Citation Nr: 20007385 Decision Date: 01/30/20 Archive Date: 01/29/20 DOCKET NO. 11-22 660 DATE: January 30, 2020 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes, is denied. FINDING OF FACT The Veteran’s hypertension is not shown to be causally or etiologically related to his active military service and is not shown to be caused or aggravated by his service-connected diabetes. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1962 to June 1965 with additional service in the National Guard. He died in April 2009, and his surviving spouse is the appellant. In a November 2016 VA Memo, the appellant was formally substituted for the Veteran in this appeal. Entitlement to service connection for hypertension The appellant contends that the Veteran’s hypertension began during service, is related to herbicide exposure, or is secondary to his service-connected diabetes. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 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) medical 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); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. 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. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. The evidence confirms that the Veteran served in Vietnam. Accordingly, exposure to herbicides in service is conceded and presumptive service connection must be determined. The VA has determined that the presumption is not warranted for any condition other than those for which VA has found a positive association between the condition and such exposure. Hypertension has not been presumptively associated with exposure to herbicide agents. The Veteran had a diagnosis of hypertension. Service treatment records (STRs) are negative for elevated blood pressure readings or a diagnosis of hypertension. The question that remains is whether hypertension is at least as likely as not related to an in-service injury, due to herbicide exposure, or in the alternative, whether it is proximately due to or was aggravated by his service-connected diabetes. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s hypertension is directly due to his military service to include as due to herbicide exposure, nor was it caused or aggravated by his service-connected diabetes. On the application for service connection, the Veteran indicated he was diagnosed with hypertension in January 2005. An entry from the Peace Valley Internal Medicine from February 2009 identified benign hypertension as one of the Veteran’s chronic problems. A VA examiner completed a record review and provided opinion in October 2017. During his separation examination, the Veteran reported high blood pressure in 1958 when he had pyelonephritis, but had had no trouble since that time. The examiner noted there was no evidence of a diagnosis of hypertension, which is defined as 3 elevated blood pressure readings on at least 2 separate clinical evaluations during service or within one year of discharge, to suggest a nexus for aggravation or for direct service connection. In January 2019 VA obtained another opinion. The examiner concluded it is less likely than not that the Veteran’s hypertension was caused by or aggravated by his service-connected diabetes. The examiner referenced a medical record from September 1993, which showed the Veteran had normal blood pressure. The examiner also noted that there was no evidence of hypertension in service or within one year of discharge. The examiner referenced February 2009 laboratory studies that revealed the Veteran had normal kidney function. Using the evidence of the laboratory findings, the examiner indicated due to the fact that there was no evidence of kidney disease there is no evidence of a link between hypertension and diabetes. In April 2019, the appellant submitted a research study noting a connection between hypertension and diabetes. This research is not specific to the Veteran or his experiences, therefore afforded no probative weight. In June 2019 an opinion was rendered. The examiner concluded the Veteran’s hypertension is less likely than not either proximately due to or the result of or aggravated beyond clinical expectation by his diabetes mellitus. The examiner noted there is no evidence the Veteran required antihypertensive agents as a result of chronic kidney disease secondary to diabetic nephropathy. The Veteran’s hypertension was well-controlled with lisinopril alone, and his normal kidney function (BUN/CR/microalbumin) indicates absent diabetic nephropathy. The examiner noted that the appellant’s cited reference does correctly illustrate diabetes and hypertension co-morbidity. The examiner further noted that the evidence submitted by the appellant does not show an established causal or aggravating association with hypertension. In November 2019, another opinion was rendered. The examiner opined it is less likely than not that hypertension had its onset in or is otherwise related to active duty service, to include his exposure to herbicides while in Vietnam. The STRs are silent for any evidence of nor treatment for hypertension while in service, nor within one year of discharge. In November 2018, the National Academy of Sciences upgraded the relationship between hypertension and herbicide exposure from limited or suggestive association to sufficient, indicating there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. The examiner noted the statement “association” is not a cause, and the “study” is not a conclusion of fact. The examiner concluded there is no evidence based medical literature to date, nor any supporting evidence in the medical records that would provide evidence to support the claim. Although the appellant believes the Veteran’s hypertension is proximately due to or aggravated by the service-connected diabetes, she is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners’ opinions. The October 2017, January 2019, June 2019, and November 2019 opinions establish that the claimed hypertension is not due to service, to include herbicide exposure, nor is it caused or aggravated by his service-connected diabetes. Taken as a whole, the examiners’ rationale was that there is no basis in medical fact to support the claim, and the Veteran’s hypertension was well controlled on medication and he did not have abnormal kidney function to suggest aggravation. To reiterate what has been stated above, there is no probative evidence of a diagnosis of hypertension in service or shortly post-discharge. There is no evidence that his hypertension is due to herbicide exposure, or secondary to his diabetes. The examiners’ opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no competent opinion to the contrary. (Continued on the next page)   In other words, the most probative evidence of record does not show that the Veteran’s claimed hypertension is directly due to service or secondary to diabetes. Therefore, the claim must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, 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.