Citation Nr: 21064109 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 16-30 399 DATE: October 19, 2021 ORDER Service connection for breast cancer is granted. Service connection for right arm lymphedema is granted. REMANDED Service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, her breast cancer is at least as likely as not related to exposure to industrial solvents during service. 2. The Veteran's right arm lymphedema is proximately due to her service-connected breast cancer. CONCLUSIONS OF LAW 1. The criteria for service connection for breast cancer are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for lymphedema as secondary to service-connected breast cancer are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Army from February 1983 to February 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 and September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran attended a videoconference hearing before the undersigned in September 2019. In January 2020, the Board remanded this matter for further development. Service Connection Breast Cancer Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. To establish service connection for a disability, 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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran contends that her breast cancer is due to exposure to industrial solvents during service. For the following reasons, the Board agrees and finds that service connection is warranted. The Veteran has a current diagnosis of breast cancer. At her hearing, the Veteran testified that she was exposed to industrial solvents during service. The Veteran is competent to testify about the circumstances of service and the Board finds her testimony to be credible. Accordingly, the Board finds the Veteran to meet the first two elements of service connection. Turning to the third element, medical nexus, the evidence consists of a VA examiner's opinion and an opinion from the Veteran's treating physician. In July 2020, the Veteran underwent a VA examination for her claim. The examiner opined that it was less likely than not that the Veteran's breast cancer is due to exposure to industrial solvents during service. Their rationale was that the Veteran's exposure to industrial solvents was for a short period of time. The examiner is competent to provide this opinion, the Board finds them to be credible and affords the opinion great probative weight. The Veteran submitted a January 2020 letter from her treating physician. The physician opined that the Veteran's diagnosis of breast cancer is at least as likely as not due to industrial solvent exposure during service. They based their opinion on research noting the adverse effects of solvents to include being a human carcinogen and the Veteran's duty tasks placing her in a hazardous environment. The physician is competent to provide this opinion, the Board finds them to be credible, and affords the opinion great probative weight. The Board finds the evidence to be in relative equipoise. If the evidence is supportive or is in relative equipoise, then the veteran prevails. See 38 C.F.R. § 3.102. Accordingly, service connection for breast cancer is granted. 38 C.F.R. § 3.304. Right Arm Lymphedema The Veteran contends that she has a right arm disability due to treatment for her breast cancer. For the following reasons, the Board agrees and finds that service connection for right arm lymphedema is warranted. Service connection may be granted for a disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. The Veteran has a current diagnosis of lymphedema in the right arm. The Board has now granted service-connection for breast cancer. Accordingly, the Veteran meets the first two elements for secondary service connection. Turning to the next element, the evidence consists of a VA examination and an opinion letter from the Veteran's physician. In July 2020, the Veteran underwent a VA examination. The examiner found the Veteran to have lymphedema due to breast cancer treatment. Their rationale was that lymphedema is a common post-op residual of node dissection and the Veteran's medical records support complaints of right axilla pain with numbness radiating into the right upper extremity following surgery. The Board notes that the examiner found it was less likely than not that the Veteran's lymphedema was due to a service-connected disability, but the Board has now found service connection is warranted for the Veteran's breast cancer. As such, the Board finds this opinion to support service connection for lymphedema of the right arm. The Veteran also submitted a December 2019 opinion letter from her treating physician. The physician opined that it is as likely as not that the Veteran's lymphedema was due to treatment for her breast cancer. Their rationale was that lymphedema is not uncommon in patients who received radiation treatment or had lymph nodes removed during surgery and that the Veteran complained of pain in her right arm after surgery. The Board finds the evidence to support that the Veteran's right arm lymphedema is due to her service-connected breast cancer. As such, service connection for right arm lymphedema is granted. 38 C.F.R. § 3.310. REASONS FOR REMAND Hypertension In August 2020, the Veteran underwent a VA examination for her claim. The examiner found it was less likely than not that the Veteran's hypertension was caused by her PTSD. However, the examiner's rationale focuses on whether the Veteran's hypertension was related to service. This is not the correct standard for secondary service connection. Furthermore, the examiner did not discuss the articles submitted by the Veteran that suggest a link between stress from PTSD and hypertension. The examiner also did not discuss a letter from the Veteran's primary care physician who agreed that stress can affect the Veteran's blood pressure and a February 2000 treatment note that states control of anxiety could improve control of blood pressure. The Board notes that anxiety is a symptom of the Veteran's service-connected PTSD. The examiner's opinion is inadequate and a remand is necessary to obtain an addendum opinion. Furthermore, in an August 2021 informal hearing presentation, the Veteran's representative raised a contention that the Veteran's hypertension may be related to her breast cancer treatment. They refer to the Veteran's blood pressure being elevated during treatment as support for this contention. No VA examienr has opined on this theory and a remand is necessary to obtain an addendum opinion. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not (50 percent or greater probability) proximately due to her service-connected PTSD or service-connected breast cancer or aggravated beyond its natural progression by her service-connected PTSD or service-connected breast cancer. The examiner is to address the articles submitted by the Veteran suggesting a link between stress caused by PTSD and hypertension. The examiner is also to address the letter from the Veteran's primary care physician stating that stress can affect the Veteran's blood pressure. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.