Citation Nr: 21006747 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 13-32 552 DATE: February 5, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to Agent Orange exposure and service-connected diabetes mellitus type II, is denied. FINDINGS OF FACT 1. The Veteran was exposed to herbicide agents while serving at U-Tapao Royal Air Force Base, Thailand. 2. The Veteran is currently service connected for diabetes mellitus type II. 3. There is no evidence linking the Veteran’s hypertension directly to service, to include on the basis of exposure to herbicides, and the Veteran did not claim such an association. 4. The preponderance of the evidence is against a finding that the Veteran’s hypertension was caused or aggravated beyond its natural progression by his service-connected diabetes mellitus type II. CONCLUSION OF LAW The criteria for service connection for hypertension, to include as secondary to Agent Orange exposure and 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 served from September 1965 to July 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In February of 2014, the Veteran was afforded a Board hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the file. The Board previously remanded this issue for further development in a March 2020 decision. The requested development has been completed and the claim is properly before the Board for additional appellate consideration. 1. Entitlement to service connection for hypertension, to include as secondary to exposure to Agent Orange and diabetes mellitus type II. In this post-remand case, the Veteran contends he is entitled to service connection for hypertension as secondary to his service-connected diabetes mellitus type II. Although the Veteran has consistently claimed this disability as secondary to diabetes, the Board has additionally considered entitlement to service connection for hypertension on a direct basis. In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established via a secondary service connection theory of entitlement. To establish secondary service connection for disabilities that otherwise would not be considered service-connected, evidence must be provided that reasonably suggests the non-service-connected disability is either (1) proximately due to or the result of a service-connected disability; or (2) aggravated, or increased in severity, beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310; see Allen v. Brown, 7 Vet. App. 439 (1995). Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the present of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Although lay persons are considered competent to provide opinions on some medical issues, some medical issues fall outside of the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). Per the Board’s March 2020 remand instructions, an addendum opinion regarding secondary service connection to include whether the Veteran’s hypertension was caused or aggravated by his service-connected diabetes mellitus. Previously, the Veteran was afforded a VA examination in August 2017. The examiner confirmed the Veteran’s diagnosis and provided a negative nexus opinion with the rationale that, because he does not experience renal involvement, his hypertension is not a complication of diabetes. An addendum opinion was provided in October 2020. The examiner stated the Veteran’s hypertension is less likely than not (less than 50 percent probability) proximately due to or the result of his service-connected diabetes mellitus type II. The examiner’s rationale is the Veteran’s medical record show he has a history of essential hypertension which is not caused by diabetes. The examiner notes there is no history of secondary hypertension. Furthermore, the examiner states that his medical records do not support a history of hypertension aggravated beyond natural progression by his diabetes. His hypertension has been stable through the years and there is no indication of uncontrolled blood pressure due to diabetes. Lastly, the examiner notes the Veteran’s records show no history of additional medication indicating his blood pressure has worsened and given the absence of diabetic nephropathy it is unlikely his diabetes has aggravated his hypertension beyond natural progression. There is also no competent medical opinion that contradicts the above-noted opinions from October 2020. The Board further notes that there is no evidence linking the Veteran’s hypertension directly to service, to include on the basis of exposure to herbicides, and the Veteran has not claimed such an association. Hypertension is also not currently one of the disorders recognized as warranting service connection on a presumptive basis based on exposure to Agent Orange. 38 C.F.R. § 3.309(e). Accordingly, given the negative opinions as to whether the Veteran’s hypertension was caused or aggravated by his service-connected diabetes mellitus noted above, and the lack of any evidence supporting a direct link between the Veteran’s hypertension and service based on exposure to Agent Orange or otherwise, the Board must unfortunately find that the preponderance of the evidence is against entitlement to service connection for hypertension. Therefore, entitlement to service connection for this disorder is not warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. DeBoer, 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.