Citation Nr: 20005612 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 14-10 625A DATE: January 23, 2020 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a spinal hematoma is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that hypertension began during active service or is otherwise related to an in-service injury or disease, to include the Veteran’s presumed exposure to herbicide agents. 2. Service connection has not been established for hypertension; and, the Veteran’s spinal hematoma is not otherwise shown to be related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1116, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307(a), 3.309(e). 2. The criteria for service connection for a spinal hematoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1968 to June 1974. The Veteran’s service included service in the Republic of Vietnam, and he is presumed to have been exposed to herbicide agents, to include Agent Orange. See U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). The Veteran and his spouse testified before the undersigned Veterans Law Judge in a December 2016 hearing. A transcript of that hearing is of record. The Veteran’s appeal was remanded in March 2018 to provide the Veteran with examinations. Those examinations were obtained in April 2019. The Board concludes that there has been substantial compliance with the Remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 104-05 (2008); Dyment v. West, 13 Vet. App. 141 (1999). The matter is once again before the Board. Service Connection Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection, the evidence 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 current disability and the in-service disease or injury (or in-service aggravation). Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009. Service connection may also be granted for any injury or disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted on a presumptive basis for certain chronic diseases if the disability manifested to a compensable degree within the applicable presumptive period following a veteran’s separation from active service. 38 U.S.C. §§ 1110, 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). For hypertension, the presumptive period is one year. 38 C.F.R. § 3.307(a)(3). Applicable regulations provide that those diseases listed in 38 C.F.R. § 3.309(e) which are associated with exposure to certain herbicide agents shall be considered to have been incurred in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.309(e). VA has determined that there is no positive association between exposure to herbicides and any other condition for which it has not specifically been determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-46 (1994); see also 61 Fed. Reg. 57586-89 (1996). 1. Entitlement to Service Connection for Hypertension The Veteran contends that hypertension onset during active service. He refers to a blood pressure reading of 138/90 in June 1974. In his hearing testimony, he reported that he often took measures to lower his blood pressure to protect his flight status during active service. While the Veteran has a current diagnosis for hypertension, the Board concludes that the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303 (a), (d); Holton, 557 F.3d at 1366. At his enlistment examination in October 1968, the Veteran blood pressure was 120/84. It was recorded as 138/88 in February 1969, and 120/82 in December 1969. A reading of 138/90, as noted by the Veteran, was documented in June 1974. However, in an April 2019 VA examination, an examiner concluded that the Veteran’s in-service blood pressure readings, which were taken in a clinical setting, did not satisfy the diagnostic criteria for hypertension. The Veteran’s 1974 reading was abnormal; however, it is, on its own, inadequate to show the Veteran satisfied the diagnostic criteria for hypertension at that time. The examiner noted that the abnormal reading was not verified with follow-up readings. The lone abnormal reading was also unreliable because it was taken in a clinical setting where readings can be elevated due to “white coat syndrome.” She also noted the Veteran was relatively young and essentially healthy at the time. The examiner’s opinion is probative. It was based on a thorough review of the Veteran’s service treatment records and provided a rationale that was based on the diagnostic criteria for hypertension applicable during the Veteran’s active service and currently. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran is presumed to have been exposed to herbicide agents during active service; however, the Board concludes that the preponderance of the evidence weighs against the Veteran’s contention that hypertension is due to that exposure. As an initial matter, presumptive service connection is not warranted because hypertension is not listed among the diseases found to be associated with exposure to herbicide agents. See 38 C.F.R. § 3.309(e); See Notice, 59 Fed. Reg. 341-46 (1994); see also 61 Fed. Reg. 57586-89 (1996). With respect to whether there is a direct, rather than presumed, nexus between the Veteran’s herbicide exposure and his hypertension, see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994), the Board concludes that there is not. As noted in the Board’s March 2018 remand, the National Academy of Sciences Institute of Medicine (IOM) has concluded there is “limited or suggestive evidence of an association” between herbicide exposure and hypertension. An article in the November 2016 Journal of Occupational and Environmental Medicine entitled Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans similarly suggests that herbicide exposure history and Vietnam service status were significantly associated with hypertension risk. Both studies/reports were considered by the April 2019 examiner. The examiner noted the IOM’s research and the November 2016 