Citation Nr: 21004148 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 18-03 893 DATE: January 26, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s hypertension began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from December 1961 to November 1966, and in the United States Air Force from November 1966 to August 1988, to include service in Vietnam. The Veteran was dishonorably discharged in August 1988. The period of November 21, 1980 to August 26, 1988 was determined to be dishonorable for VA purposes and the Veteran is ineligible for VA benefits for this period of military service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in February 2019 and September 2020 for additional development. The development ordered by the Board has been completed (namely, obtaining an adequate opinion regarding the etiology of the Veteran’s hypertension); with such substantial compliance with the Board’s remand instructions, the case may move forward. 1. Entitlement to service connection for hypertension The Veteran is seeking entitlement to service connection for hypertension. Generally, to establish service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 U.S.C. § 1116(f), a claimant, who, during active service, served in the Republic of Vietnam during the Vietnam era, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that he was not exposed to any such agent during that service. Diseases associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309(e), will be considered to have been incurred in service under the circumstances outlined in that section even though there is no evidence of such disease during the period of service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the listed diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). 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). The Veteran had active service in the Republic of Vietnam during the requisite time period and is, therefore, presumed to have been exposed to herbicide agents, to include Agent Orange. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). VA has determined that there is no positive association between exposure to herbicides and any other condition for which it has not specifically been determined that a presumption of service connection is warranted and entitlement to presumptive service connection is limited to the conditions listed in 38 C.F.R. § 3.309(e). 59 Fed. Reg. 341-46. Review of the Veteran’s service treatment records (STRs) reveal that there is no complaints, diagnosis, or treatment of hypertension. Additionally, blood pressure readings taken during the Veteran’s active service were within the normal range. The Veteran appeared for a VA examination in September 2017 to determine the nature and etiology of his hypertension. The examiner confirmed the Veteran’s diagnosis of hypertension. The Veteran also reported that he was unsure of the date of onset. The examiner ultimately determined that the Veteran’s hypertension was less likely than not related to his service-connected diabetes. In the February 2019 Board remand, the Board found this medical opinion to be inadequate as it did not address any possible relationship between the Veteran’s hypertension and his exposure to herbicides, pursuant to a new study published by the NAS in November 2018 suggesting a possible connection. In accordance with the February 2019 Board remand directives, the Veteran appeared for a second VA examination in January 2020. The examiner determined that the Veteran’s hypertension was less likely than not related to his active service. The examiner explained that the Veteran was diagnosed with hypertension 25 years after service and did not have any documentation of hypertension in his STRs. The examiner also opined that the Veteran’s hypertension was less likely than not related to exposure to herbicides. The examiner explained that although there was a study present, hypertension was not recognized by the VA as being associated with herbicides. In the September 2020 remand, the Board found this opinion to also be inadequate, specifically because the rationale was based on hypertension not being on the VA presumptive disease list instead of determining if a relationship existed on a direct basis based on the unique facts of the Veteran’s case. Pursuant to the September 2020 Board remand, the Board received an addendum opinion from the January 2020 VA examiner in October 2020. In the addendum opinion, the examiner opined that the Veteran’s hypertension was less likely than no related to herbicide exposure. In addressing the NSA study, the examiner concluded that the study was not based on cause and effect scientific research, but was instead derived from epidemiological statistics. Thus, the examiner found that this study was not reliable in establishing a relationship between hypertension and herbicide exposure. Additionally, the examiner also opined that the Veteran’s hypertension was less likely than not related to his active service. The examiner explained that the Veteran’s hypertension is classified as essential hypertension. The examiner stated that factors for essential hypertension include genetics and heredity, race, age, alcohol abuse, and physical inactivity. The examiner noted that this was a very common condition in the general population. The Board finds that the October 2020 VA examiner's opinion is entitled to great probative weight as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Further, there is no medical opinion to the contrary of record. Upon reviewing all of the pertinent evidence of record, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim. In this regard, while the Veteran was exposed to herbicides during his active duty service, the October 2020 opinion expressed that his hypertension was likely due to predisposition and lifestyle factors instead of herbicide exposure. Accordingly, the Board finds that a nexus has not been established and entitlement to service connection for hypertension is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claims for service connection for hypertension. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. K. Hall, 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.