Citation Nr: 18140795 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 16-24 925 DATE: ORDER Entitlement to service connection for hypertension is granted. REMANDED Entitlement to service connection for asthma is remanded. FINDING OF FACT The appellant’s hypertension manifested to a compensable degree within one year of his separation from active service and is not attributable to intercurrent causes. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served on active duty in the United States Air Force from January 1991 to April 1991, including service in Southwest Asia from January 19, 1991 to March 26, 1991. He was a member of the United States Air Force Reserve from August 1978 to December 18, 2003. Entitlement to service connection for hypertension is granted. The appellant contends that service connection is warranted for his hypertension as it was diagnosed within the presumptive 1-year period after his separation from active duty. After a review of the evidence of record, the Board concludes that the appellant’s hypertension was diagnosed and manifested to a compensable degree in December 1991, during the applicable presumptive period. Establishing that a disability is service connected for purposes of entitlement to VA disability compensation generally requires evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the claimed in-service injury or disease and the current disability. See 38 U.S.C. § 1110; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (2018). For certain specifically enumerated chronic diseases such as hypertension, however, there is an alternative method of establishing service connection. Specifically, if the record demonstrates that a chronic disease was present in service or manifest to a compensable degree within the applicable presumptive period, present manifestations of the same chronic disease at any later date are service connected, unless clearly attributable to an intercurrent cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The specifically enumerated chronic diseases include hypertension. 38 C.F.R. § 3.309(a). The applicable presumptive period for hypertension is one year from the date of separation from active service. 38 C.F.R. § 3.307(a). Under VA regulations, hypertension is defined as diastolic blood pressure predominantly 90mm or greater. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Hypertension is considered compensable when either diastolic pressure is predominantly 100mm or more, systolic pressure is predominantly 160mm or more, or when an individual with a history predominantly 100mm or more who requires continuous medication for control. Id. While the appellant was not diagnosed with hypertension during active service, Air Force Reserve treatment records from October 1991 through April 1992 reveal he was diagnosed with hypertension and placed on medication for the control of hypertension in December 1991. This diagnosis occurred within the applicable presumptive period and the fact that he was prescribed continuous medication for control of hypertension evidences that it was manifest to a compensable degree during that period. Finally, the record shows that the appellant underwent a VA examination in April 2016 which showed that he currently has hypertension. Moreover, the examiner concluded that the appellant’s current hypertension was at least as likely as not incurred in service as he had been prescribed continuous medication since service. A review of the evidence of record does not raise an indication of any intercurrent causes for the appellant’s hypertension. As such, the Board finds that service connection is warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309(a). REASONS FOR REMAND 1. Entitlement to service connection for asthma is remanded. The appellant asserts that he developed asthma due to environmental exposure to heavy smoke, dust, and environmental pollutants during his tour of duty in Southwest Asia during the Gulf War. After a review of the evidence of record, the Board finds that further development is necessary prior to adjudicating this claim. The appellant’s private treatment records present an onset date for the appellant’s asthma in November 2005. Service treatment records from November 2002 contain a denial from the appellant that he was on any medication for an airway problem. In August 2003, the appellant did not select asthma from a list of current disabilities, nor did he report using medication for asthma treatment at that time. The appellant underwent a VA examination in April 2016, wherein the examiner opined that because the appellant’s asthma was a diagnosed disease with a clear and specific etiology, it was not an undiagnosed illness related to service in Southwest Asia. The examiner explained that medical research has determined that Gulf War Illness is based on exposure to pyridostigmine bromide tablets and the use of pesticides around the base camp areas. The examiner found no evidence of exposure to these types of chemicals in the record, and so found the appellant’s asthma not at least as likely as not related to his service in Southwest Asia. Despite this rationale, which addresses whether the appellant’s current disability is related to an undiagnosed illness caused by service in the Gulf War, the Board finds an addendum medical opinion is necessary because the examiner failed to address the appellant’s assertion that his asthma was caused by exposure to smoke, dust, haze, possibly depleted uranium, and other environmental hazards he was exposed to in Southwest Asia on a direct basis. The examiner seems to be unsure as to whether the appellant was exposed to any environmental hazards during his tour of duty in Saudi Arabia. The Board notes that the appellant is competent to report exposure to things such as smoke, dust, and haze, as that is something that may be perceived by use of his senses. As such, on remand, the examiner should provide an opinion as to whether the appellant’s asthma was at least as likely as not caused by exposure to smoke, dust, or haze, other environmental hazards associated with service in Southwest Asia on a direct basis. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the appellant’s diagnosed asthma is at least as likely as not related to his reported exposure to environmental hazards such as smoke, haze, and dust, during his service in Southwest Asia. In providing this opinion, the examiner should explain the etiological causes of asthma, and whether asthma diagnosed many years later, would likely to be caused by exposure to environmental hazards present in the Southwest Asia theater of operations. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kleponis, Associate Counsel