Citation Nr: 21000098 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 15-23 249A DATE: January 4, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected service-connected disease or injury or herbicide exposure is denied. FINDINGS OF FACT 1. Hypertension was not manifest during service or within one year of service and is unrelated to service. 2. Hypertension is unrelated (causation or aggravation) to a service-connected disease or injury. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by service, nor can hypertension be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. Hypertension is not proximately due to, the result of or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1967 to February 1973. The Veteran appeals an April 2013 Rating Decision. The Veteran and his sister appeared at a Board hearing in April 2019; a transcript is of record. During the Board hearing, the undersigned Veterans Law Judge clarified the issues on appeal, identified potential evidentiary defects, and clarified the type of evidence that would support the Veteran’s claim. The actions of the Veterans Law Judge supplement the Veterans Claims Assistance Act (VCAA) and comply with any related duties owed during a hearing. See 38 C.F.R. § 3.103. The claim was remanded by the Board in December 2019 and July 2020 and has been since returned to the Board. 1. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetic neuropathy, service-connected diabetes mellitus, and herbicide exposure Veterans are entitled to compensation if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service). To establish entitlement to service-connected compensation benefits, 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 -the so-called ‘nexus’ requirement.” See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). 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 or injury will be service-connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). The Veteran’s service records confirm that he served on active duty in Vietnam and his exposure to herbicide agents is thus presumed. 38 C.F.R. § 3.307(e)(6)(iii). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected even though there is no record of such disease during service. 38 C.F.R. § 3.309(e). However, hypertension is not a disease listed under section 3.309(e). Hypertension is identified as a “chronic disease” under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309(a). It should be noted at the outset that for VA compensation purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 or greater; and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 or greater with diastolic blood pressure less than 90. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Veteran argues that his hypertension is related to service. The Veteran has testified that a private physician has informed him that his hypertension is secondary to his diabetes and his diabetic nephropathy. The Veteran’s representative notes that the Veteran has previously stated that hypertension was never an issue is his life before his active duty and his hypertension had its onset between 1968 and 1973. Service treatment records do not document any relevant treatment, complaints, symptoms, diagnoses, or other notations specific to hypertension. The Board notes that the Veteran left service after being diagnosed with Thoracic Outlet Syndrome, per a Medical Board Report. It was noted in the report that there were no other significant findings. Service treatment records do not contain examinations with blood pressure readings. In 1973, a VA examination disclosed a reading of 112/64. The Veteran first referenced being diagnosed with hypertension in approximately 1995 according to his April 2019 testimony. The first reference to a diagnosis of hypertension within the Veteran’s file is in a doctor’s note dated September 2, 2003. On that day, his blood pressure measured 154/90. See Medical Treatment Record- Non-Government Facility, received January 3, 2005. The Veteran did not list his hypertension on any of his submitted VA 21-526 Forms, but subsequently added it as a claim during a call with the VA on January 10, 2005. Blood pressure measurements located within the Veteran’s VA records were taken on January 25, 2005. The Veteran’s blood pressure was measured at 168/90, 170/94, and 164/94. In June 2019, a VA examiner assessed the Veteran. The VA examiner concluded that the Veteran’s hypertension is not secondary to his diabetes mellitus type II. The examiner stated that “Hypertension caused or aggravated by diabetes is unlikely unless there is severe diabetic nephropathy with eGFR less than 25 (Stage 4-5 chronic kidney disease). His current eGFR as of June 6, 2019 is 46.” See Diabetes Mellitus Disability Benefits Questionnaire, dated June 13, 2019. The examiner also concluded that the Veteran’s hypertension was not “due to renal dysfunction or caused by [his] kidney condition.” See Kidney Conditions (Nephrology) Disability Benefits Questionnaire, dated June 13, 2019. In a subsequent addendum opinion issued in July 2020, the VA examiner concluded that the Veteran’s hypertension was not caused by herbicide exposure. The VA examiner, based on his personal knowledge, found that the association between Agent Orange and hypertension was inconclusive. The VA examiner also believed that the Veteran’s hypertension could be due to many factors, including diet, obesity, and genetic factors. The VA examiner concluded by stating that “for most adults, there is no identifiable cause for hypertension.” See Addendum/ Clarification Disability Benefits Questionnaire, dated July 29, 2020. In adjudicating a claim, the Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board accepts the June 2019 and July 2020 VA medical opinions that the Veteran’s hypertension to include as secondary to a kidney disorder, service-connected diabetes mellitus, and herbicide exposure, is not related to service or a service-connected disease or injury as probative medical evidence on this point. The Board notes that the examiner rendered these opinions after thoroughly reviewing the claims file and relevant medical records. The examiner noted the Veteran’s pertinent history and provided a reasoned analysis of the case. See Hernandez-Toyens v. West, 11 Vet. App. 379, 383 (1998); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). The Board has considered the lay statements of the Veteran regarding his hypertension. The Veteran is competent to provide evidence of what he experiences, including his symptomatology and medical history. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran is competent to report what he experienced. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).   However, the Board does not find his statements to be as probative as the VA examiner’s opinion, which was based on extensive review of the record, thorough examination, consideration of the lay statements, and the VA examiner’s medical expertise. Notably, the Veteran has not indicated that a medical professional provided him with a diagnosis of hypertension during active service, or within a year of separation. In sum, there is insufficient competent and probative evidence linking the Veteran’s hypertension to service or a service-connected disease or injury. Service treatment records do not document any relevant notations and the 1973 VA examination disclosed that blood pressure was 112/64. There is no credible proof of hypertension during service or within one year of separation. Hypertension was not noted during the critical time frame and he did not have characteristic manifestations sufficient to identify the disease entity of hypertension. Furthermore, the more probative evidence establishes that here is no relationship between the remote onset of hypertension and herbicide exposure. The Veteran has reported that there was a relationship between the hypertension and a service connected disease or injury, to include nephropathy or diabetes. We find his report of what he may have been told to be credible and competent. However, this lay recounting is unsupported by a factual background and is of no greater value than the medical opinion upon which it is based. We find that the VA opinion, extablishing no relationship (causation or aggravation) to be well explained and far more probative than the lay recounting in this particular case. In   sum, the more probative evidence establishes that there is no relationship (causation or aggravation) between the remote onset of hypertension and a service-connected disease or injury. The preponderance of the evidence is against the claim and there is no doubt to be resolved. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jonah Nelson, 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.