Citation Nr: 21067431 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-22 087 DATE: November 4, 2021 ORDER Entitlement to service connection for hypertension, to include as due to herbicide exposure, is granted. FINDING OF FACT The Veteran's hypertension has been shown to be etiologically related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1964 to October 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision by a Department of Veterans Affairs Regional Office (RO). This claim was previously remanded in January 2019, July 2020 and April 2021. In August 2021, the Board remanded this case and instructed the Agency of Original Jurisdiction (AOJ) to obtain a VA examination. The Board notes that the requested VA examination report was obtained in September 2021, and has been associated with the claims file. Accordingly, after reviewing the actions of the AOJ, the Board finds there was substantial compliance with the requested development. Dyment v. West, 13 Vet. App. 141 (1999); Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Hypertension The Veteran seeks entitlement to service connection for hypertension. Specifically, the Veteran asserts that he developed hypertension due to in-service herbicide exposure. See September 2014 Letter. Alternatively, he asserts that his hypertension is secondary to his service-connected disabilities. See February 2017 VA Examination. Initially, the Board notes that the Veteran is shown to have served in Vietnam and exposure to herbicides is thereby conceded. Although hypertension is not listed among the list of presumptive diseases associated with exposure to herbicide agents that may be presumed to have been incurred in service even if there is no evidence of the disease in service, notwithstanding the presumption, service connection for a disability claimed as due to exposure to herbicides may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. See Brock v. Brown, 10 Vet. App. 155, 162-64 (1997); Combee v. Brown, 34 F. 3d 1039, 1044 (Fed. Cir. 1994), citing 38 U.S.C. §§ 1113(b),1116 and 38 C.F.R. § 3.303. In this regard, the Board notes that in the Veterans and Agent Orange: Update 11 (2018), the National Academy of Sciences Institute of Medicine (NAS) found sufficient evidence of an association for hypertension and exposure to Agent Orange and other herbicides used during the Vietnam War. Additionally, hypertension has been upgraded from its previous classification in the category of "limited or suggestive" evidence of an association to the category of "sufficient" evidence of an association. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. With regard to whether the Veteran's hypertension is secondary to his in-service herbicide exposure, the evidence of record includes a May 2020 VA examination report in which the examiner opined that a nexus had not been established between exposure to herbicides and the development of hypertension. In this regard, the examiner noted recent studies showing an association between hypertension and veterans assigned to the Chemical Corps who had high exposure to herbicides. However, the examiner noted that no such association was noted with veterans with other military occupational specialties. The examiner further stated that the prospect of exposure to tetrachlorodibenzodioxin (TCDD) from Agent Orange in ground troops in Vietnam seemed unlikely in light of the environmental dissipation of TCDD, little bioavailability and the properties of the herbicides and circumstances of application that occurred. Additionally, it was noted that photochemical degradation of TCDD and limited bioavailability of any residual TCDD present in solid on vegetation suggested that dioxin concentrations in ground troops who served in Vietnam would have been small and indistinguishable from background levels even if they had been in recently treated areas. The examiner concluded that there was little or no exposure to veterans who served in Vietnam. Another study (the Framinghan study) was also noted to reveal that 90 percent of people ages 55 and over eventually developed hypertension, and, therefore, 90 percent of all Vietnam era veterans had a 90 percent chance of developing hypertension regardless of exposure to Agent Orange. Another VA examiner came to a different conclusion. In a September 2021 VA examination report, the examiner opined that it was "at least as likely as not (50 percent or greater probability)" that the Veteran's hypertension was etiologically related to service. In this regard, the examiner specifically found that the Veteran's hypertension was etiologically related to his in-service exposure to herbicides. In support of this opinion, the examiner noted a VA medical study which yielded "strong evidence of ties between herbicides and high blood pressure in Vietnam-era Vets." The examiner also noted a National Academy of Sciences study showing a sufficient level of evidence linking hypertension and exposure to herbicide agents. Both examiners considered the same evidence, and based on medical studies, came to differing conclusions. Accordingly, the Board finds the evidence is at least in relative equipoise with regard to a causal connection between the Veteran's conceded in-service herbicide exposure and his hypertension. The claim is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lamb, 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.