Citation Nr: 21075570 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 16-05 871 DATE: December 20, 2021 ORDER Entitlement to service connection for hypertension, to include as due to exposure to herbicidal agents and as secondary to diabetes mellitus, type II is denied. FINDING OF FACT The Veteran's hypertension is not shown to have been caused or aggravated by service, to include exposure to herbicidal agents, nor is it shown to have been caused or aggravated by his service-connected diabetes mellitus, type II. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, to include as due to exposure to herbicidal agents and as secondary to diabetes mellitus, type II have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty military service from August 1967 to September 1969, including service in the Republic of Vietnam. The Board notes that the Veteran had filed claims for service connection for ischemic heart disease and for an increased disability rating for his diabetes mellitus, type II, which were denied in the August 2013 rating decision. The VA Form 9 filed in February 2016 specifically indicated that only the claim of service connection for hypertension was being appealed. Because the claims of service connection for ischemic heart disease and for increased disability rating for diabetes were not included in the appeal with limited issues, those claims were not perfected and are not currently before the Board. Entitlement to service connection for hypertension, to include as due to exposure to herbicidal agents and as secondary to diabetes mellitus, type II The Veteran seeks service connection for hypertension, which he contends is either caused or aggravated by his service-connected diabetes. (See NOD, 09/18/2013.) He has also asserted that his hypertension was aggravated by his military service (see Form 9, 02/09/2016) and his representative has asserted that it may have been caused by his exposure to herbicidal agents during his service in Vietnam. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All three elements must be established by competent and credible evidence in order that service connection may be granted. Service connection is also provided for a disability which is proximately due to, the result of, or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310. VA has amended 38 C.F.R. § 3.310 to reflect that it will not concede aggravation unless certain additional conditions are met. 38 C.F.R. § 3.310 (b). Specifically, it must be possible to determine a baseline level of disability prior to the aggravation by the service-connected disability. A veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to certain designated herbicide agents during such service, absent affirmative evidence to the contrary. 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(iii). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, law provides that specific diseases shall be service connected even though there is no record of such disease during service. 38 C.F.R. § 3.309 (e). While the list of such diseases includes diabetes mellitus, type II, and ischemic heart disease, it does not include hypertension. Where the disability on appeal is alleged to be the result of exposure to herbicides but is not a listed presumptive disability under 38 C.F.R. § 3.309 (e), service connection is not precluded. Rather, the Veteran or Appellant may demonstrate entitlement based on proof of direct causation in the form of medical evidence linking the Veteran's claimed disability to his service and his exposure to herbicides. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). As noted above, the Veteran is shown to have had service in the Republic of Vietnam and is, therefore, presumed to have been exposed to herbicidal agents such as Agent Orange. However, as hypertension is not a listed condition for which presumptive service connection may be granted, competent medical evidence linking the Veteran's hypertension to his service and to his exposure would be required. In this instance, the record does not contain any medical evidence or opinion linking the Veteran's hypertension to his service or his exposure to herbicidal agents. The service treatment records do not show any complaints of, treatment for, or diagnosis of hypertension in service. Therefore, direct service connection is not shown. The record shows that the Veteran has been exhibiting elevated blood pressure readings since approximately 1997. (See Medical Treatment Record, 06/07/2012.) A cardiac stress test in August 1997 showed evidence of persistent systolic and diastolic hypertension. (See Medical Treatment Record, 06/07/2012.) He has been receiving regular treatment and medication for hypertension since approximately 2004. (See Medical Treatment Record, 06/07/2012.) He was diagnosed and treated for left ventricular hypertrophy in 2009. A VA examination in August 2013, the examiner offered the opinion that the Veteran's hypertension was less likely than not the result of his heart condition. (See CAPRI, 08/06/2013.) Rather, the examiner felt it was more likely that the Veteran's hypertension had caused his left ventricular hypertrophy, given that hypertension was diagnosed on routine examination in 1993 despite being asymptomatic, and ventricular hypertrophy was diagnosed some 15 years later. The examiner also noted that the Veteran had a diagnosis of patent foramen ovale, which is a congenital heart defect found on echocardiogram in 2002. This defect is not a form of ischemic heart disease. In the Form 9 appeal filed in February 2016, the Veteran asserted that his hypertension was secondary to his diabetic condition and was aggravated by his military service. (See Form 9, 02/09/2016.) He asserted that the medical records would support this statement. He reported that he was being treated for hypertension and was presently taking daily medication as prescribed. At the VA examination in May 2018, the examiner considered the Veteran's assertions regarding a relationship between his hypertension and his diabetes. (See C&P Exam, 05/01/2018.) The examiner offered the opinion that the Veteran's hypertension was not aggravated by his diabetes, as shown by the fact that it had been well-controlled by medication for the past 6 years and there had been no change in the prescribed medications since he was diagnosed with diabetes in 2008. The examiner noted that hypertension was diagnosed in 1993 and diabetes in 2008. (See C&P Exam, 05/01/2018.) Thus, the evidence is also against a finding that hypertension is proximately due to diabetes mellitus. The only available theory for secondary service connection on the facts of this case is via secondary aggravation. After considering all of the evidence of record, with special attention to the documents discussed above, the Board finds that the requirements for service connection for hypertension have not been met. Specifically, the Veteran is not shown to have had hypertension in service or within the first year following service separation. Rather, hypertension was initially diagnosed in 1993, more than 20 years after service separation. In addition, hypertension is not a disability which has been presumptively linked to exposure to herbicides and there is no competent medical evidence linking the Veteran's hypertension to such exposure. The Veteran's hypertension is also not shown to have been caused by his diabetes mellitus, which was diagnosed 15 years after hypertension, or to have been aggravated by his diabetes, given that there is no evidence of the condition having worsened since the diagnosis of diabetes, per the examiner's conclusions. The Board acknowledges the Veteran's sincere belief that there is a link either causation or aggravation between his diabetes and hypertension. However, the Veteran does not have medical training or expertise and therefore his belief does not constitute competent medical evidence of such a link. For all of these reasons, the Board finds that service connection for hypertension is not warranted. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cheryl E. Handy 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.