BVA Case 23-0092: Back

The Board found that the April 2015 VA medical opinion address[ing]whether the [v]eteran's current endocrine conditions and hypertension were related to his service-connected diabetes was inadequate because it failed to discuss the theory of aggravation or provide a sufficient explanationfor its conclusions.

In addition,the Board noted that an opinion addressing the potential relationship betweenthe veteran's hypertensionand presumedherbicide exposure was warranted given that the National Academies of Sciences,Engineeringand Medicine (NAS),[had recently]upgraded hypertension from its previous classification in the category of 'limited or suggestive'evidence of an association to Agent Orange to the category of 'sufficient'evidence of an association.

Therefore,an exam was ordered to address (a)whether the veteran's hypertension was at least as likely as not related to his active duty service,to include his presumed exposure to herbicide agents,and (b)whether the veteran's hypertension,adrenal gland condition, thyroid condition,and/or pituitary gland condition were at least as likely as not caused or aggravated by his service-connected diabetes.

In assessing the etiology of the veteran's hypertension, the physician provideda negative opinionregardingdirect service connection,includingin-service herbicide exposure,stating that the diagnosis of hypertension was not evident during active service and thus [was]not related to active service including events,injuries,diseases,or exposures during service.

ditions were all manifestations of his autoimmune polyglandular syndrome type II, but the physician did not address whether his polyglandular syndrome is secondary to his service- connected diabetes.

In addition,the Board found that there may be outstanding VA treatment records that could be relevant to his claim for hypertension,warranting remand for that issue as well.

A September 2022 VA opinion completed by a nurse practitioner concluded that there was scant data supporting a nexus between the current diagnosis of autoimmune polyglandular syndrome type II .

November 2022 Board Decision In the November 17,2022,decision now on appeal,the Board denied service connection for pituitary gland and adrenal gland conditions,to include as secondary to diabetes,and service connection for hypertension except as presumptively related to herbicide exposure pursuant to the PACT Act.