Citation Nr: A20008929 Decision Date: 05/19/20 Archive Date: 05/19/20 DOCKET NO. 190517-14780 DATE: May 19, 2020 ORDER Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran served on active duty from November 1968 to July 1971, with verified service in the Republic of Vietnam (RVN). 2. Hypertension was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; the current diagnosis of hypertension is not causally or etiologically related to service, to include herbicide exposure. CONCLUSION OF LAW Hypertension was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for veterans dissatisfied with VA’s decision on their claim to seek review. This decision has been written consistent with the new AMA framework.   As a procedural matter, the rating decision on appeal was issued in March 2019. The Veteran disagreed and submitted a timely VA Form 10182 in May 2019 and selected the Evidence Submission lane. Based upon his selection of the Evidence Submission lane, the Board may consider evidence submitted during the following time periods: (1) from the date of claim, which includes the 90-day period following the May 17, 2019 receipt of the NOD. 38 C.F.R. § 20.202(b)(3). Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may be granted on a presumptive basis for certain diseases resulting from exposure to an herbicide agent (including Agent Orange) for veterans who, during active military, naval, or air service, served in the Republic of Vietnam between January 1962 and May 1975, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). Importantly, hypertension is not one of the enumerated diseases for which presumptive service connection is permitted. 38 C.F.R. § 3.309 (e). Service records confirm that the Veteran served in the Republic of Vietnam and is therefore presumed to have been exposed to herbicides, but hypertension is not a disorder presumed to be associated with herbicide exposure. Nevertheless, the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the evidence, the Veteran’s private medical records reveal a diagnosis for essential hypertension since at least 2002. As such, a current diagnosis has been shown and the first element of service connection is met. As to an in-service incurrence, service treatment records (STRs) are silent for complaint, treatment, or diagnosis of hypertension. The July 1971 separation examination showed a blood pressure reading of 120/80. Thus, the second element of direct service connection is not met, and the medical evidence does not support direct service connection. To the extent that the Veteran asserts a medical nexus between hypertension and service, the medical evidence does not support the claim. Initially, hypertension is not on the list of diseases presumed to be associated with herbicide exposure. Therefore, the evidence does not support the claim on an Agent Orange presumptive basis. In support of his claim, the Veteran submitted two letters from his private treatment providers in October 2018 and May 2019 to the effect that hypertension was at least as likely as not a result of his herbicide exposure. In these letters, the clinicians discussed that hypertension was uncontrolled and symptomatology; however, neither physician provided a rationale for their conclusion. Additionally, the examiners failed to address the medical record to any extent. Specifically, the VA treatment records revealed a long family history of uncontrolled hypertension, which was not discussed. The Veteran also submitted internet articles suggesting a correlation or relationship between herbicide exposure in service and the development of hypertension; however, these articles and abstracts are broad and general and are not directly and specifically pertinent to his individual case, such that they possess any real probative value toward establishing a clinical association between his hypertension and herbicide exposure, or any incident of service. Moreover, while the National Academy of Science has found limited or suggestive evidence that hypertension is associated with herbicide exposure (one of the articles submitted by the Veteran), hypertension has not been found to be “sufficient evidence” of an association. As such, the articles are speculative in nature and do not present a conclusive clinical finding of a definitive link and do not apply to the specific facts and circumstances of the Veteran’s case. Accordingly, they are afforded lesser probative weight. Next, hypertension is a chronic disease under 38 C.F.R. § 3.309 and presumptive service connection will be considered. However, no chronic disease or injury was shown in service. As noted above, STRs are silent for complaints of, treatment for, or a diagnosis of hypertension. Therefore, the medical evidence does not support presumptive service connection on a “chronic disease or injury shown in service” basis. Next, the medical evidence does not support presumptive service connection based on continuity of symptomatology since service. Specifically, the medical evidence shows that the Veteran was first diagnosed with hypertension, at the earliest, in 2002. As he separated from service in July 1971, the medical evidence shows that symptoms of his current disability developed over 30 years after service. As such, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. As stated, the Veteran separated from service in 1971 but treatment notes did not note symptoms until 2002 at the earliest. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. The Board has also considered the Veteran’s lay statements that hypertension was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yacoub, 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.