Citation Nr: 22018407 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 16-00 545 DATE: March 29, 2022 REMANDED Entitlement to service connection for hypertension, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from November 1964 to August 1968 and in the U.S. Air Force from November 1971 to December 1975. In September 2021, the Board of Veterans' Appeals (Board) remanded the issue of entitlement to service connection for hypertension for further development. Specifically, the Board instructed the regional office (RO) to schedule the Veteran for a VA examination pertaining to his claim. In May 2021, the Veteran testified at a virtual hearing before the undersigned. A transcript of the hearing is associated with the claims file. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Entitlement to service connection for hypertension, to include as due to herbicide exposure and as secondary to service-connected diabetes mellitus, is remanded. The Board finds that a new medical opinion is warranted for the Veteran's claim. The Veteran contends that his hypertension is related to herbicide exposure while in service, or in the alternative, is secondary to his service-connected diabetes mellitus. The Veteran underwent a VA examination in December 2021, in which the examiner noted a diagnosis of hypertension from 1990. He ultimately opined that the Veteran's hypertension was less likely than not related to service, to include herbicide exposure, because he was not diagnosed with hypertension in service. He also opined that it was less likely than not the Veteran's hypertension was proximately due to or the result of or aggravated by the Veteran's diabetes mellitus. Instead, the examiner found that since the Veteran lost 80 to 100 pounds after gastric bypass surgery, his blood pressure has been normal, so the weight loss seemed to have made his hypertension quiescent while the diabetes remained. However, the Board finds that the December 2021 examination and opinion do not substantially comply with the Board's September 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). In this regard, the December 2021 examiner failed to address the 2018 NAS update that identified a relationship between herbicide agent exposure and hypertension, as well as the September 2020 private opinion from Dr. H.C. and the June 2021 private opinions from Dr. M.H. and Dr. H.C. that showed the Veteran's hypertension was at least as likely as not caused or aggravated by his service-connected diabetes mellitus, as directed by the Board. Accordingly, a remand is necessary to obtain a new medical opinion to ascertain the nature and etiology of the Veteran's hypertension. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file updated treatment records. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran's hypertension. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and examination of the Veteran, the examiner should respond to the following: (a.) Whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hypertension had its onset in or is related to service, to include CONCEDED presumed exposure to herbicide agents? In rendering such opinion, the examiner must take into account and address the 2018 NAS update identifying a relationship between herbicide agent exposure and hypertension. In considering whether herbicide agent exposure caused the Veteran's hypertension, please keep in mind that the mere fact that VA has not included a certain diagnosis on a list of presumptive conditions is not, in and of itself, a sufficient rationale for finding that the condition is not related to service. In other words, the Board needs an opinion as to the likelihood that the Veteran's hypertension, without regard to the conditions VA recognizes as being due to herbicide exposure, was nevertheless at least as likely as not related to his exposure to herbicides in Vietnam. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir.1994). (b.) Whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's hypertension was caused or aggravated by the Veteran's service-connected diabetes mellitus. The examiner must specifically address the September 2020 private opinion from Dr. H.C., and the June 2021 private opinions from Dr. M.H. and Dr. H.C. that show the Veteran's hypertension was at least as likely as not the Veteran's hypertension was caused or aggravated by his service-connected diabetes mellitus. (c.) If the examiner finds that the Veteran's hypertension was aggravated by his service-connected diabetes mellitus, then he/she should specify the baseline level of disability of the disability prior to aggravation due to the service-connected condition. Note that aggravation means any incremental increase in disability in non-service-connected disability (i.e., any additional impairment of earning capacity) resulting from the service-connected condition. (Continued on the next page) The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.