Citation Nr: 20051064 Decision Date: 07/31/20 Archive Date: 07/31/20 DOCKET NO. 13-19 599 DATE: July 31, 2020 ORDER Entitlement to service connection for hypertension, to include as secondary to post-traumatic stress disorder (PTSD) and/or herbicide exposure, is denied. FINDINGS OF FACT 1. The Veteran’s hypertension was neither caused nor aggravated beyond the normal course of its progression by his service-connected PTSD. 2. The Veteran’s hypertension is not related to his in-service exposure to herbicides. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, to include as secondary to PTSD and/or herbicide exposure, are not met. 38 U.S.C. §§ 1110, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from April 1968 to March 1970, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This matter was previously before the Board, most recently in September 2018. At that time, the matter was remanded to afford the Veteran a VA examination addressing the theory that his hypertension was related to herbicide exposure in service. The Veteran was afforded an updated VA examination addressing this theory in August 2019, with an addendum VA opinion issued in December 2019. Accordingly, the Board finds that there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran’s Contentions The Veteran contends that his hypertension is a reaction to his PTSD and/or was caused by his exposure to herbicides in service. Entitlement to service connection for hypertension, to include as secondary to PTSD and/or herbicide exposure Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110, 38 C.F.R. § 3.303(a). To establish service connection 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. See Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted where a disability is proximately due to or aggravated by an already service-connected disability. 38 C.F.R. § 3.310. To establish secondary service connection for a disability there must be (1) a current disability (for which secondary service connection is sought); (2) an existing service-connected disability; and (3) evidence that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310. See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service connection may also be established presumptively for certain diseases listed in 38 C.F.R. § 3.309(e) for any veteran who was exposed to an herbicide agent as defined in 38 C.F.R. § 3.307(a)(6) during active duty service. Where, as here, a Veteran contends that a disability not found in 38 C.F.R. § 3.309(e) is related to exposure to herbicide agents, the Veteran may still present evidence to establish the nexus element on a direct, rather than a presumptive, basis. 38 U.S.C. § 1113(b); Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Here, the record reflects that the Veteran was initially diagnosed with hypertension in 2005. The Veteran’s separation examination listed the Veteran’s systems as normal and noted that the Veteran did not have high blood pressure. The Veteran was afforded VA examinations to consider the etiology of his hypertension in February 2017 and August 2019. The February 2017 VA examiner concluded that the condition was not related to active duty because it was not diagnosed until 2005. The examiner opined that there was no causal relationship between PTSD and hypertension based on the lack of any medical research to support a connection. The examiner also opined that there was no indication in the medical documentation that the Veteran’s hypertension was aggravated by his PTSD. The August 2019 VA examiner concluded that the Veteran’s hypertension was less likely than not incurred in or caused by service due to the lack of hypertension in his service treatment records (STRs) and the 35-year gap between discharge and diagnosis. The August 2019 VA examiner also considered whether the Veteran’s hypertension was related to his presumed exposure to herbicides in service. The examiner noted that hypertension is a disease with clear and specific diagnosis and is a vascular condition whose risk factors include age, genetics and dietary factors. The examiner noted that the weight of literature did not support a link between hypertension and environmental exposure and that the length of time between discharge and diagnosis made it less likely than not that the Veteran’s hypertension was incurred in or caused by herbicide exposure. The August 2019 VA examiner issued an addendum/clarification opinion in December 2019 discussing the National Academy of Science (NAS) Update 11 regarding the association between herbicide exposure and hypertension. The examiner noted that the Veteran’s essential hypertension was caused by risk factors including age, genetics, family history and dietary factors and that the association between the disease and these factors was higher than the association between hypertension and herbicide exposure. The examiner thus concluded that it was less likely than not that the Veteran’s hypertension was causally related to the Veteran’s herbicide exposure. The Board finds the VA examiners’ opinions highly probative as they provide sufficient rationale and are based on thorough reviews of the claims file, examination of the Veteran and relevant medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, there is no competent medical opinion of record that contradicts the VA opinions. The Board recognizes the Veteran’s representative’s advancement of the theory that hypertension is related to herbicide exposure and reference to findings from the Institute of Medicine (IOM). However, the study referred to by the Veteran’s representative, standing alone, does not address the specific facts of this case. See Mattern v. West, 12 Vet. App. 222, 228 (1999). Moreover, the August 2019 VA examiner specifically addressed the existence of medical research showing evidence of an association between herbicide exposure and hypertension, but distinguished the specifics of the Veteran’s medical history and its impact on his condition in the August 2019 and December 2019 VA opinions. While the theory of a connection between exposure to herbicides and hypertension may have general acceptance, it does not specifically address the Veteran’s situation, including the numerous risk factors noted by the VA examiner and the lapse of time between exposure and diagnosis. The Board also acknowledges the Veteran’s lay assertion that the stress associated with his PTSD causes his hypertension. While the Veteran is competent to report on his symptoms and matters of personal knowledge, there is no indication in the record that he is competent to provide an opinion as to the diagnosis or etiology of his hypertension. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Based on the foregoing, the Board finds that the Veteran’s hypertension was neither caused nor aggravated by his service-connected PTSD, nor related to his in-service exposure to herbicide agents. Accordingly, service connection is not warranted. As the preponderance of evidence is against the claim, the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Snyder, 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.