article, remarking that it was possible that the Veteran’s hypertension was due to herbicide-agent exposure. The use of “possible” is speculative. Medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient basis upon which to support a claim. Jones v. Shinseki, 23 Vet. App. 382, 389-90 (2010). In that regard, the examiner explained that the Veteran’s hypertension was more likely than not due to his age at the time of onset, history of smoking, and family history. The examiner noted the Veteran’s family history of cardiopulmonary conditions among his parents and grandparents, and noted that family history, smoking, and age are the leading causes of hypertension. The examiner’s conclusion is highly probative. It is based an accurate medical history, considers the Veteran’s risk factors for developing hypertension, and addresses pertinent research and conclusions regarding hypertension and herbicide-agent exposure. See Nieves-Rodriguez, 22 Vet. App. at 304. Hypertension can also be service connected on a presumptive basis if it manifested with one year after the Veteran’s active service. 38 U.S.C. §§ 1110, 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). The record does not include treatment records diagnosing the Veteran’s hypertension within one year of his separation from active service. The earliest diagnosis reported in treatment records was in October 2007, more than three decades after the expiration of the one-year presumptive period for service connection that applies to hypertension. See 38 C.F.R. § 3.307(a)(3). Thus, entitlement to service connection is not warranted on a presumptive basis. A veteran may establish service connection for hypertension through continuity of symptomology. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Treatment records do not show a continuity of symptomology following the Veteran’s separation from active service in June 1974 and the first diagnosis of hypertension in October 2007. The Board notes the Veteran’s testimony regarding questions regarding his blood pressure following active service. According to his hearing testimony, the Veteran was asked about his blood pressure from time to time in connection with his post-service employment. He noted, for example, that employee screenings noted that his blood pressure “was on the high side.” However, the Veteran testified that it did not concern him, and he never sought treatment for high blood pressure. The Veteran’s testimony and statements also do not describe any symptoms associated with high blood pressure or hypertension upon his separation form active service that continued thereafter. Thus, the evidence does not show a continuity of symptomatology. See 38 C.F.R. § 3.303(b). Consideration has been given to the Veteran assertion that the in-service elevated blood pressure reading represented the initial onset of his hypertension as well as his belief that his hypertension is proximately due to his exposure to herbicide agents. However, his testimony and statements are not competent evidence of a nexus between hypertension and his active service. The etiology of hypertension is medically complex and requires medical knowledge that the Veteran does not possess based on the evidence of record. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 & n.4 (Fed. Cir. 2007). Consequently, the Board affords the opinion of the VA examiner, who possess medical training and provided a rationale for the opinion proffered, greater value than the Veteran’s opinion. In light of the foregoing, the Board concludes that the preponderance of the evidence weighs against the Veteran’s claim. Accordingly, the benefit of the doubt doctrine does not apply, and the Veteran’s claim of entitlement to service connection for hypertension must be denied. See 38 U.S.C. § 5107, 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990). 2. Entitlement to Service Connection for a Spinal Hematoma The Veteran contends that he is entitled to service connection for a spinal hematoma. In particular, he maintains that it is proximately due to his hypertension. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may be established for a disorder that is caused or aggravated by a service-connected disability. Id. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). To establish secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 511 (1998); Allen, 7 Vet. App. at. 448. Here, March 2012 VA treatment records discuss treatment for a spinal hematoma, satisfying the first requirement of secondary service connection. See 38 C.F.R. § 3.310(a). His claim, however, fails on the second requirement. Service connection for hypertension has not been established. Thus, as a matter of law, his claim that his spinal hematoma was caused or aggravated by his hypertension fails as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Hypothetically, even if service connection for hypertension was established, an April 2019 examiner opined that the Veteran’s hematoma was less likely than not due to hypertension. The examiner stated there is no known etiologically relationship between hypertension and spinal hematomas documented in medical literature. Rather, they are rare events that occur spontaneously. This is particularly true of patients on anticoagulant therapy. The Veteran was taking aspirin, a very common blood thinner, at the time of the spinal hematoma in 2012. The Veteran’s claim for secondary service connection would thereby fail the third requirement as well. The Veteran does not contend—and the evidence of record does not show—that his spinal hematoma was caused or aggravated by any of his service-connected disabilities. Thus, the Veteran’s claim of entitlement to service connection for a spinal hematoma must be denied. See id.; Wallin, 11 Vet. App. at 511. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Douglas M. Humphrey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.