Citation Nr: 20041493 Decision Date: 06/18/20 Archive Date: 06/18/20 DOCKET NO. 16-00 374 DATE: June 18, 2020 ORDER Entitlement to service connection for hypertension, to include as due to herbicide exposure, is denied. FINDING OF FACT Hypertension was not shown in service or for many years thereafter and the Veteran’s current hypertension is not shown to be related to service, to include herbicide exposure therein. 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, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1966 to March 1968, including service in Vietnam. This matter is on appeal before the Board of Veterans Appeals (Board) from an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, a Board hearing was held at the Nashville, Tennessee RO before the undersigned; a transcript of the hearing is of record. The claim was remanded in September 2018. 1. Entitlement to service connection for hypertension, to include as due to herbicide exposure. The Veteran alleges that his current hypertension is related to herbicide exposure during service. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (1) competent and credible evidence confirming the Veteran has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a relationship or correlation between the disease or injury in service and the currently claimed disability - which is the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain listed, chronic disabilities, including hypertension, are presumed to have been incurred in service if they become manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Additionally, the law provides a presumption of service connection for certain diseases associated with exposure to herbicide agents that become manifest within a specified time period, even if there is no record of evidence of such disease during the period of service. Veterans who during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, are presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). As the record reflects that the Veteran served in Vietnam during the requisite time period, his exposure to herbicide agents coincident with such service is presumed. However, hypertension is not one of these diseases. Nonetheless, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran’s service treatment records do not show any diagnoses or findings of high blood pressure or hypertension. At the May 2018 Board hearing, the Veteran testified that during service, he was deployed outside of Pleiku, Vietnam. He recalled flying around the compound in a Chinook Helicopter and spraying the herbicide, Agent Orange, on vegetation surrounding the compound. Consequently, he knew he was exposed to herbicides. Additionally, he indicated that he was currently taking medication for hypertension and had been diagnosed with the disease by his primary care physician, Dr. H, several years previously. In a June 2018 letter, Dr. H indicated that he had been treating the Veteran since August 1990 and that the Veteran had been on medication for essential hypertension for more than 20 years. The physician found that it was very possible that the Veteran’s hypertension developed as a result of various exposures during his service in Vietnam. At an August 2019 VA contract examination, the Veteran was diagnosed with hypertension. He reported that he was diagnosed with the disease in his 50s or 60s. The examiner opined that the hypertension was less likely than not incurred in or caused by military service or exposure to herbicides during service. The examiner noted that there was no evidence in the service treatment records that military service caused or worsened any hypertension and found that the Veteran’s hypertension was more likely than not due to independent factors. The examiner noted that according to the mosaic theory, multiple factors contribute to hypertension including malfunction of ion pumps on sarcolemmal membranes of smooth muscle cells that can lead to increased vascular tone. Hereditary is a predisposing factor and dietary sodium, obesity, and stress also seem to affect the disease. The examiner commented that the Veteran’s advanced age associated with increased vascular tone and genetics (African American), both primary risk factors per UpToDate (medical database), were the most likely etiology of Veteran’s current hypertension. Thus, based on review of the medical records and the medical examination, the Veteran’s hypertension was less likely than not incurred in or caused by military service or exposure to herbicides during service. The above summarized evidence does not show any medical evidence of hypertension during service. In this regard, the service treatment records are negative for any findings or diagnoses of high blood pressure or hypertension. Also, Dr. H’s letter indicates that the Veteran was not diagnosed with hypertension any earlier than 1990, approximately 22 years after service. Such a long period of time between service separation and the first medical indication of disease is a factor that weighs against a claim for direct service connection. See Maxson v. West, 12 Vet. App. 452 (1999), affd, 230 F.3d 1330 (Fed. Cir. 2000). Regarding a potential nexus between current hypertension and the Veteran’s military service, Dr. H, in his June 2018 letter, found that it was very possible that the Veteran’s hypertension developed as a result of various exposures during his service in Vietnam. On the other hand, in the August 2019 opinion, the VA contract examiner opined that the hypertension was less likely than not incurred in or caused by military service or exposure to herbicides during service and more likely than not due to independent, non-service-related factors. The examiner supported this opinion with a specific rationale based on the medical literature: that the Veteran’s multiple non-service-related primary risk factors for hypertension, age associated increased vascular tone and genetics (i.e. African American) were the most likely etiology of his current hypertension. The Board finds that the VA contract examiner’s opinion must be afforded more probative weight because it is supported by this specific rationale whereas Dr. H did not explain the basis for his conclusion. The Veteran has generally asserted that his current hypertension is related to his herbicide exposure during service. However, as a layperson without any demonstrated expertise concerning the etiology of hypertension, this general assertion may not be afforded any probative value. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In sum, hypertension or high blood pressure was not shown during service or for many years thereafter and the weight of the evidence is against a finding that the Veteran’s current hypertension is related to service, including herbicide exposure therein. Accordingly, the preponderance of the evidence is against this claim and it must be denied. 38 C.F.R. §§ 3.303, 3.307, 3.309; Alemany, 9 Vet. App. 518 (1996). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dan Brook, 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.