Citation Nr: 20048652 Decision Date: 07/21/20 Archive Date: 07/21/20 DOCKET NO. 12-22 137 DATE: July 21, 2020 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The Veteran’s hypertension was not present in service or for many years thereafter, and is not otherwise related to service, to include presumed exposure to herbicide agents, nor is it secondary to the Veteran’s service-connected type II diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION Introduction The Veteran served on active duty in the United States Coast Guard from May 1966 to May 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2015, the Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. When this case was before the Board in December 2015 and July 2018, it was remanded for additional development. The case has now been returned to the Board for further appellate consideration. The Board observes that the Veteran has perfected an appeal of the issues of entitlement to service connection for bilateral cataracts, entitlement to earlier effective dates for the awards of service connection for bilateral upper extremity neuropathy, entitlement to increased ratings for diabetes and bilateral upper and lower extremity neuropathy, and entitlement to a total disability rating based on individual unemployability (TDIU). Pursuant to his appeal of these issues, the Veteran has requested a separate hearing before the Board. Accordingly, these issues are being processed by VA on a separate docket from the present appeal and will not be addressed herein. Instead, these issues will be the subject of a future Board decision, if otherwise in order. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 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). In addition, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). Moreover, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Background and Analysis The record shows the Veteran was diagnosed with hypertension in approximately 2003. He has contended the condition is related to his active duty, to include as due to exposure to herbicide agents. Alternatively, he has contended the condition is secondary to his service-connected type II diabetes mellitus. In its December 2015 remand, the Board resolved reasonable doubt in favor of the Veteran and determined that in-service exposure to herbicide agents was established. In this regard, the Board notes that hypertension is not among the conditions for which presumptive service connection is warranted for veterans exposed to herbicide agents. See 38 C.F.R. § 3.309(e). However, a claimant is not precluded from establishing service connection for a disability due to exposure to herbicides with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran was afforded a VA examination in May 2016. The examiner noted the Veteran had been diagnosed with hypertension in 2003, approximately the same time he was also diagnosed with diabetes. Ultimately, the examiner concluded the Veteran’s hypertension was unrelated to herbicide exposure on the basis that hypertension is not a condition for which VA has established presumptive service connection based on herbicide exposure. The examiner also determined that the Veteran’s hypertension was not caused or aggravated by his diabetes on the bases that his hypertension was diagnosed around the same time as his diabetes and that his blood pressure was well-controlled at the time of the examination. In its July 2018 remand, the Board requested a supplemental VA medical opinion. Accordingly, the Veteran was afforded an additional VA examination in June 2019. The examination was conducted by a different examiner than conducted the May 2016 examination. The examiner again noted that hypertension and diabetes were both diagnosed in approximately 2003. Ultimately, the examiner first determined the Veteran’s hypertension was unrelated to his military service. In support of her opinion, she stated that the Veteran was not diagnosed with and did not meet the diagnostic criteria for hypertension during service, and instead developed hypertension approximately 33 years after separation from active duty. In addition, she stated that a review of relevant medical literature was absent for any link between exposure to herbicide agents and future development of hypertension. The examiner further determined that the Veteran’s hypertension had not been caused or aggravated by his diabetes. In support of her opinion, the examiner again stated the Veteran reported developing both diabetes and hypertension at approximately the same time. She further stated that diabetes does not cause, nor aggravate hypertension. In this regard, she stated there was neither a consensus in the medical literature nor in the medical community that supports a causal or aggravating relationship between diabetes and hypertension. Upon review, the Board finds the June 2019 VA medical opinion to be highly probative, as it was based on a review of the Veteran’s medical history, as well as relevant medical literature, and provided clearly reasoned explanations supported by the record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Upon careful review, there is no medical evidence of record to contradict the VA examiners’ findings. (Continued on the next page)   In summary, the medical evidence of record shows the Veteran’s hypertension is unrelated to service, to include herbicide exposure, or to his service-connected type II diabetes mellitus. After careful consideration of the foregoing, the Board has determined that a preponderance of the evidence weighs against the Veteran’s claim for service connection for hypertension. Accordingly, the claim must be denied. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Hampton, 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.