Citation Nr: 18144293 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 13-21 838 DATE: October 24, 2018 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) or as a due to exposure to herbicide agents, is denied. FINDING OF FACT The Veteran’s hypertension did not manifest during, and is not otherwise related to, his active military service or service-connected PTSD. CONCLUSION OF LAW The criteria for establishing service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1963 to March 1970, to include service in the Republic of Vietnam. His awards and decorations include a Purple Heart, a Bronze Star, and a Combat Infantryman Badge, among others. This matter comes before the Board of Veterans’ Appeals (Board) from July 2010 and January 2012 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously before the Board in August 2017 where it was remanded for additional development, and has since been returned for further appellate review. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in May 2017. A transcript of the hearing is of record. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. The Veteran contends that his hypertension is secondary to his service-connected PTSD or as due to herbicide agent exposure in the Republic of Vietnam. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as hypertension. See 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Additionally, 38 C.F.R. § 3.309(e) provides that veterans who have been exposed to an herbicide agent during active service – including Agent Orange – are entitled to presumptive service connection for certain listed diseases. Veterans who served specifically in the Republic of Vietnam between January 9, 1962, and May 7, 1975, shall be presumed to have been exposed to an herbicide agent. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). As the evidence reflects that the Veteran served in the Republic of Vietnam, herbicide exposure based on Vietnam service under 38 C.F.R. § 3.307(a)(6)(iii) is presumed. As an initial matter, the Veteran’s medical treatment records dated throughout the appeal confirm a diagnosis of hypertension. However, the evidence of record does not establish an in-service incurrence or aggravation of hypertension. Although his service separation examination indicated an elevation in systolic blood pressure, a diagnosis of hypertension for VA purposes must be confirmed by readings at least two or more times on three different days, which his STRs are negative for. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). While this reading certainly reflects elevated blood pressure on the date of his separation examination, there is no evidence of a clinical diagnosis of hypertension at any time in service or the first post-service year. The medical record is silent regarding hypertension or high blood pressure readings until decades after service, with the record noting a diagnosis of hypertension in 2002. As hypertension is not shown to be present during service or in the year following separation from service, in-service incurrence of hypertension cannot be presumed. 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a). In addition, while the Veteran is presumed to have been exposed to herbicide agents while serving in the Republic of Vietnam, hypertension is not one of the diseases that VA recognizes as related to herbicide agent exposure. Thus, presumptive service connection for hypertension as a result of herbicide agent exposure is not warranted. See 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Pursuant to the Board’s previous remand, the Veteran was afforded a VA examination in October 2017. Upon review of the Veteran’s claims file and medical records, the examiner opined that it was less likely than not that his hypertension was incurred in or caused by his military service or service-connected PTSD. The examiner noted that blood pressure readings during service were normal except for one elevated reading at separation, and that hypertension was not diagnosed until 2002, more than three decades after service. The examiner further explained that although PTSD may temporarily aggravate hypertension, the medical literature does not support PTSD as a cause or permanent aggravator of hypertension. Finally, as there is only limited evidence that individuals exposed to herbicide agents are more likely to develop hypertension, the examiner also opined that it was less likely than not that his hypertension was caused by Agent Orange exposure. There is no medical evidence in significant conflict with the above findings and opinion of the VA examiner. While the Veteran continues to be treated for hypertension, no other medical provider has provided a probative opinion as to its etiology. Thus, the preponderance of the evidence is against a finding that the Veteran’s hypertension manifested during, or is otherwise related to, his military service, to include as secondary to his service-connected PTSD. The Board acknowledges that a veteran is competent to describe symptoms that he can perceive through the use of his senses and to give evidence about what he has experienced. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007. However, whether any symptoms the Veteran experienced in service or following service are in any way related to his current hypertension requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). As the Veteran is not shown to possess any medical expertise, his opinions as to the etiology of his hypertension is not competent medical evidence. The Board finds the medical opinion of record more probative than the Veteran’s lay statements, as the opinion was offered by a medical professional after examination of the Veteran and consideration of the history of the disability and is supported by a clear rationale. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in this case, and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Scarduzio, Associate Counsel