires personal knowledge, which comes to him through his senses. Layno v, Brown, 6 Vet. App. 465, 470 (1990); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Further, the Board additionally finds that the Veteran provided competent, credible testimony about the onset and incurrence of his tinnitus. Overall, in reviewing all probative evidence, the Board also finds that the evidence is at least in relative equipoise, given the Veteran's military occupational specialty as a combat engineer who worked around heavy explosives, airplanes, and other equipment that produced extremely loud noise, and his competent, credible lay statements about the onset and history of his tinnitus. Thus, by resolving all reasonable doubt in his favor, service connection for tinnitus is granted. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Right Eye Disability Although the Veteran also asserted that he was entitled to service connection for a right eye disability, service treatment records indicate that the Veteran had a pre-existing eye disability at the time he enlisted into military service. Generally, a Veteran is considered to be in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at entrance into service or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. However, only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Thus, as the Veteran's January 1962 enlistment examination notes diagnoses of amblyopia and esotropia of the right eye, the Board must consider whether these right eye conditions were subject to aggravation during service. 38 U.S.C. § 1153. Particularly, any in-service aggravation of a pre-existing condition is considered as sufficient basis for service connection, unless there is clear and unmistakable evidence that the disorder was not permanently aggravated beyond the natural progression of the condition during service. See 38 C.F.R. § 3.306. Once the evidence establishes the presence of a pre-existing condition, the Board must first determine whether there was a measured worsening of the disability during service, and if so, it must also determine whether any worsening of this disability constitutes an increase in the disability, which must be permanent in nature. Browder v. Brown, 5 Vet. App. 268, 271 (1993). In reviewing all service treatment records, however, no worsening of his pre-existing eye conditions is shown. Approximately two months after his January 1962 enlistment examination, additional treatment records, from the same month in which he enlisted into service, provided additional details about the Veteran's eye disability. Specifically, a March 1962 service record additionally indicates that the Veteran had poor vision, and a separate, March 1962 health record also indicated that the Veteran had constant right esotropia, prescription was not ordered for his eye condition, and that the last time he wore prescription glasses (before this March 1962 consultation), was six years prior to the date of this March 1962 health record (prior to his enlistment into service). Approximately one year after his enlistment into service, service treatment records continued to reflect diagnoses of esotropia with suppressive amblyopia of the right eye. See e.g. April 1963 Clinical Record Cover Sheet. It was not until May 1963 when the Veteran underwent eye surgery to correct the right eye esotropia. However, no service treatment records, post-operative right eye procedure, suggested or indicated that the Veteran sustained any side effects or complications from his right eye procedure. Post service, and more specifically, from the time the Veteran filed his claim for an eye disability to the time he passed away, medical treatment records do not show that he had any other, additional eye disabilities or conditions. Nonetheless, the Veteran was afforded a VA examination for eye conditions in November 2016. After this VA examination, a VA examiner indicated that the Veteran was diagnosed with congenital right eye esotropia, and congenital right eye amblyopia. However, this VA examiner opined that the Veteran's right eye disability, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury, or illness. As the rationale for this opinion, the VA examiner explained that the Veteran had esotropia since childhood, and that shortly after that, he developed amblyopia, as expected. Further, the VA examiner reasoned that his vision, upon enlistment into service, was the same as it was, at the time of this examination, "best corrected." Further, the VA examiner explained that the medical rectus during service, in no way, aggravated his pre-existing condition, and that the Veteran stated that he felt that there was no change or aggravation by his in-service procedure. Although an October 2017 private medical from Dr. L.K. acknowledges that the Veteran underwent surgery to correct an eye defect while in service, he did not render an opinion as to whether his right eye disability was aggravated by his service. Thus, this October 2017 medical opinion does not render any probative value in evaluating this right eye disability claim. The Veteran has not submitted, nor does