Citation Nr: 18151139 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 13-32 355 DATE: November 16, 2018 ORDER Service connection for hypertension is denied. FINDING OF FACT The weight of the competent and probative evidence is against finding that hypertension had its onset during or is otherwise related to the Veteran’s period of service, to include due to presumed in-service herbicide agent exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1969 to December 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in September 2017, at which time the claims of entitlement to hypertension and an acquired psychiatric disorder were remanded for further development. A June 2018 rating decision granted service connection for an acquired psychiatric disorder, which constituted a full grant of the benefit sought. Accordingly, the claim of entitlement to service connection for an acquired psychiatric disorder is no longer in appellate status and is thus not currently before the Board. As the requested development has been completed, no further action to ensure compliance with the September 2017 remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for hypertension. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the 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. Certain chronic diseases, including hypertension, will be considered incurred in service if manifest to a degree of ten percent within one year of service. 38 C.F.R. §§ 3.307, 3.309(a). Under 38 C.F.R. § 3.303(b), an alternative method of establishing service connection for the chronic diseases listed in Section 3.309(a) is through a demonstration of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). In relevant part, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). After review of the record, the Board finds that the criteria for service connection for hypertension have not been met. The record contains a competent diagnosis of hypertension. 11/09/2012, CAPRI. Accordingly, the Board finds competent evidence of a current disorder. A February 1969 entrance examination indicates blood pressure of 132/70. The Veteran denied having high blood pressure in February 1969 and November 1970. The Veteran’s service treatment records do not contain complaints of, treatment for, or a diagnosis of hypertension, nor do they contain hypertensive blood pressure readings, during his period of active service. 07/24/2014, STR-Medical; see also 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, Note (1) (defining hypertension as diastolic blood pressure predominantly 90mm or greater; and defining isolated systolic hypertension as systolic blood pressure predominantly 160mm or greater with a diastolic blood pressure of less than 90mm). A VA examination in January 1972, less than one month after discharge, reflects the following blood pressure readings: 120/72; 110/70; 100/80; 100/60; and 110/74. 01/24/1972, VA Examination. A March 2000 treatment note indicates that the Veteran was borderline hypertensive at that time. An August 2000 treatment note indicates a diagnosis of hypertension. 11/09/2012, CAPRI. In February 2018, a VA examiner opined that it is less likely than not that the Veteran’s hypertension had its onset during or is otherwise related to his period of service. In support, the examiner noted that service records do not demonstrate that the Veteran had a series of elevated blood pressure values while on active duty that met the criterion for the diagnosis of hypertension, and that the blood pressure readings taken shortly after discharge were normal. 02/07/2018, C&P Exam. The Board finds the February 2018 VA examiner’s opinion to be competent, credible, and highly probative, as it is supported by review of the relevant medical and lay evidence, medical expertise, and an adequate rationale. In light of the foregoing, the Board finds that the weight of the competent and probative evidence is against finding that the Veteran’s hypertension had its onset during or manifested within one year of service, or that it was noted in service with evidence of symptoms on a continuous basis since. The Board notes that the weight of the evidence supports a finding that the Veteran was not diagnosed with hypertension until August 2000, more than 28 years after service, and, in fact, the Veteran was not considered hypertensive as of March 2000. If a veteran was exposed to an herbicide agent during active service, the diseases set forth in 38 C.F.R. § 3.309(e) will be presumed to be related to such service if they become manifest to a degree of 10 percent or more at any time after service, with an exception not applicable to this case. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(ii). VA has conceded presumed in-service herbicide agent exposure based on the Veteran’s service in Korea in the Second Engineer Battalion of the Second Infantry Division from July 1969 to August 1970. See 38 C.F.R. § 3.307(a)(6)(iv); see also 04/16/2018, Rating Decision; 08/15/2012, Military Personnel Record. As hypertension is not one of the diseases set forth in 38 C.F.R. § 3.309(e), a presumption based on in-service herbicide agent exposure is not warranted. However, the Board will consider whether there is evidence of actual direct causation of hypertension due to presumed herbicide agent exposure. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). In February 2018, a VA examiner opined that it is less likely than not that the Veteran’s hypertension is due to presumed in-service herbicide agent exposure. The examiner explained that the pathogenesis of essential hypertension is multifactorial and highly complex, and that multiple factors, including genetic predisposition, excess dietary salt intake, and adrenergic tone, may interact to produce hypertension. According to the American Heart Association, the risk factors for hypertension include that of family history, advancing age, gender, race (African American), chronic kidney disease, lack of physical activity, unhealthy diets (especially one high in sodium), being overweight or obese, drinking too much alcohol, sleep apnea, high cholesterol, diabetes, smoking and tobacco use, and stress, for example. Here, the examiner noted that the Veteran is African American, has a family history of hypertension in both parents, and was in the overweight range when diagnosed with hypertension in August 2000. The examiner acknowledged that the National Academy of Sciences Institute of Medicine has concluded that there is “limited or suggestive evidence of an association” between herbicide agent exposure and hypertension, but explained that this notation is tenuous in nature and not conclusive in proving that the herbicide agent exposure is an established cause for hypertension. The examiner pointed out that the statement from the Institute of Medicine did not consider other medical literature citations that have described hypertension as being multifactorial in nature, and that it is a generalization that does not include the Veteran’s particular medical background and history. Specifically, the Veteran has established risk factors for hypertension which include his race, male sex, advancing age, being overweight, and his family history of hypertension. The examiner concluded that either alone or in concert, the noted risk factors would have made it more likely that the Veteran would have developed hypertension than from the events in service, including herbicide agent exposure. 02/07/2018, C&P Exam. The Board finds the February 2018 VA examiner’s opinion to be competent, credible, and highly probative and deserving much weight, as it is supported by review of the relevant medical and lay evidence, medical expertise, review and explanation of the relevant medical literature, and an adequate rationale that considers the specific circumstances of the Veteran. Accordingly, the Board finds that the weight of the competent and probative evidence is against finding that the Veteran’s hypertension is due to his period of service, to include presumed herbicide agent exposure. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel