Citation Nr: 20044036 Decision Date: 06/30/20 Archive Date: 06/30/20 DOCKET NO. 18-40 374 DATE: June 30, 2020 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for an eye disorder, other than left eye ptosis (claimed as cataracts). is denied. Entitlement to service connection for a skin disorder is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran’s favor, his currently diagnosed hypertension is etiologically related to his exposure to herbicide agents during service. 2. The Veteran’s current skin and eye disorders, other than left eye ptosis, did not have their onset in service, did not manifest to a compensable degree within one year of separation, and are not otherwise related to service, to include exposure to herbicides. CONCLUSIONS OF LAW 1. The criteria to establish service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for skin and eye disorders, other than left eye ptosis, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310, 3.313. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1961 to April 1966. This matter is before the Board of Veterans’ Appeals (Board) on appeal from June 2017 and June 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket. This matter was previously before the Board in March 2019 where it was remanded for additional development of which substantial compliance has since been undertaken. The issues of entitlement to service connection for lumbar spine, stroke residuals, and left eye ptosis were previously on appeal, but the claims have since been granted and are thus no longer before the Board. Specifically, a March 2020 rating decision subsumed the claimed residuals of stroke as a function of the already service-connected atherosclerotic cardiovascular disease and assigned an increased evaluation for the disorder to reflect the newly associated condition. Concerning the Veteran’s eye disorders, only entitlement to left eye ptosis has been awarded, therefore the claim has been recharacterized to reflect the outstanding claimed issues including cataracts. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). 1. Entitlement to service connection for hypertension The Veteran is presumed to have been exposed to herbicide agents in service. See i.e. DD 214. The Veteran has a current diagnosis of hypertension. VA regulations do not provide hypertension as a presumptive disability associated with herbicide exposure. However, the National Academy of Sciences (NAS), in 2006 and 2008 updates, concluded that there was “limited or suggestive evidence of an association” between hypertension and herbicide exposure. See 75 Fed. Reg. 32,540, 32,549 (June 8, 2010); 75 Fed. Reg. 81,332, 81,333 (December 27, 2010). In a recent 2018 update, the NAS found that there was “sufficient” evidence of an association between hypertension and exposure to Agent Orange and other herbicides used during the Vietnam War. Thus, according to the NAS, the sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. The Board finds this epidemiologic evidence highly probative and persuasive. Regarding the medical opinions associated with the claims file, the Board finds the March 2020 examiner’s negative conclusion concerning a potential relationship between hypertension and herbicide exposure to be of no probative value. In the rationale, the examiner merely identified that hypertension was “not a presumed diagnosis.” However, the Board finds the March 2020 examiner’s recognition of a relationship between the service-connected atherosclerotic cardiovascular disease significant, especially in light of this notion having been illuminated by the July 2018 Heart Conditions DBQ. Compare July 2018 Heart Conditions DBQ (“atrial fibrillation due to HTN”) with March 2020 VA examination (“hypertension can contribute to atherosclerotic cardiovascular disease”). When coupling these opinions positively correlating an etiological relationship between already service-connected conditions due to presumed herbicide exposure and the Veteran’s hypertension, especially in light of the above, recent NAS findings, reasonable doubt may be resolved in the Veteran’s favor and service connection for hypertension is therefore warranted. 2. Entitlement to service connection for an eye disorder, other than left eye ptosis (claimed as cataracts). 3. Entitlement to service connection for a skin disorder. The Veteran has current diagnoses of residuals of cataracts surgery and actinic keratosis; therefore, he satisfies the first element for the claimed conditions. See i.e. March 2020 VA Eye Conditions examination (“pseudophakia, bilateral…date of diagnosis 2008”); March 2020 VA Skin Conditions examination (“actinic keratosis…date of diagnosis 2012”). Service connection on a presumptive basis for the current actinic keratosis and cataract surgery residuals is not warranted, as these disabilities are not found to be related to herbicide agent exposure. 38 C.F.R. § 3.309(e). Nor are either disease relegated to the “suggestive evidence” status by NAS as discussed above. Though service connection on a presumptive basis is not warranted, service connection on a direct basis may still be warranted if it is nevertheless shown by competent evidence that the Veteran’s disabilities are directly related to his active service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Service connection on a direct basis fails as the evidence does not satisfy the third element - a nexus between his current disability and his in-service herbicide agent exposure. The Veteran’s STRs are silent as to any complaints, treatment, or diagnoses related to cataracts or any eye condition. Concerning the skin, an October 1964 service record reflects a single treatment for acneiform scarring of the face. Upon discharge in April 1966, no skin or eye conditions were noted on physical evaluation. Post-service, the earliest treatment records reflecting diagnoses of the current cataract and actinic keratosis conditions are 2008 and 2012, as noted above. Thus, the Board finds that service connection is not warranted on any available theory of direct entitlement as the medical evidence of record shows the onset of the current skin and eye conditions to be more than one-year post service, and the only probative evidence of record has attributed the current disabilities to the normal aging process. Specifically, following a review of the record, interview with the Veteran and physical evaluation including contemporaneous x-rays, the March 2020 VA examiner identified the current actinic keratosis and cataract disabilities to be consistent with aging. The examiner noted the Veteran’s lay statements about the onset of the eye and skin disorders, but linked the findings with aging, rather than any in-service disease or injury. In the rationale, the examiner explained that the current actinic keratosis was not etiologically related to the in-service acne treatment which was limited to a single instance of care and that there were also no current cataract residuals as the lens implant were “clear and centered.” The Veteran has not presented or identified any contrary medical opinion that supports the claims for service connection, and he is not shown to be competent to provide the requisite etiology of the current disabilities as he does not possess medical expertise. Therefore, the Veteran’s assertion that his current disabilities are related to his service is not probative For these reasons, the Board concludes that the claims of entitlement to service connection for skin and eye disorders are denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Marcus J. Colicelli 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.