Citation Nr: 20036747 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 13-28 585A DATE: May 28, 2020 ORDER Service connection for hypertension is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s hypertension was incurred in or caused by service or caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1963 to March 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2014, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In September 2015, the Board denied, among other claims, service connection for hypertension, and the Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court). In a May 2017 Memorandum Decision, the Court vacated, among other things, the portion of the Board’s decision denying service connection for hypertension and remanded the claim for proceedings consistent with the Court’s decision. In November 2017, the Board remanded the claim for further development. The requested development has been completed, and the claim has been returned to the Board for further appellate action. The Board notes that claims for service connection for diabetes mellitus, heart disease, and a psychiatric disorder were also remanded in November 2017. However, those claims were subsequently granted in rating decisions issued in March 2019 and September 2019. Therefore, those issues are no longer before the Board. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Additionally, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and hypertension becomes manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be presumed for certain diseases if a veteran was exposed to an herbicide agent, including Agent Orange, during service, and the disease manifested to a degree of ten percent or more any time after service. 38 C.F.R. § 3.307(a)(6), 3.309(e). A veteran who served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f) (2012); 38 C.F.R. § 3.307(a)(6)(iii). 1. Entitlement to service connection for hypertension The Veteran asserts that his hypertension is secondary to his service-connected diabetes mellitus, type II, or alternatively, he appears to suggest that it was caused by exposure to Agent Orange. Upon review of the record, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s hypertension was incurred in or caused by service or caused or aggravated by a service-connected disability. The Veteran has not asserted, and the record does not suggest, that his hypertension began during service or within one year of service. Indeed, service treatment records show no diagnosis of or treatment for hypertension during service, and a March 1971 report of medical examination shows that the Veteran’s blood pressure was 124/78 upon his discharge from active duty. During a June 1973 Navy Reserve reenlistment examination, the Veteran’s blood pressure was 112/78, and he denied any history of high or low blood pressure on an accompany report of medical history. Thereafter, the record shows no diagnosis of or treatment for hypertension until approximately 2004. The Board has also considered the Veteran’s assertion that his hypertension may be related to in-service exposure to Agent Orange. However, hypertension is not among the disabilities presumptively related to exposure to herbicide agents, and there is otherwise no competent evidence of record linking the Veteran’s hypertension to herbicide exposure. See 38 C.F.R. § 3.309(e); see also Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994), rev’d in part, Combee v. Principi, 4 Vet. App. 78 (1993). The Board acknowledges that VA has not obtained a medical opinion with respect to direct service connection. However, there is no competent evidence of record suggesting that the Veteran’s hypertension is directly related to service, including exposure to herbicide agents. Therefore, a VA medical opinion is not required with respect to direct service connection. See 38 C.F.R. § 3.159(c) (2019); see also McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would “eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran’s disability case”). With respect to secondary service connection, the Veteran underwent a VA examination in July 2019, and an addendum opinion was provided in November 2019. The VA examiner reviewed the evidence of record and opined that it was less likely than not that the Veteran’s hypertension was caused or aggravated by his service-connected diabetes with chronic kidney disease. In support of this, the examiner explained that for patients with diabetes, secondary hypertension is caused by diabetic nephropathy, which alters the resin-aldosterone mechanism and leads to the development of hypertension. Because the Veteran was diagnosed with hypertension several years before he developed chronic kidney disease, the examiner concluded that it was less likely than not that the Veteran’s hypertension was caused by his diabetes with kidney disease. The examiner further indicated that there was no evidence that the Veteran’s hypertension was aggravated beyond normal progression, as his blood pressure values were normal in 2013 and 2016; his dose of Lisinopril was lowered and 2016; and the record showed only one blood pressure reading after 2016. The Board finds the opinion of the VA examiner to be highly probative and persuasive, as it is based on a review of the evidence of record and supported a with reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Although the Veteran believes that his hypertension is related to service or a service-connected disability, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of hypertension are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the etiology of his hypertension is not competent medical evidence. In sum, the preponderance of the competent and probative evidence is against the claim, and service connection is denied. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.