the medical evidence provide any probative medical evidence or opinion that is controverting or contrary to this November 2016 VA opinion. Further, the Veteran has not submitted any other evidence to suggest that his right eye disability was aggravated by his service. He did not assert, nor did the evidence show, that he sustained an additional eye injury or eye condition that aggravated his pre-existing eye disability during service, or that he suffered from any side effects or complications from the in-service eye procedure that corrected his pre-existing right eye condition. To the contrary, the Veteran testified that he had a "crossed eye" when he was drafted into service; and that "they straightened [his] eye out" during service. Additionally, he expressly clarified that the procedure did not correct his vision, nor did it make it worse, but rather, "it corrected [his] eye, as far as being straight", even though he never regained vision in it; and that it stayed the same all the time. See October 2019 DRO Hearing Transcript. Thus, in reviewing all probative evidence, including and not limited to, service treatment records, post-service treatment records, and all of lay statements from the Veteran, the Board finds that the evidence does not show that the Veteran's pre-existing eye disability was aggravated by his service. Thus, as the preponderance of the evidence is against this claim, service connection for a right eye disability is denied. Gilbert, 1 Vet. App. at 53; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Spinal Stenosis The appellant additionally asserts entitlement to service connection for a lumbar spine disability. At his hearing, the Veteran testified that he had problems with his back during service and that his service treatment records include a May 31, 1962 note which indicates that he was diagnosed with myositis. Although he stated that he had back issues afterwards, he clarified that he underwent a spinal fusion after his separation from service, even though he was not specific as to when or how long, after separation from service, he underwent this procedure. See October 2019 DRO Hearing Transcript. Service treatment records entail a March 1962 health record (rather than a May 1962 health record the Veteran cited, as noted above),which indicates that the Veteran had an "exaggerated[,] deep respiration and movement [of] left arm and back"; the Veteran preferred to lie on his right side." Although this, very, treatment note reflects a diagnosis of myositis, it is not clear as to whether the examiner was actually referring to lumbar myositis, left arm myositis, or both. Nonetheless, no other treatment records indicate or reflect any follow-up complaints, treatment, diagnoses, or other evidence of a recurrent or chronic back condition. Although the Veteran did not expressly indicate when he underwent his spinal fusion procedure, but rather, vaguely stated that it was after his separation from service, post-service medical treatment records suggest that the Veteran underwent a lumbar spine procedure in 2003. See e.g. July 2010 Private Treatment Record. In support of his claim, the Veteran submitted a private opinion from Dr. B.J.G. Specifically, in this August 2017 medical opinion, Dr. B.J.G. acknowledged that the Veteran was treated for multiple health problems. Although he stated that the "relationship of these maladies would require forensic study and analysis of his active duty, he, opined that "a 50% threshold is probable for . . . his spinal neural-osteopathology resulting in chronic back pain." However, the Board cannot rely on this opinion, in adjudicating this claim, because Dr. B.J.G. did not provide a rationale for this opinion. Subsequently, the Veteran submitted another medical opinion from another private physician, Dr. L.K. In this October 2017 medical opinion, Dr. LK. noted that Dr. G. treated the Veteran with stenotic lumbar surgery, without providing a date or time frame. As he did not render an opinion on the etiology of the Veteran's lumbar spine disability, however, this opinion has no probative value in the adjudication of this claim. Thereafter, the Veteran submitted another, updated medical opinion from Dr. B.J.G. In this December 2019 medical opinion, Dr. B.J.G. reiterated, in pertinent part, that "a 50% threshold is probable for his spinal neural-osteopathology resulting in chronic back pain." However, this opinion is, likewise, inadequate for want of a rationale to support it, and thus, the Board cannot rely on it, in adjudicating this claim. In reviewing all probative evidence, overall, there is no probative evidence that the Veteran's lumbar spine disability was incurred in, and/or is related to his active service. Despite the Veteran's report of an in-service back condition, and only one treatment note, from his service treatment records, which indicates that the Veteran complained of a back condition, no other evidence from his STRs shows that the Veteran had recurrent or chronic back problems, and given that his normal separation examination and report of medical history are silent about back complaints, treatment, or diagnoses, this suggests that his in-service back complaint resolved by the time he separated from service. Additionally, there are not treatment records, from a period that is closely proximate to his separation from service, which suggest that the Veteran had chronic back problems since his separation from service. Evidence of the Veteran's lumbar surgery was approximately forty years after his separation from active service, and with no evidence of a back condition, this is too remote in time to establish a correlation between a back disability ( at the time he filed this claim, until his passing) and his service. Thus, the Board finds that a nexus between a diagnosis of spinal stenosis and his service is not established. 