Citation Nr: 18142674 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-24 214 DATE: October 17, 2018 ORDER Entitlement to service connection for hypertension, to include as due to Agent Orange exposure, is denied. REMANDED Entitlement to service connection for a skin disability, to include as due to Agent Orange exposure, is remanded. Entitlement to service connection for headaches, to include as due to Agent Orange exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to Agent Orange exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to Agent Orange exposure, is remanded. FINDING OF FACT The weight of the competent and probative evidence does not show a current diagnosis of hypertension. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from September 1961 to August 1965, to include service in the Republic of Vietnam from October 1964 to July 1965. In July 2018, the Veteran testified before the undersigned Veterans Law Judge in a videoconference hearing. A copy of the transcript is of record. Entitlement to service connection for hypertension, to include as due to Agent Orange exposure The Veteran maintains that he should be service-connected for hypertension, to include as due to Agent Orange exposure. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Initially, the Board notes that additional records have been added to the record since the issuance of the last statement of the case in June 2015. However, this evidence is not relevant to the issue of service connection for hypertension. Thus, this claim may be properly adjudicated. Post-service treatment records are negative for a diagnosis of hypertension. There is no diagnosis of this disability dated within a year of discharge from service. While there have been observations of elevated blood pressure, no formal diagnosis of hypertension has ever been given, nor has the Veteran been treated for a hypertensive disability. In fact, the Veteran himself reported in June 2014 that he experienced “white coat hypertension” which resulted in elevated readings when at the doctor’s office, and that his blood pressure when taken at home typically ranged from 125-130s over 65-75. He also indicated that his pulse typically remained in the lower 50s or 40s. This range was confirmed when he was provided a blood pressure device for home use. He has consistently denied hypertension when seeking VA and private medical treatment. The Board finds that the weight of the evidence is against the first criterion for service connection under any theories of entitlement, a diagnosis of a current disability. The Board notes that the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see, e.g., Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that section 1110 of the statute requires the existence of a present disability for VA compensation purposes). In this case, the Board finds that the weight of the competent and probative does not reflect a current diagnosis of hypertension. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While the Veteran has shown some isolated instances of elevated blood pressure readings, he attributed them to white coat syndrome, demonstrating proof of lower readings when at home, and medical professionals have not provided a diagnosis of this disability. Looking at the record as a whole, the Board finds that the preponderance of the evidence weighs against a diagnosis of hypertension during or proximately to the appeal period. While the Veteran believes he has a current diagnosis of hypertension, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In the absence of competent and probative evidence to show that the Veteran has his claimed disability, service connection cannot be established as the first element is not met. As the Board finds that the evidence does not show a current diagnosis of hypertension, service connection cannot be granted. As the preponderance of the evidence is against the claim, the Board finds that service connection for hypertension is not warranted. REASONS FOR REMAND The Board observes that the Veteran was provided VA examinations for his remaining claimed disabilities in September 2018. Regarding his claims for a skin disability and for migraines, he was diagnosed with dry skin and tension headaches; however, the examiner did not provide etiological opinions. Further, regarding the Veteran’s claimed skin disability, he submitted a Disability Benefits Questionnaire from a private physician indicating a diagnosis of actinic keratosis since June 2016 which has not been addressed. While the Board acknowledges that neither of these conditions may be presumptively service-connected due to Agent Orange exposure, this fact does not preclude service-connection on a direct basis. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). On remand, the Board requires opinions regarding the etiology of these conditions, to include whether there is any evidence that the Veteran’s established exposure to Agent Orange during his Vietnam service directly caused these disabilities. Concerning the Veteran’s claimed peripheral neuropathy of the bilateral lower extremities, the examiner failed to diagnose peripheral neuropathy, but did note mild paresthesias and/or dysesthesias of both lower extremities without providing an attributable cause. On remand, the Board requests that the examiner opine on the etiology of this symptom. As noted above, since the issuance of the statement of the case in June 2015, additional evidence has been associated with the claims file, including the aforementioned September 2018 VA examinations, without waiver of review by the Agency of Original Jurisdiction (AOJ). Following the provision of the requested addendum opinions, a review of the relevant new evidence and issuance of a supplemental statement of the case (SSOC) is needed for the Veteran’s claims. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. After obtaining the necessary authorization from the Veteran, obtain and associate with the claims file any identified relevant private medical records. All attempts to secure these records must be documented in the record. If any requested records are unavailable, the Veteran should be notified of such in accordance with 38 C.F.R. § 3.159 (e). 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s diagnosed dry skin disability is at least as likely as not related to service, to include as directly related to exposure to Agent Orange. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s headache disability is at least as likely as not related to service, to include as directly related to exposure to Agent Orange. 5. Obtain an addendum opinion from an appropriate clinician regarding the findings of mild paresthesias and/or dysesthesias of both lower extremities at the September 2018 VA examination. 6. Following any additional development deemed necessary by the AOJ, readjudicate the Veteran’s claims on appeal with consideration of all additional evidence associated with the claims file since the June 15, 2015 SOC. If any claim on appeal remains denied, provide the Veteran and his representative with an SSOC and allow an appropriate time for response before returning the matters to the Board for further adjudication, if otherwise in order. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bush