Veteranclaims’s Blog

July 4, 2019

The Purplebook; March 2018; version 1.0.0; Agent Orange and hypertension; National Academy of Sciences (NAS);

The Purplebook

Version 1.0.0

March 8, 2018

  • INTRODUCTION
  • Version 1.0.0
  • The Purplebook
  • March 8, 2018,
  • VI
  • I. INTRODUCTION
  • VII.This document was created as part of a Board-wide priority project to document and consolidate all internal policies and procedures. It began as a project conducted by a workgroup of Office of Veterans Law Judges and Appellate Group staff in 2013 and 2014 to merge and update Board Directive 8430 and Board Handbook 8430.2, which had been in effect since 1999 and 1997, respectively. The project was expanded in scope in 2016 to encompass all Board policies and procedures, not just those listed in the Directive and Handbook. The organizational structure was created by staff from the Office of the Principal Deputy Vice Chairman (PDVC), and it is designed to be easy to update and maintain, so that Board policies and procedures can be modified as needed to improve efficiency and effectiveness. The numbering system is based on that used in the Veterans Benefits Administration’s (VBA) M21-1 Adjudication Procedures Manual, to allow for consistency in citation format.

IX. ADJUDICATORY BEST PRACTICES v. DENIALS

Version 1.0.0

The Purplebook

March 8, 2018

115

include a prejudicial error analysis to explain why those records do not have to be obtained under the duty to assist for any claim being denied.

B. Deciding an increased rating issue while remanding a TDIU issue for a VA examination or opinion In Brambley v. Principi, 17 Vet. App. 20, 24 (2003), CAVC held that it “was premature for the Board to decline extraschedular consideration where the record was significantly incomplete in a number of relevant areas probative of the issue of employability.” In that case, the Board declined to refer the matter for extraschedular consideration, but remanded the issue of entitlement to TDIU because “additional employment and medical information was necessary to adjudicate fairly the TDIU claim.” Id. CAVC explained that, “[a]lthough it is well settled that extraschedular consideration and TDIU claims are not necessarily inextricably intertwined, here both adjudications require a complete picture of the appellant’s service-connected disabilities and their effect on his employability.” Id. (Internal citations and quotations omitted). Thus, it was premature for the Board to decline extraschedular consideration where the record was significantly incomplete in a number of relevant areas probative of the issue of the appellant’s employment. Id. 4.Agent Orange Claims

A. SC Hypertension, Bladder cancer, and hypothyroidism In cases where presumptive (or actual) exposure to Agent Orange has been conceded, do not deny service connection for hypertension, bladder cancer, or hypothyroidism without first obtaining a VA medical opinion on the nexus element. Although VA has not conceded a relationship between hypertension and Agent Orange, it is significant to note that prior to 2006, the National Academy of Sciences (NAS) placed hypertension in the “inadequate or insufficient evidence” category. However, in its 2006 Update, NAS elevated hypertension to the “limited or suggestive evidence” category. Update 2012 provides the history of NAS changing the categorization of hypertension beginning in its 2006 Update and subsequent updates. See 79 Fed. Reg. 20,308 (Apr. 11, 2014). The NAS updates are published in the Federal Register by VA, and thus VA is on notice as to the information contained therein. Update 2012 notes that NAS has defined this category of limited or suggestive evidence to mean that the “evidence suggests an association between exposure to herbicides and the outcome, but a firm conclusion is limited because chance, bias, and confounding could not be ruled out with confidence.” Id. at 20,309.

IX. ADJUDICATORY BEST PRACTICES v. DENIALS

Version 1.0.0

The Purplebook

March 8, 2018

116

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