4. Claim for Disabilities, to Include as Secondary to Agent Orange Exposure Further, the Veteran asserted entitlement to direct service connection for type 2 diabetes and COPD, and alternatively, entitlement to presumptive service connection due to an in-service exposure to herbicide agents, include Agent Orange. See e.g. October 2019 DRO Hearing Transcript. Generally, "a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent... unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service." 38 U.S.C. § 1116 (f); see also 38 C.F.R. § 3.307. If a Veteran was exposed to herbicide agents during active military, naval, or air service, service connection is presumed for a specific enumerated list of diseases, including and not limited to, type 2 diabetes. 38 C.F.R. § 3.309 (e). In this case, however, the Veteran has not asserted, and his service personnel records have not shown, that he served in Vietnam. Rather, the Veteran asserts, and service personnel records confirm, that he was stationed in Korat, Thailand, during his active service from 1962 to 1963. Pertinent to this claim, VA adopted a procedure for verifying exposure to herbicide agents in Thailand during the Vietnam era, as it determined that there was significant use of herbicide agents on the fenced-in perimeters of military bases in Thailand. The majority of troops in Thailand during the Vietnam era were stationed at the Royal Thai Air Force Bases of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. Thus, if a veteran served on one of these air bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by MOS, performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. Given that service personnel records, among other probative evidence, including and not limited to, photographs, corroborate the Veteran's assertions, the Board conceded that the Veteran was exposed to Agent Orange due to his involvement in work at the perimeter of the base, as well as building roads and work at a construction site outside the base, building a munitions point. See April 2021 Board Decision (adjudicating other, additional service connection claims from which the Veteran similarly asserted that he was exposed to Agent Orange during his active service in Thailand). Thus, as VA has already conceded exposure to Agent Orange during his active service in Thailand, the Board shall now consider whether the Veteran is entitled to service connection for type diabetes and/or COPD, on a presumptive basis, due to said exposure to Agent Orange. A. Type 2 Diabetes With respect to his service connection claim for type 2 diabetes, post-service medical records reflect a medical diagnosis of type 2 diabetes. See e.g. June 2020 Hospital Medical Record. Thus, by resolving all reasonable doubt in favor of the Veteran, given his service personnel records, his competent, credible statements, and pertinent information regarding herbicide use in Thailand, the Board finds that the Veteran was presumptively exposed to herbicide agents during his active service at U-Tapao. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Therefore, service connection for type 2 diabetes is granted. See 38 C.F.R. §§ 3.303, 3.307, 3.309. B. COPD Although VA concedes presumptive exposure to Agent Orange, COPD is not on the enumerated list of diseases that are presumptively associated with exposure to Agent Orange. Therefore, service connection for COPD, on a presumptive basis, is not established. At the same time, this is not dispositive of this claim, as direct service connection can still be established under 38 C.F.R. § 3.303(d), if there is evidence that the disability was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043 44 (Fed. Cir. 1994). However, service treatment records do not show any evidence of an illness, disease, treatment, and/or diagnosis of COPD or any other COPD-related condition. In support of his claim, the Veteran submitted a private medical opinion from Dr. B.J.G. Specifically, in this August 2017 medical opinion, Dr. B.J.G. acknowledged that the Veteran was treated for multiple health problems, including, among other conditions, COPD. Although he stated that the "relationship of these maladies would require forensic study and analysis of his active duty, he, opined that "a 50% threshold is probable for . . . COPD." However, the Board cannot rely on this opinion, in adjudicating this claim, because