Citation Nr: 20022063 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 16-57 606 DATE: March 30, 2020 ORDER Entitlement to service connection for high blood pressure (hypertension), to include as due to herbicide agent exposure, is denied. FINDINGS OF FACT Hypertension is not shown to be causally or etiologically related to any disease, injury, or incident in service or the Veteran’s presumed in-service exposure to an herbicide agent and did not manifest within one year of service discharge. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty service from March 1968 to March 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In the December 2018 Board decision, the claim was remanded to obtain all VA treatment records since July 2018 and a VA examination. Upon review, all VA treatment records since July 2018 have be associated with the claim file. Also, the Veteran was afforded an adequate VA examination in June 2019. Thus, there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Entitlement to service connection for hypertension, to include as due to herbicide agent exposure, is denied. The Veteran contends his hypertension is related to service, including as due to herbicide exposure. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases, to include cardiovascular renal disease. 38 C.F.R. §§ 3.303(a), (b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). Service may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303(d). In order to establish service connection for the claimed disability, there must be (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, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). VA regulations provide that a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era shall be presumed to have been exposed to herbicides unless there is affirmative evidence to establish that the veteran was not exposed. 38 C.F.R. § 3.307(a)(6)(iii). Certain diseases are deemed associated with herbicide exposure under current law. The RO conceded that that the Veteran served in the Republic of Vietnam. If a Veteran was exposed to an herbicide agent, such as Agent Orange, during active service, service connection will be presumed for certain diseases, including ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease), if they become manifest to a degree of 10 percent or more at any time after service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). However, hypertension is not one of those diseases for which service connection will be presumed. Notwithstanding the presumption, service connection for a disability claimed as due to exposure to herbicides may be established by showing that a disorder resulting in disability or death was in fact causally linked to such exposure. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994), citing 38 U.S.C. § 1113(b) and 1116 and 38 C.F.R. § 3.303. A veteran is entitled to the benefit of the doubt, standard of proof for benefit claim decisions. 38 U.S.C. § 5107(b). The benefit of the doubt is applicable when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Board has first considered whether service connection is warranted on a presumptive basis. However, the clinical evidence of record fails to show that the Veteran manifested hypertension to a degree of 10 percent within the one year following his discharge from service in March 1970. In this case, the clinical evidence does not reveal an assessment of hypertension within one year of service discharge as the VA treatment records suggest that the Veteran was first diagnosed with hypertension in December 2015. As such, presumptive service connection is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. While the evidence of record shows that the Veteran has currently diagnosed hypertension, the probative evidence of record demonstrates that such is not related to his service. In this regard, the Board places great probative weight on the June 2019 VA opinion that found it to be less likely than not that the Veteran’s hypertension was incurred in or caused by his service. The VA examiner reasoned that the Veteran’s service treatment records were silent for hypertension diagnosis, and that he denied “elevated blood pressure” in his March 1970 separation examination. Further, the examiner reasoned that the claim file was silent for a diagnosis or treatment for hypertension in the intervening 43 years between the Veteran’s separation and care for hypertension. Additionally, the June 2019 VA examiner opined that it was less likely than not that the Veteran’s hypertension is due to or the result of herbicide exposure during service. The VA examiner reasoned that current medical literature was silent for any mechanism by which herbicide exposure may cause or aggravate hypertension. Alternately, the examiner noted that current and past medical literature reveals that lifestyle choices were the leading cause of chronically elevated blood pressure. Thus, the examiner concluded that the Veteran’s reported history, per his medical record, was most consistent with the lifestyle choices rationale. Based upon review of the evidence, the Board finds that the June 2019 VA medical opinion is highly probative. The June 2019 VA examiner relied on a complete review of the Veteran’s medical history (in-service and post-service) and relevant medical literature. In conjunction, the June 2019 VA examiner conducted a physical examination of the Veteran. This opinion had clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). No contrary medical opinion is of record. The Board notes that the Veteran has contended that his hypertension is the result of his service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to” and a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran’s hypertension and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current hypertension symptoms, the Board accords his statements regarding the etiology of such a disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinion of the Veteran is nonprobative evidence. Therefore, hypertension is not shown to be causally or etiologically related to any disease, injury, or incident in service, to include exposure to herbicide agents; and did not manifest within one year of service discharge. Consequently, service connection for such disorder is not warranted. Given that the preponderance of the evidence is unfavorable to the claim, VA’s benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the Board finds the preponderance of the evidence is against the claim and service connection, direct and presumptive, is denied. Kristy L. Zadora Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Willoughby, 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.