Citation Nr: 18153925 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 11-26 119 DATE: November 28, 2018 ORDER Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and as secondary to diabetes mellitus type 2, is denied. FINDING OF FACT The Veteran’s hypertension is neither proximately due to nor aggravated beyond its natural progression by service-connected diabetes mellitus type 2 and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for hypertension, on a direct basis or secondary to diabetes mellitus type 2, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1968 to June 1970, including service in the Republic of Vietnam. A hearing was not requested. In August 2017, the Board determined that a December 2015 VA medical opinion was not sufficiently probative and remanded the Veteran’s claim for an addendum opinion. In May 2018, the Board submitted a request for a VHA opinion, which was received in September 2018. The Veteran and his representative were given an opportunity to provide further evidence and/or argument in response to this opinion and have not chosen to do so. 1. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents and as secondary to diabetes mellitus type 2 Service connection will also be presumed for certain chronic diseases, including hypertension, if manifest to a compensable degree within one year after discharge from active service. See 38 C.F.R. §§ 3.307, 3.309. However, as there is no evidence that the Veteran developed hypertension within one year of discharge, entitlement to service connection is not available on a presumptive basis. 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, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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) 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). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). An increase in severity of a nonservice-connected disease or injury shall not be service-connected if it is due to the natural progression of the nonservice-connected condition. Id. at 447–48. Service connection on a secondary basis may not be granted without medical evidence of a current disability and evidence of a nexus between the current disability and a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512–14 (1998). Regarding direct service connection, the first element is satisfied, in that the October 2017 VA hypertension examination indicates a current diagnosis of hypertension. The second element is also satisfied, in that the Veteran argues that this disorder is the result of in-service exposure to herbicide agents. Unfortunately, service connection on a direct basis is not available because the nexus element is not satisfied. The July 2018 VHA opinion notes that there are “no [peer-reviewed] medical studies proving the link between Agent Orange and [hypertension].” More specifically, the examiner noted that only a statistical review had reported an increase incidence among the Army Chemical Corp but that “this was not proof and was limited to the Chemical Corp. The examiner went on to state that “it would require a peer reviewed retrospective double-blind study adequately powered,” and “this has not been done.” Also, “there is nothing in the nephrology literature to suggest a causation.” For these reasons, the examiner concludes that the Veteran’s hypertension is less likely than not related to exposure to herbicide agents. The Board also again notes that the Veteran and his representative were given an opportunity to dispute the examiner’s statements, including those regarding the probative value of existing studies, but chose not to do so. The Board further notes that a causal relationship between hypertension and Agent Orange has not yet been recognized by VA to warrant the addition of hypertension to the list of presumptive disease, and the lack of a basis to add hypertension to the list is additional evidence against the claim. This medical opinion is probative because it is based on a review of the record and contains clear conclusions with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301–02 (2008). Because the preponderance of the evidence is against the existence of a nexus between hypertension and exposure to herbicide agents, entitlement to service connection on a direct basis must be denied. Service connection is also not available on a secondary basis. The October 2017 VA medical opinion notes that the Veteran has several risk factors for hypertension, including a family history for this disorder. Also, his hypertension is well-controlled by blood pressure medications. For these reasons, the examiner concludes that “there is insufficient medical evidence to suggest that [the Veteran’s] hypertension was aggravated beyond its normal progression by his [service-connected] diabetes type 2.” Consistent with this, the July 2018 VHA opinion notes that hypertension “is related to vascular resist[a]nce and the renin-angiotensin system regula[t]ed by the kidneys.” By contrast, diabetes mellitus type 2 “is an endocrine disorder of insulin resist[a]nce.” Because these disorders have different underlying etiologies, hypertension and diabetes are independent “diseases and neither will cause the other.” For this reason, the VHA examiner concludes that the Veteran’s hypertension “is therefore not proximately due to [the Veteran’s] service-connected [diabetes mellitus type 2] nor aggravated by it.” These medical opinions are probative because they are based on a review of the record and contain clear conclusions with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez, 22 Vet. App. at 301–02. Because the preponderance of the evidence is against the existence of a nexus between hypertension and the Veteran’s service-connected diabetes mellitus type 2, entitlement to service connection on a secondary basis must also be denied. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Cannon, Associate Counsel