Dr. B.J.G. did not provide a rationale for this opinion. The Veteran also submitted another medical opinion from another private physician, Dr. L.K. In this October 2017 medical opinion, Dr. L.K. opined that the Veteran's COPD was "directly related to his traumatic exposure to Agent Orange[,] in performance of his multiple duties while stationed in Korat, Thailand during November 1962 to November 1963[,] as specified in his military records. In rendering this opinion, however, Dr. L.K. provided a detailed account of how and why he was exposed to Agent Orange in Thailand. However, he failed to provide an explanation as to why the Veteran's diagnosis of COPD was due to his exposure to Agent Orange. The Veteran's exposure to Agent Orange is not in dispute, as VA concedes in-service exposure to Agent Orange in Thailand. However, as noted above, COPD is not on the limited, enumerated list of diseases, under 38 C.F.R. § 3.309. Nonetheless, the National Academies of Sciences, Engineering, and Medicine published "Veterans and Agent Orange: Update 11" (2018), to provide the latest update of diseases that have "sufficient evidence", "limited or suggestive evidence", or "inadequate or insufficient evidence" of an association with Agent Orange. However, COPD was not listed under any of these categories. Thus, as Dr. L.K. failed to provide or cite to any contrary or controverting medical literature to support his finding that there is an association or relationship between COPD and Agent Orange, the Board finds that this opinion is supported by an inadequate rationale, and thus, cannot attribute any probative value to it. Further, the Veteran also submitted another medical opinion from Dr. B.J.G. In this December 2019 medical opinion, Dr. B.J.G. reiterated that the Veteran was treated for multiple health problems, including COPD, among other conditions. He rendered the same opinion as his August 2017 opinion, thereby stating that "a 50% threshold is probable for . . . COPD", and additionally stated that there were no significant medical changes since his previous visit, and that the Veteran had constant problems associated with the same diagnoses at his prior examination. As Dr. B.J.G., again, did not provide a rationale for this opinion, the Board finds that this opinion is also inadequate. In reviewing all probative evidence, however, the Board finds that the preponderance of the evidence is against this claim. There is no indication that the Veteran's COPD was incurred in, and/or was the result of his active service. Neither the Veteran or appellant submitted any other probative evidence, such as, for example, private treatment records from a period of service or lay statements from fellow servicemen about a related in-service condition, to show that there was any correlation between the Veteran's active service and his COPD. Therefore, the preponderance of the evidence is against this claim and service connection for COPD is denied. Gilbert, 1 Vet. App. at 53; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND The Board regrets further delay, as an additional development is required before the Board may render a fully-informed decision on the remaining issues on appeal. 1. Bilateral Hearing Loss Prior to his death, the Veteran asserted that his bilateral hearing loss was the result of loud noise exposure during his active service. See e.g. March 2012 Statement in Support of Claim; see also October 2019 DRO Hearing Transcript. In November 2012, he was afforded a VA examination for hearing loss. However, a VA examiner opined that it is less likely than not his bilateral hearing loss was caused by or a result of military service noise exposure. As the rationale for this opinion, the VA examiner reasoned that the Veteran's separation audiological examination revealed normal hearing, and further, the VA examiner erroneously found that the Veteran's military occupational specialty was a supply clerk, with a low probability of exposure to hazard noise levels. To the contrary, however, service personnel records and other credible evidence confirm that the Veteran's principal duty was as an engineer equipment helper who was exposed to loud noises while working near planes that were landing and taking off, as well as heavy equipment used in a construction site. Thus, as this VA opinion is based on an inaccurate factual premise, and more so, it is primarily reliant on the absence of evidence of hearing loss at separation from service, it is inadequate for evaluating this claim. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (holding that "[if] the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely.") (citing Reonal); see too, Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that a VA examination is inadequate where the VA examiner did not comment on the Veteran's report of in-service injury and instead relied entirely on the absence of evidence in the service treatment records to provide a negative opinion). Although the Veteran submitted private medical opinions on the nexus between his bilateral hearing loss and his service, however, none of them are adequate for evaluating this claim, as these opinions are not supported by a rationale. See e.g. August 2017 Private Medica Opinion; see also October 2017 Private Opinion; see too, December 2019 Private Medical Opinion. Therefore, a remand is required for a new VA opinion on the nexus between the Veteran's active service and his bilateral hearing loss. 2. Hypertension The Veteran asserted that his hypertension was due to his service-connected diabetes, and/or the result of his exposure to Agent Orange. See e.g. March 2012; see also October 2019 DRO Hearing Transcript. Although hypertension is not on the limited, enumerated list of diseases that are presumptively the result of Agent Orange exposure, under 38 C.F.R. § 3.309(e), the National Academy of Medicine (NAS) Institute of Medicine found that there is now "sufficient evidence" of an association between hypertension and Agent Orange. See Veterans and Agent Orange: Update 2018. At the same time, however, "association with" does not equate "causation." Therefore, this issue must be remanded for a VA examiner to opine on the etiology of the Veteran's hypertension, and more specifically, an opine whether his hypertension was secondary to his exposure to Agent Orange or his service-connected type 2 diabetes. 3. RLE & LLE Peripheral Neuropathy The Veteran asserted that his RLE and LLE peripheral neuropathy (bilateral lower extremity peripheral neuropathy) was due to his service-connected diabetes, and/or the result of his exposure to Agent Orange. See e.g. October 2019 DRO Hearing Transcript. Although early onset peripheral neuropathy is on the limited, enumerated list of diseases that are presumptively the result of Agent Orange exposure, under 38 C.F.R. § 3.309(e), the probative medical evidence does not show that the Veteran was diagnosed with early onset peripheral neuropathy. However, to the extent that the medical evidence suggests that his bilateral lower extremity peripheral neuropathy may be secondary to his service-connected type 2 diabetes, a remand is required for a VA opinion on the etiology of the Veteran's bilateral lower extremity peripheral neuropathy. The matters are REMANDED for the following action: 1. Obtain a new VA opinion on the nexus between the Veteran's bilateral hearing loss and his active service. The VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral hearing loss was incurred in, was related to, or was a result of his active service. b. In rendering an opinion, consideration should be given to the Veteran's principal duty as an engineer equipment helper who was exposed to loud noises while working near planes that were landing and taking off, as well as heavy equipment used in a construction site during his active service. c. Also, please consider all prior lay statements from the now-deceased Veteran about onset and in-service noise exposure. The Veteran's lay statements should be considered as competent, credible statements, unless the VA examiner has articulated reasons to believe that the Veteran's lay statements were not credible. d. A detailed explanation is requested for all opinions. If it is not possible to render an opinion without resorting to speculation, please provide an explanation as to why this is this case, and what additional evidence, if any, would make it feasible to render such an opinion. 2. Also, obtain a VA opinion on the Veteran's hypertension. The VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (more than 50 percent probability) the Veteran's hypertension is the result of his exposure to herbicide agents, including Agent Orange, during his active military service in the Kingdom of Thailand. b. In rendering an opinion, please consider and address NAS' "Veterans and Agent Orange: Update 11 (2018)", which made a finding that there is "sufficient evidence" of an association between hypertension and herbicide agents/Agent Orange exposure. c. If, and only if, the VA examiner finds that the Veteran's hypertension was not the result of his in-service exposure to herbicide agents, including Agent Orange, he/she must: i. Opine whether it is at least as likely as not the Veteran's hypertension was caused by his service-connected type 2 diabetes; and also: ii. Opine whether it is at least as likely as not the Veteran's hypertension was aggravated by his service-connected type 2 diabetes. "Aggravation" means an increase in severity of the disorder beyond any medically established baseline. d. A detailed explanation is requested for all opinions. If it is not possible to render an opinion without resorting to speculation, please provide an explanation as to why this is this case, and what additional evidence, if any, would make it feasible to render such an opinion. 3. Additionally, obtain a VA opinion on the Veteran's bilateral lower extremity peripheral neuropathy. The VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. The VA examiner must undertake the following: a. Was the Veteran's peripheral neuropathy related to his type II diabetes mellitus? Why do you say so? M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt, 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.