Citation Nr: 18101545
Decision Date: 05/07/18	Archive Date: 05/07/18

DOCKET NO. 10-40 289
DATE:	May 7, 2018
ORDER
Service connection for hypertension is granted.  
 
FINDING OF FACT
The Veteran’s hypertension is related to in-service herbicide exposure.  
CONCLUSION OF LAW
The criteria to establish service connection for hypertension have been met.  38 U.S.C. §§ 1110, 1131 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).
REASONS AND BASES FOR FINDING AND CONCLUSION
Background
The Veteran served on active duty from February 1963 to September 1966.
This case is before the Board of Veterans’ Appeals (Board) from a March 2012 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA).
The Veteran appeared at a hearing before the undersigned Veterans Law Judge in in February 2015.
In May 2015, the Board reopened previously denied claims of service connection for a back disability and hypertension, and granted service connection for degenerative disc disease of the lumbar spine and chronic myelogenous leukemia.  The Board also remanded the hypertension claim for additional development.
Legal Criteria
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, 1131; 38 C.F.R. § 3.303.  “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)). 
Service connection may be presumed for certain diseases associated with herbicide exposure, which may also be presumed for service in Vietnam.  See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e).
Service connection may also be granted on a secondary basis.  See 38 C.F.R. § 3.310.
Analysis
The Veteran seeks service connection for hypertension.  He contends that his hypertension is warranted on a secondary basis to already service-connected diabetes mellitus.  In the alternative, the theory of whether the hypertension is due to in-service herbicide exposure has been raised.
He served in Vietnam, and thus, is presumed to have been exposed to herbicide agents such as Agent Orange.  Although hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e), the National Academy of Sciences Institute of Medicine (NAS) has concluded that there is “limited or suggestive evidence of an association” between herbicide exposure and hypertension.  See 77 Fed. Reg. 47924, 47926-927 (Aug. 10, 2012).
In January 2018, in accordance with 38 U.S.C. § 7109 and 38 C.F.R. § 20.901, the Board requested a medical expert opinion from the Veterans Health Administration (VHA).  The opinion was received in March 2018 from a physician who specializes in internal medicine at a VA Medical Center.  First, the expert provided a persuasive opinion as to why the Veteran’s hypertension is not secondary to service-connected diabetes mellitus, both as to causation and aggravation.  However, as to direct service connection, the March 2018 VHA opinion states that it is more than likely that the Veteran’s hypertension is related to exposure to herbicides during service, noting a 2016 study from the NAS in which it was concluded that ‘occupational herbicide exposure history and Vietnam-service-status were significantly associated with hypertension risk.’  
The Board affords significant probative value to the opinion rendered by the VHA expert, as it constitutes persuasive competent medical evidence.  The evidence is in at least equipoise as to the nexus element, and thus resolving all reasonable doubt in favor of the Veteran, the Board finds that his hypertension is related to in-service herbicide exposure.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  Therefore, based on the specific facts and circumstances of this case, including specific medical opinion evidence, the Board concludes that service connection for hypertension is warranted.  
 
RYAN T. KESSEL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Taylor, Counsel