Citation Nr: 21005236 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 13-23 188 DATE: January 29, 2021 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The evidence is at least in equipoise that the Veteran’s hypertension is related to presumed herbicide agent exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1956 to March 1960 and from April 1960 to September 1975. He served honorably in the U.S. Navy, including service in the Republic of Vietnam during the Vietnam era. The Board thanks the Veteran for his service to our country. The issue of entitlement to service connection for hypertension was previously before the Board in October 2014 and September 2016, when the Board remanded the issue, and again in July 2017, when the Board denied the claim. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court). In a December 2018 memorandum decision, the Court vacated and remanded the July 2017 Board decision for readjudication. The Board remanded this case in July 2019 for additional development and again in August 2020 to ensure compliance with the July 2019 remand. The case has now returned to the Board for further appellate review. Entitlement to service connection for hypertension is granted. The Veteran contends, through his representative, that service connection for hypertension is warranted as related to presumed in-service herbicide exposure. The Board agrees. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Any veteran who served in the Republic of Vietnam during the period beginning January 9, 1962 and ending on May 7, 1975, is presumed to have been exposed to an herbicide agent. 38 C.F.R. § 3.307(a)(6). The Board previously found that the Veteran served in the Republic of Vietnam and that exposure to herbicide agents is presumed. In a July 2019 Appellate Brief, the Veteran’s representative raised the National Academy of Sciences (NAS) publication, Veterans and Agent Orange: Update 11 (2018), which found “sufficient evidence” of an association between hypertension and herbicide agent exposure. NAS had previously concluded that there was “limited or suggestive evidence of an association between exposure to the compounds of interest and hypertension.” 75 Fed. Reg. 32,540, 32,549 (June 8, 2010). In an October 2020 VA addendum opinion, the clinician concluded that the Veteran’s hypertension is less likely than not related to presumed herbicide agent exposure. Noting the NAS finding of “sufficient” evidence of an association, the clinician cited a NAS press release stating that a “finding of limited or suggestive evidence means that epidemiologic research results suggest an association between exposure to herbicides and a particular outcome, but a firm conclusion is limited because chance, bias, and confounding factors could not be ruled out with confidence.” The examiner found this to mean that other risk factors for hypertension must be taken into consideration. The Board notes that, as stated above, NAS had changed the classification for hypertension from “limited or suggestive evidence” to “sufficient evidence”. Noting that the Veteran was in his 60s when he was diagnosed with hypertension and that advancing age is a significant risk factor for hypertension, the clinician concluded, “[g]iven our medical understanding of known established risk factors for hypertension per the evidence-based medical literature and given how this particular Veteran’s hypertension has specifically manifested, his advancing age played a significant role in his development of hypertension and most likely played a more significant role and factor in development of hypertension compared to his herbicide exposure.” While the clinician relied on the significant role that advancing age played in the development of hypertension to conclude that the Veteran’s hypertension is less likely than not related to herbicide agent exposure, the Board observes that there is no legal requirement that herbicide agent exposure must be the sole cause of the claimed disorder. Indeed, the clinician concluded that advancing age played a “more significant” role in development of hypertension than herbicide agent exposure, conceding that the Veteran’s hypertension is related to presumed herbicide agent exposure. As the evidence is at least in equipoise that the Veteran’s hypertension is related to presumed herbicide agent exposure, service connection for the disorder is granted. Gilbert, 1 Vet. App. at 55. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Vashaw, 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.