Citation Nr: 18138167 Decision Date: 09/25/18 Archive Date: 09/25/18 DOCKET NO. 12-19 753 DATE: September 25, 2018 ORDER Service connection for hypertension is granted. Service connection for a heart disability is granted. FINDINGS OF FACT 1. The Veteran’s hypertension was incurred in service. 2. The Veteran’s current heart disability, including aortic dissection, aortic aneurysm, and hypertensive vascular disease, is secondary to his hypertension. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R §§ 3.102, 3.303. 2. The criteria for service connection for a heart disability secondary to hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1965 to July 1969. This matter is before the Board following his appeal of an April 2012 rating decision. The Board previously remanded this matter in September 2014 and September 2017. Service Connection The Veteran is seeking service connection for hypertension and a heart disability, which he asserts were caused by in-service exposure to herbicides. Alternatively, he asserts that his heart disability was caused or is aggravated by his hypertension. Following review of the record, and resolving reasonable doubt in his favor, the Board finds that service connection for both hypertension and a heart disability is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in, or aggravated by, active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Regulations also provide that service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may also be warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Here, the most probative evidence of record supports that the Veteran’s currently-diagnosed hypertension is directly related to service, to include stress therein, and that his other heart disabilities are secondary to hypertension. In this regard, pursuant to a request for a VHA opinion to address the Veteran’s heart disability (and not hypertension), a VA cardiologist offered an unsolicited opinion in October 2017 that “severe hypertension needs to be considered.” The cardiologist explained that prolonged stress, such as that experienced by the Veteran while serving in Vietnam, is commonly considered to provoke hypertension. He found that the notion that “being normotensive during a discharge physical” indicated that war experience did not cause hypertension to be “spurious and without merit,” and further noted that the trauma of war does not end at the time of discharge. The cardiologist also noted that the Veteran’s other heart problems, including a 1992 Type A aortic dissection, and a 2015 aortic aneurysm that was complicated by aortic insufficiency and mitral insufficiency, “are usually the consequence of hypertensive cardiovascular disease,” which was shown throughout the Veteran’s medical records. The cardiologist concluded that the Veteran’s 1992 aortic dissection was a direct result of the Veteran’s severe hypertensive vascular disease, which the examiner linked directly to the Veteran’s service in Vietnam. The Board finds the VA cardiology expert’s opinions regarding the nature and etiology of the Veteran’s hypertension and heart disabilities to be highly probative, because they were based on the examiner’s expertise in cardiology, an accurate medical history, and provided an explanation that contains clear conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Significantly, there is no contrary opinion of record. To the extent that there are other VA opinions of record, they address whether the Veteran has a diagnosis of ischemic heart disease or a heart disability that is related to herbicide exposure; they do not address hypertension or whether any heart disability is secondary to hypertension. Furthermore, the VA cardiologist’s conclusions are supported by other medical evidence of record. For example, VA treatment notes show that, in furtherance of treatment and in establishing care at VA in 2011, the Veteran reported that he had been treated for hypertension since the late 1970s or early 1980s, supporting an onset more proximate to service. Indeed, when the Veteran was seen for follow-up in January 1993 after his December 1992 aortic dissection, it was noted that the Veteran’s past medical history at that time was remarkable for hypertension. Moreover, the private cardiologist in January 1993 noted that the Veteran’s hypertension was “the most likely culprit” behind the development of an aortic dissection. The Board also observes that in March 2006, it was noted that the Veteran’s poorly controlled hypertension could be contributing to progressive left ventricle cavity dilation and aortic insufficiency, and Veteran was also subsequently noted in April 2013 to have valvular heart disease stemming from the previous aortic dissection. The foregoing evidence is entirely consistent with the VA cardiologist’s conclusions that the Veteran’s hypertension was directly caused by service, and that his subsequent heart problems are secondary to his hypertension. In short, the Board finds that the most probative evidence of record weighs in favor of a finding that the Veteran’s current hypertension was incurred in service, and that his subsequent heart problems developed because of his longstanding hypertension. Hence, entitlement to service connection for hypertension and a heart disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Fagan, Counsel