Citation Nr: 18160146 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 17-03 207 DATE: December 27, 2018 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected renal cell carcinoma, is granted. FINDING OF FACT The Veteran’s hypertension was caused or aggravated by his service-connected renal cell carcinoma, or the treatment thereof. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active duty service with the United States Marine Corps from February 1966 to June 1970, including service in the Republic of Vietnam. The Veteran was awarded (among other decorations) the Combat Action Ribbon and the Vietnam Service Medal. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an November 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. Entitlement to service connection for hypertension, to include as secondary to service-connected renal cell carcinoma Service connection is warranted where the evidence of record established that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if preexisting, such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). “To establish a right to compensation for a present disability, a veteran must show: ‘(1) the existence of a present disability; (2) 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.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). A Veteran can receive compensation via secondary service connection. Service connection may be secondarily established when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2018). 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) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The Board must assess the credibility and weight of all of the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2012); Gilbert, 1 Vet. App. at 49. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2018). The Veteran claims entitlement to service connection for hypertension, specifically asserting that his hypertension is secondary to his service-connected renal cell carcinoma. See 38 C.F.R. § 3.310 (2018); see also VA Form 9, dated January 2017; Rating Decision, dated November 2016; Fully Developed Claim, dated October 2015. As outlined below, the evidence is at least in equipoise in support of this claim. The Veteran’s service treatment records are silent for measurements consistent with a diagnosis of hypertension, or any medical diagnosis thereof. See Service Treatment Records, dated May 1970, February 1966. The record first reflects a diagnosis of hypertension in November 2012. In the discharge records, after the partial nephrectomy, the Veteran’s urologist noted that the Veteran had an episode of hypertension while in the hospital, and his urologist recommended that he follow-up with his primary care physician. See Private Treatment Records, dated November 2012. The Veteran underwent a VA examination to determine the etiology of the Veteran’s renal cell carcinoma in April 2016. In the April 2016 VA examination for the Veteran’s renal cell carcinoma, the VA examiner noted that the Veteran had residual complications from his renal cell carcinoma or its treatment. Notably, the VA examiner included hypertension among the residual complications. The examiner specifically noted that the Veteran developed hypertension after his nephrectomy. The VA examiner noted, in a May 2016 VA examination determining the severity of the Veteran’s hypertension that the Veteran had a diagnosis of hypertension and that the Veteran should follow up with his primary care physician for treatment. The Veteran was noted to be taking medication for treatment of hypertension in June 2016. See VA Examination, dated June 2016. The Veteran received a subsequent VA examination to address his renal disability and hypertension in July 2016. The VA examiner stated that the Veteran had a diagnosis of hypertension, but he did not have hypertension due to either renal dysfunction or as caused by any kidney condition. In October 2016, the July 2016 VA examiner provided an addendum opinion. He stated that the Veteran had hypertension concurrent with his exam, but etiology of his hypertension was not established in the service treatment records. The examiner noted that the Veteran’s Urologist touched on it as an incidental finding. The examiner further supported his opinion by noting that the Veteran did not currently have renal dysfunction. The examiner noted that he agreed with the rationale for the previous denial of service-connection, as contained in the claims file. The Veteran has a current diagnosis of hypertension, for which he receives medical intervention. Id; Allen, 7 Vet. App. at 448 (1995); See VA Examinations, dated July 2016, May 2016. As such, the Board finds that the first Allen element is met. The Board further finds that the evidence is at least in equipoise that the Veteran’s hypertension was either caused or aggravated by the Veteran’s service-connected renal carcinoma, the second Allen element. Notably, the April 2016 VA examiner specifically stated that the Veteran’s hypertension was as a result of either the Veteran’s renal disability or the treatment thereof. The April 2016 examiner is a licensed medical professional, competent to afford such an etiological nexus opinion, and there is no evidence that he is not credible. Moreover, the April 2016 examiner’s opinion is consistent with the evidence of record, insomuch as the Veteran had no evidence of hypertension until his hospitalization for a total nephrectomy, in November 2012. The Veteran’s urologist encouraged him to see his primary care physician after discharge to care for this symptomatology. Based upon the above information, the Board assigns the April 2016 VA examination great probative weight. To the extent that contrary opinions exist, they would do nothing more than place the evidence in equipoise, under which circumstances the Veteran’s claim must still be granted. Thus, resolving doubt in favor of the Veteran, the Board finds that his hypertension is causally related to his service-connected renal cancer. As such, service connection is warranted in this case. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018); Gilbert, 1 Vet. App. at 53-56. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Trotter, Associate Counsel