Citation Nr: 20051177 Decision Date: 08/03/20 Archive Date: 08/03/20 DOCKET NO. 16-29 072 DATE: August 3, 2020 ORDER Entitlement to service connection for hypertension, to include as due to herbicide exposure and secondary to service-connected diabetes mellitus, is denied. FINDING OF FACT The Veteran first developed hypertension many years after discharge from service, his hypertension is unrelated to service, including his presumed exposure to herbicides, and his hypertension is not caused or aggravated by service-connected diabetes. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1957 to January 1979. In January 2018 the Board found that new and material evidence had been submitted and reopened the Veteran’s claim for service connection for hypertension. The January 2018 Board decision remanded the Veteran’s claim for further development. In December 2019 the Board again remanded the hypertension claim for further development. The requested development has been completed and the Veteran’s claim is now ready for Board review. The Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the probative evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). In general, service connection may be granted for a disability or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). The Veteran’s service treatment records (STRs) reveal no diagnoses of hypertension. The blood pressure measurements during service were primarily normal. Three blood pressure readings during service are considered to be elevated. An October 1963 health record notes blood pressure readings of 138/90, and 130/98, and a September 1978 record notes a blood pressure reading of 138/90. When examined for discharge from service the Veteran checked off on his September 1978 report of medical history that he did not know if he had ever had high or low blood pressure. The earliest notation of the Veteran having hypertension in his medical treatment records is dated in May 1989, more than 10 years after discharge from service. In January 2020, a VA fee-basis physician reviewed the Veteran’s records and opined that the Veteran’s hypertension was less likely than not related to service. The physician noted that even if the Veteran had two or three elevated blood pressure readings (during service) that does not signify essential hypertension, it just indicates isolated elevated blood pressure readings. There is no medical evidence indicating that the Veteran developed hypertension during service or indicating that the Veteran’s current hypertension is related to service. Accordingly, service connection for hypertension is not warranted on a direct basis. 38 C.F.R. § 3.303. Service connection may also be granted for disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). “When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.” Allen v. Brown, 7 Vet. App. 439 (1995). In July 2015 a VA examiner examined the Veteran and his medical records and opined that the Veteran’s hypertension was not caused by his service-connected diabetes mellitus. The examiner pointed out that the Veteran developed hypertension years before he developed diabetes mellitus. In July 2018 a VA examiner examined the Veteran and his medical records and opined that the Veteran’s hypertension was not aggravated beyond its natural progression by the service-connected diabetes mellitus. There is no evidence of record indicating that the Veteran’s hypertension was caused or aggravated by his service-connected hypertension. Accordingly, service connection for hypertension as secondary to hypertension is not warranted. 38 C.F.R. § 3.310. Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). For hypertension, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). In this case, the Veteran was not diagnosed with hypertension within one year of separation from service and there is no competent evidence documenting the presence of symptoms of the disease within one year. As such, entitlement to service connection for hypertension as a chronic disease on a presumptive basis is not warranted. 38 C.F.R. § 3.309(a). The Veteran maintains that he developed hypertension due to his exposure to Agent Orange during service. Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active service in the Republic of Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). Here, the Veteran had service in the Republic of Vietnam during the appropriate period and his exposure to herbicide agents is conceded. However, hypertension is not listed as a condition that is presumed to be the result of exposure to herbicides. 38 C.F.R. § 3.309(e). The Board notes that hypertension is specifically excluded by regulation from service connection on a presumptive basis as due to exposure to herbicides. 38 C.F.R. § 3.309(e), Note 2. Nevertheless, when a Veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must be reviewed to determine whether service connection can be established on another basis. Combee v. Brown, 34 F. 3d. 1039 (Fed. Cir. 1994). As such, the Board will also consider whether service connection is warranted based upon exposure to herbicides without the presumption. It is notable that the National Academy of Sciences (NAS) has placed hypertension in the category of “limited or suggestive evidence of an association” with exposure to herbicides. See e.g., Health Effects Not Associated with Exposure to Certain Herbicide Agents, 75 Fed. Reg. 32,540, 32,549 (June 8, 2010). In November 2018, the NAS moved hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and exposure to agent orange. See Veterans and Agent Orange: Update 2018. The Board notes that even though the NAS has found that there is “sufficient” evidence of an association between hypertension and exposure to herbicides, this does not provide evidence that this Veteran’s hypertension is caused by exposure to herbicides. Evidence of an association is not the same as evidence of causation. In this case a review of the Veteran’s extensive medical records and other evidence reveals no evidence linking the Veteran’s hypertension to his exposure to herbicides. To the extent that the Veteran has argued that his hypertension is due to his exposure to herbicides, such falls outside the realm of common knowledge of a lay person as this is beyond the capability of a lay person to observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The diagnosis and determination of the etiology of hypertension requires specialized testing and medical knowledge. Consequently, the Veteran’s statements are of no probative value. As noted above, the most probative evidence indicates that the Veteran’s hypertension is not related to exposure to herbicides during service, is not caused or aggravated by service-connected diabetes mellitus and is not otherwise related to service. Consequently, the Board finds that the preponderance of the probative evidence is against the Veteran’s claim for service connection for hypertension, and service connection is not warranted. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. E. Jones, 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.