Citation Nr: A25041229 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 241008-479990 DATE: May 6, 2025 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from December 1954 to February 1974. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2024 rating decision. In an October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the hearing docket. In January 2025, a virtual hearing was held before the undersigned; a transcript is in the record. Therefore, the Board's review is limited to the evidence of record as of the September 2024 rating decision, the Veteran's testimony, and any evidence he submitted within 90 days of the Board hearing. One feature of the Appeals Modernization Act (AMA) is the Board's limited authority to remand cases for further development and opinions. Remands under the AMA are limited to pre-decisional duty to assist errors and correction of any other error by the Agency of Original Jurisdiction (AOJ) in satisfying a regulatory or statutory duty if correction of the error would have a reasonable possibility of aiding in substantiating the Veteran's claim. 38 C.F.R. § 20.802(a). In this case, as discussed more fully below, the Board has identified pre-decisional duty to assist errors in that the AOJ relied upon inadequate VA medical opinions in rendering the above rating decision. Thus, a remand is necessary to provide the Veteran with adequate VA medical opinions. The Veteran asserts that his hypertension is due his in-service exposure to herbicide agents, jet fuels, and/or asbestos. A September 2023 VA Toxic Exposure Risk Activity (TERA) memorandum notes that the Veteran participated in a TERA because he served as an aircraft maintenance technician and was exposed to jet engine fuel. On October 2023 VA hypertension examination, hypertension was diagnosed with an approximate onset date in 2005. The Veteran reported that he experienced a myocardial infarction and underwent stent placement in 2005. He related that he thought he was prescribed antihypertensive medication at that time. In an October 2023 VA hypertension opinion, the examiner opined it was less likely than not that the Veteran's hypertension was caused by a TERA during service. He explained that there was no medical or scientific evidence available that provided any indication of a relationship between the development of the condition at issue and the TERA. The examiner noted that the primary risk factors for hypertension included obesity, unhealthy diet, physical inactivity, excess alcohol, tobacco use, older age, and genetic factors and then indicated that the Veteran had no specific risk factors. He also indicated that the Veteran's hypertension was not a condition that was due to particulate matter, burn pit or oil well fires, fuels, oils, or fume exposure and was not recognized by the VA as presumptive to a TERA. An additional, December 2023, VA TERA memorandum notes that the Veteran participated in a TERA because he served as an aircraft engine mechanic and was likely exposed to fuel, and he served as a jet engine mechanic and was likely exposed to asbestos. On January 2024 VA hypertension examination, hypertension was diagnosed. The Veteran reports an approximate 10-year history of high blood pressure and related that his hypertension had been well controlled on his blood pressure medication. In a January 2024 VA hypertension opinion, the examiner opined that it was less likely than not that the Veteran's hypertension was related to his service. She noted that the Veteran was diagnosed with hypertension in 2015, at the age of 79, more than 40 years after his military retirement, and that his service treatment records (STRs) were silent for any hypertension treatment. The examiner also opined that it was less likely than not that the Veteran's hypertension was caused by exposure jet fuel and/or asbestos. She explained that he was not diagnosed with hypertension until 2015 and that according to medical literature, hypertension is the result of increased salt absorption resulting in volume expansion, an impaired response of the renin-angiotensin-aldosterone system (RAAS), and increased activation of the sympathetic nervous system. The examiner also indicated that some risk factors included age, diet, family history, and level of physical activity and that such risk factors far outweighed the factors identified in the TERA. The Board finds that the October 2023 VA opinion is inadequate because although the examiner indicated that there was no medical or scientific evidence available that provided any indication of a relationship between the development of the condition at issue and the TERA, he did not address whether the Veteran's hypertension was related to his asbestos exposure, which was noted in a December 2023 VA TERA memorandum. Additionally, although he noted the primary risk factors for hypertension, he also indicated that the Veteran had no specific risk factors for hypertension and failed to identify a likely etiology for his hypertension. The Board also finds that the January 2024 VA opinion is inadequate for multiple reasons. The examiner indicated that the Veteran was diagnosed with hypertension in 2015 but did not discuss December 2005 to January 2012 private treatment records which showed that the Veteran received treatment for hypertension and that it was primarily under good control during this time frame. This suggests a less than thorough review of the Veteran's claims file. Also, while opining that it was less likely than not that the Veteran's hypertension was caused by exposure jet fuel and/or asbestos, in support of such opinion she simply defined what hypertension was and did not provide rationale or a likely etiology. Considering the foregoing, the failure to obtain an adequate medical advisory opinion regarding the Veteran's hypertension constitutes a pre-decisional duty to assist error. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Thus, the Board finds that remand is warranted to obtain an adequate medical advisory opinion regarding the etiology of the Veteran's hypertension. The Board notes that the Veteran has also claimed that his hypertension is due to exposure to herbicide agents during service. In a November 2023 statement, he reported that he served on the U.S.S. Kearsarge while it was in the territorial waters off Guam and served on the U.S.S. Bonhomme Richard while it was in Vietnam waterways. However, an August 2024 records research response and a September 2024 VA Memorandum indicated that the Veteran's reports of herbicide exposure could not be substantiated because the evidence of record did not show that the Veteran had service in a qualifying nautical location. Therefore, remand to conduct additional research into the Veteran's claims regarding herbicide agent exposure is not necessary. The matter is REMANDED for the following: Forward the Veteran's claims file to an appropriate VA clinician (other than the providers who furnished the October 2023 and January 2024 opinions) for the issuance of a medical opinion regarding the nature and etiology of the Veteran's hypertension. The claims file and a copy of this remand must be reviewed by the provider. [If the provider determines that a physical examination is necessary to provide the opinion, one should be scheduled.] After review of the claims file (and examination of the Veteran if found necessary), the provider should: (a) Identify the likely etiology for the Veteran's hypertension and opine whether such began in service or is otherwise the result of military service, to include elevated blood pressure readings of 144/90 and 146/94 in May 1964. (b) If the Veteran's hypertension is found to not be related to his service, further opine whether his hypertension is the result of exposure to asbestos while in the Navy and/or whether his hypertension is the result of his exposure to jet engine fuel and fumes while working with aircraft. (c) If the Veteran's hypertension is determined to not have been incurred in service, or due to exposure to asbestos, or jet engine fuel and fumes, identify the etiology considered to be more likely (and explain why that is so). (d) In addressing the above, the provider is advised that a finding that the Veteran did not have a diagnosis of hypertension during service is not fatal to his claim. (e) If a requested opinion cannot be provided without resort to mere speculation, it must be so stated, with explanation why the opinion would require mere speculation. The provider should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (no one could respond given the current state of medical science and the known facts) or by a deficiency in the record or the examiner (additional facts are required-if so identify them, or the examiner lacks the requisite knowledge or training). The opinion must include complete rationale that cites to factual data and medical principles/medical literature, as deemed appropriate). John R. Doolittle, II Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bayles, James J. 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.