Citation Nr: 21073644 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 16-00 051 DATE: December 9, 2021 ORDER Entitlement to service connection for hypertension is denied. INTRODUCTION The Veteran served on active duty from January 1966 to January 1968. In March 2019, the Veteran and his son testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. When this case was previously before the Board in April 2019 and June 2021, the above-noted issues were remanded for additional development. The case has now been returned to the Board for further appellate review. FINDING OF FACT The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION VA's Duty to Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C. §§ 5103, 5103A, and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159, provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The record reflects that all pertinent available service treatment records (STRs) and all available post-service medical evidence identified by the Veteran have been obtained. The Veteran was afforded appropriate VA examinations to address his claimed hypertension in November 2020. The RO obtained an initial medical opinion addressing the etiology of his disability at that time, as well as additional medical opinions from a Camp Lejeune Contaminated Drinking Water Subject Matter Expert in March and July 2021. The Veteran was also afforded a hearing before the undersigned Veterans Law Judge in March 2019. Neither the Veteran nor his representative have identified any outstanding evidence that could be obtained to substantiate the claim; the Board is also unaware of any such evidence. Accordingly, the Board will address the merits of the Veteran's claim. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may 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 January 2017, VA published the final rule amending 38 C.F.R. §§ 3.307 and 3.309 relating to presumptive service connection and adding eight diseases associated with contaminants present in the water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina, from August 1, 1953, to December 31, 1987. See Diseases Associated with Exposure to Contaminants in the Water Supply at Camp Lejeune, 82 Fed. Reg. 4173 (Jan. 13, 2017). This final rule establishes presumptive service connection for veterans, former reservists, and former National Guard members who served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) during this period, and who have been diagnosed with any of the following eight diseases: kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. The final rule became effective March 14, 2017 and the amended provisions of 38 C.F.R. §§ 3.307 and 3.309(f) are applicable to claims received by VA on or after January 13, 2017, and claims pending before VA on that date. Accordingly, the law now provides that in addition to the general rules pertaining to establishing service connection set forth above, there are certain diseases that are presumed associated with exposure to "contaminants in the water supply at Camp Lejeune," if the requirements of 38 C.F.R. § 3.307 (a)(7) are met, even though there is no record of the disease during service. Additionally, when a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. 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, 4.3; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Factual Background and Analysis A review of the file indicates the Veteran has been diagnosed on several occasions with essential hypertension. He has asserted his disability was caused by his exposure to contaminated water during his time at Camp Lejeune. As noted in the June 2021 Board decision, the Veteran's official military personnel file shows he was stationed at Marine Corps Base Camp Lejeune from March 1966 to January 1968. Therefore, his exposure to contaminated drinking water has been conceded. As such, the central issue that must be resolved in this case is whether the Veteran's disability is etiologically related to his military service, to specifically include whether his hypertension was the result of his exposure to contaminated water therein. Following the November 2020 VA examination, the examiner provided a medical opinion indicating the Veteran's hypertension was less likely than not incurred in or caused by his military service, to include his exposure to contaminated drinking water at Camp Lejeune. In support of her conclusions, the examiner noted various risk factors for the development of the disability. However, the examiner found no medical studies or other scientific evidence indicating the contaminants found in the drinking water at Camp Lejeune were a risk factor in the development of hypertension. The examiner also found no evidence of elevated blood pressure in the Veteran's service treatment records (STRs). The RO subsequently obtained adjunct medical opinions from a Certified Occupational Medicine Physician in March 2021. The examiner comprehensively reviewed and discussed numerous medical journal articles addressing both risk factors associated with the development of hypertension, as well as articles discussing risks associated with the various contaminants found in the Camp Lejeune drinking water trichloroethylene (TCE) (a metal degreaser), perchloroethylene (PCE) (a dry-cleaning agent), benzene, vinyl chloride, and other VOCs. Though the examiner noted some studies indicating solvents may be important risk factors in the development of high blood pressure, she concluded the Veteran's hypertension was less likely than not caused by or a result of his exposure to contaminated water at Camp Lejeune. In support of her conclusion, the examiner indicated hypertension can be seen with heavy or prolonged exposure to solvents; however, the examiner found the Veteran was not involved in a heavy exposure job in the military. By way of a July 2021 addendum medical opinion the examiner acknowledged the Veteran's exposure to contaminated water in service included cooking, bathing, drinking, washing clothes, and inhaling of the water. However, she concluded these activities did not constitute heavy exposure to the above-noted chemicals, because those chemicals had been diluted by the water. The examiner explained the relevant medical studies involving medical conditions caused by the above-noted chemicals involved persons who were in direct contact with the chemicals, over a 40 hour work week or more, and involving a 5-20 year exposure period. The examiner further explained that although initial early studies showed a possible relationship between exposure to solvents and hypertension, no consistent studies show a causal relationship. The examiner also highlighted other risk factors such as genetics, activity, diet, and stress-levels for the development of hypertension, and noted a family history of the condition with the Veteran's younger brother also having essential hypertension. She also noted the Veteran's urinalysis and blood pressure screening at the time of separation was normal. The Board concludes that, while the Veteran has a diagnosis of essential hypertension, the preponderance of the evidence is against finding that the disability began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). A review of the Veteran's STRs does not indicate he was treated for or diagnosed with hypertension in service, and there is no evidence of elevated blood pressure therein. Additionally, there is no indication the Veteran's disability manifest to a compensable degree within the one-year period following his discharge from active duty, and as such, service connection is also not warranted on a presumptive basis under 38 C.F.R. § 3.309 (a). Further, following a comprehensive review of the file, the Board notes the Veteran has not provided any scientific studies/evidence or medical opinions indicating his hypertension was the result of his exposure to contaminated water. Again, the Board acknowledges the Veteran's sincere belief that his disability was caused by his exposure to contaminated drinking water in service; however, as noted in the June 2021 Board decision, his lay opinion concerning these matters requiring medical expertise is clearly of less probative value than the medical opinions against the claim. In sum, the Board finds the preponderance of the evidence weighs significantly against a finding that hypertension was incurred during the Veteran's period of active duty. Based on the foregoing, the Board must deny his claim. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.