Citation Nr: 22018444 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-27 128 DATE: March 29, 2022 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to March 1971. In January 2021 the Board of Veterans' Appeals (Board) issued a decision that denied entitlement to service connection for hypertension. The Veteran appealed the Board's decision to the Court of Appeals for Veterans Claims (Court). In a November 2021 order, the Court granted a Joint Motion for Remand and vacated the Board's decision. The matter returns to the Board for further action consistent with the Joint Motion for Remand (JMR). 1. Entitlement to service connection for hypertension is remanded. The November 2021 JMR concluded that the Board failed when analyzing the March 2020 medical opinion obtained as "compliant" with a prior remand order despite the March 2020 opinion needing an addendum. The VA examiner issued addendum opinion in July 2020. The Board notes that the January 2021 decision did not discuss the addendum. However, upon review of both medical opinions, the Board concludes that a new opinion is warranted. Relevant to this remand, the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). In the March 2020 opinion, the examiner opined in part that "[a]lthough it is claimed that there is evidence linking hypertension to Agent Orange exposure, the condition of hypertension has not been yet added to the list of diseases presumed service connected in veterans exposed to Agent Orange." Here, the Board finds that the VA examiner impermissibly relied on hypertension not having presumptive service connection as a reason to deny the Veteran's theory of service connection via herbicide exposure. The July 2020 addendum opinion does not consider evidence of a more-than-limited association. However, the Board is cognizant that in the National Academy of Science's "Veterans and Agent Orange: Update 11 (2018)," sufficient evidence (i.e., more-than-limited) was found of an association between hypertension and exposure to herbicide agents. As such, remand is warranted for a new medical opinion, including to expressly consider the National Academy of Science's 2018 report. The matters are REMANDED for the following action: 1. Return the claims file to a new VA examiner of appropriate expertise in order to determine the etiology of the Veteran's hypertension. The VA examiner must answer: (a.) Whether it is as least as likely as not (i.e., a probability of fifty percent or greater) that the Veteran's hypertension is directly related to service, to include herbicide agent exposure. The examiner should consider any evidence submitted by the Veteran related to this point. The examiner should also consider the National Academy of Science's "Veterans and Agent Orange: Update 11 (2018)," which found sufficient evidence (i.e., more-than-limited) of an association between hypertension and exposure to herbicide agents. The examiner should state whether exposure to herbicide agents in service was a factor, even if not the only factor, that contributed to his hypertension. (b.) Whether it is as least as likely as not (i.e., a probability of fifty percent or greater) that the Veteran's hypertension is caused by service-connected disease or injury, in particular the Veteran's coronary artery disease. (c.) Whether it is at least as likely as not (i.e., a probability of fifty percent or greater) that the Veteran's hypertension is aggravated by service-connected disease or injury, in particular the Veteran's coronary artery disease. (Continued on the next page) If service-connected disease or injury aggravates hypertension, the examiner should identify the percentage of disability which is attributable to the aggravation. 38 C.F.R. § 3.310. A complete rationale for any opinion expressed should be provided in a report. The Board notes that the VA examiner should not rely on "whether hypertension receives presumptive service connection due to herbicide exposure" when explaining rationale. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jonah Nelson, 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.