Citation Nr: 21061580 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 14-10 706A DATE: October 4, 2021 ORDER Service connection for hypertension is denied. FINDING OF FACT The preponderance of the evidence weighs against a finding that the Veteran's hypertension is etiologically related to his active duty service, manifested within one year of separation from active service, or that it is secondary to his service-connected diabetes mellitus, type II. CONCLUSION OF LAW The criteria for entitlement to 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 May 1970 to April 1972. This claim comes to the Board of Veterans Appeals (Board) on appeal from an April 2012 rating decision. This claim was previously remanded by the Board in February 2018, March 2020, and February 2021 for additional development and readjudication. Specifically, the prior remand directives ordered the Agency of Original Jurisdiction to ensure that the proper opinions regarding service connection were obtained, which has been accomplished. Thus, the Board finds there has been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be established for disability due to a disease or injury that was incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, in order to prevail on the issue of service connection the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, a disability that is proximately due to, or results from, another disease or injury for which service connection has been granted, will be considered part of the original disorder. 38 C.F.R. § 3.310(a). Moreover, 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, will be service connected. 38 C.F.R. § 3.310(b). 1. Service connection for hypertension The Veteran is claiming his hypertension is due to exposure to herbicide agents, such as Agent Orange, and/or that it is secondary to diabetes mellitus, type II. See October 2011 Claim; see also November 2017 Informal Hearing Presentation. The record reflects the Veteran had verified service in the Republic of Vietnam during the Vietnam Era. See Form DD-214. Thus, he is presumed to have been exposed to herbicide agents, such as Agent Orange, during that time. See 38 C.F.R. §§ 3.307, 3.309. Notably, service-connection is in effect for diabetes mellitus, type II. The Veteran has a current diagnosis of hypertension; thus, the questions before the Board are whether there is a nexus between his current diagnosis and active duty service (including exposure to herbicide agents) and whether there is a nexus between his hypertension and his service-connected diabetes mellitus, type II. First, the Board will consider direct service connection. Initially, the Veteran's service treatment records do not contain any indications that he had hypertension during service. Private records reflect that in December 2005 the Veteran indicated he had been taking medication for his high blood pressure for the past three years. See Medical Treatment Record Non-Government Facility, 1/29/17, pg. 23. At an April 2007 VA diabetes examination, the Veteran indicated he was being treated for hypertension which began approximately five years prior and was currently taking Lisinopril. Thus, the preponderance of the evidence reflects that the Veteran's hypertension was diagnosed in approximately 2002, which is approximately 30 years after his separation from active duty service, and which weighs heavily against his claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that the passage of many years between discharge from active service and the continuity of symptomatology or medical documentation of a claimed disability are factors that tend to weigh against a claim for service connection). The record contains a July 2021 opinion, which was obtained pursuant to the February 2021 Board remand, and which considers a recent National Academy of Sciences (NAS) study. The clinician determined it was less likely than not that the Veteran's hypertension was related to his active duty service, reasoning that his service treatment records gave no indication of elevated blood pressure readings, the Veteran has a familial history of hypertension, and that his race made him more likely to develop hypertension at an early age. The clinician acknowledged that a recent NAS study reflects there is an association with herbicide agent exposure and hypertension but noted that there was not sufficient evidence to support the pathophysiology of the Veteran's high blood pressure and that other factors listed above made herbicide agent exposure a very unlikely cause. The clinician also acknowledged that some temporary elevations of blood pressure can occur with nervousness about procedures (such as dental examinations) and white coat syndrome. Next, the Board will consider whether the Veteran's hypertension is secondary to his service-connected diabetes mellitus, type II. The Veteran has contended that his hypertension diagnoses preceded his diabetes mellitus, type II, diagnosis. See October 2020 Correspondence. The Board notes that there is some conflicting evidence regarding which diagnosis was rendered first. The Veteran submitted letters from a private provider, R.D., M.D. which mirror his contention. Specifically, a May 2012 letter indicates the Veteran was diagnosed with diabetes mellitus, type II, in August 2004 and with hypertension in March 2005; a May 2014 letter indicates that the Veteran's diabetes mellitus, type II, was diagnosed in June 2003 and that hypertension was diagnosed in March 2005. However, as referenced above, private records dated December 2005 reflect the Veteran indicated he had been taking medication for his high blood pressure for the past three years and in April 2007 he indicated he had been treated for hypertension for the past five years. See Medical Treatment Record Non-Government Facility, 1/29/17, pg. 23; see also April 2007 VA diabetes examination. The record contains an August 2020 opinion which indicates it is less likely than not that the Veteran's hypertension was caused by his diabetes mellitus, type II, as his hypertension was diagnosed after diabetes. The clinician noted that while Dr. R.D. provided letters indicating hypertension was diagnosed after diabetes, the clinician stated that this was inconsistent with medical records and the Veteran's own narrative. The clinician also opined it was less likely than not that the Veteran's hypertension was aggravated by his diabetes mellitus, type II, as there was no objective evidence of aggravation. The Board finds the April 2021 and August 2020 opinions are probative evidence against the Veteran's claim as they are accurate and contain rationales for the conclusions reached. There are no conflicting opinions of records. The Board acknowledges that the Veteran is now claiming his hypertension diagnoses was made after his diabetes diagnosis; however, the medical evidence, as well as the Veteran's own assertions, contradict this. The Board finds the Veteran's reports in December 2005 and April 2007 that he had been treated for high blood pressure since approximately 2002 to be more probative than his statements made at later dates in support of his claim for compensation benefits. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (finding that a pecuniary interest may affect the credibility of a claimant's testimony); Fed. R. Evid. 803 (4) (recognizing that statements made for the purpose of medical treatment generally are reliable); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) ("[R]ecourse to the [Federal] Rules [of Evidence] is appropriate where they will assist in the articulation of the Board's reasons.")). Courts have recognized how medical history recounted in the course of medical evaluation and treatment is especially probative (trustworthy) because the declarant has inherent incentive to give the most accurate history to, in turn, receive the best or most appropriate medical care. See Rucker, 10 Vet. App. at 73 (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The Board recognizes that the Veteran believes his hypertension is due to his active service (to include due to exposure to herbicide agents) and/or that is secondary to his service-connected diabetes mellitus, type II; however, he has not demonstrated be possesses the medical education, training, or experience to make such a determination. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of hypertension. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Based on this collective body of evidence, the Board concludes that the preponderance of the evidence weighs against findings that the Veteran's hypertension is due to his active duty service (to include exposure to herbicide agents) or that it is secondary to his service-connected diabetes mellitus, type II. Consideration has been given to the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim, it is not applicable. See 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O'Connell, Jessica L. 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.