Citation Nr: 20064153 Decision Date: 10/01/20 Archive Date: 10/01/20 DOCKET NO. 12-17 858 DATE: October 1, 2020 ORDER Entitlement to service connection for hypertension, to include as secondary to herbicide exposure, is denied. FINDING OF FACT The Veteran’s hypertension is less likely than not related to service to include as secondary to his conceded herbicide exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, to include as secondary to herbicide exposure, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 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 active duty service in the United States Army from September 1969 to September 1971. In October 2017, he testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing. A transcript of the hearing is of record. Entitlement to service connection for hypertension, to include as secondary to herbicide exposure. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during such service to certain herbicide agents (e.g., Agent Orange). In the case of such a veteran, service incurrence for certain diseases will be presumed if they are manifest to a compensable degree within specified periods even if there is no record of such disease during service. Hypertension is not currently included on the list of presumptive diseases. However, in November 2018, the National Academy of Sciences upgraded hypertension to the “sufficient” category from “limited or suggestive,” indicating that there was enough epidemiologic evidence to conclude that there was a positive association between hypertension and herbicide exposure. See Veterans and Agent Orange: Update 11 (2018). A July 2019 VA examination report confirms a diagnosis of hypertension. Therefore, the first element of service connection has been met. In addition, although the Veteran’s service treatment records do not contain any complaints, treatment, or diagnoses related to hypertension, his service personnel records confirm boots-on-ground service in the Republic of Vietnam. Exposure to herbicide agents is therefore presumed. Thus, the second element of service connection has also been met. As noted above, although exposure to herbicide agents during service has been conceded, hypertension is not among the diseases listed as presumptively associated with herbicide exposure. Thus, the Veteran is not entitled to service connection on a presumptive basis. 38 C.F.R. § 3.309(e). The Veteran may, nonetheless, establish service connection if the evidence shows that his claimed hypertension was, in fact, caused by exposure to herbicide agents, including Agent Orange, or some other incident of service. See Combee v. Brown, 34 F.3d at 1039 (Fed. Cir. 1994). Thus, the question before the Board is therefore whether there is a so-called “nexus” between the Veteran’s hypertension and conceded herbicide exposure. The Veteran’s service treatment records do not document any signs of elevated blood pressure or hypertension and he has not otherwise identified any other in-service injury of which his hypertension may be related to. As noted by the Board in its March 2020 remand, the Veteran was afforded a VA examination for his hypertension in 2019. At that time, the examiner opined that the Veteran’s hypertension was less likely than not related to service, to include herbicide exposure. As rationale, the examiner stated: Diagnosis of hypertension was not made until Veteran started receiving treatment for this condition at the Houston VAMC in 2012. Veteran had normal blood pressure recordings while in the military. There is no objective evidence that Agent Orange causes hypertension. The examiner then cited to the most recent Veterans and Agent Orange Update, which states “the sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. Because the VA examiner did not specifically address this information, the Board sought additional VA medical opinion. Such opinion was obtained in June 2020. A different VA examiner again opined that the Veteran’s hypertension was less likely than not related to service. The examiner explained: The Veteran did not develop hypertension until 2011 with medication initiation 1/10/12. Hypertension is multifactorial, with age being the single greatest predictor. Heredity, salt intake, amount of exercise and weight are all factors. The NAS study, while noting the association between hypertension and Agent Orange exposure, does not establish cause and effect. The current, widely accepted, peer-reviewed literature has not established Agent Orange as a cause of hypertension. Additionally, any exposure leading to hypertension, more likely than not, would cause early-onset and progressive hypertension more proximate to service or exposure. When taken together, the VA opinions are highly probative. The examiners both agreed that although the Update upgraded hypertension to the “sufficient” category from “limited or suggestive,” the medical evidence still weighs against a “cause and effect” relationship. The June 2020 VA examiner then went on to consider this Veteran’s medical history and stated that hypertension is consistent with his current age and other health factors. The examiners provided clear conclusions with supporting rationale. There are no medical opinions of record in support of the Veteran’s claim. The Board acknowledges the Veteran’s sincere belief that his hypertension is related to his herbicide exposure. However, he is not competent to provide an opinion as to the etiology of his hypertension as that requires specialized medical expertise. Because the Veteran has not shown that he has the necessary medical expertise, his opinions on the matter are outweighed by the probative VA examination reports of record.   The preponderance of the evidence weighs against the Veteran’s claim. Service connection for hypertension, to include as secondary to herbicide exposure, must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Martha R. Luboch, 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.