Citation Nr: 21011505 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 13-06 179A DATE: March 2, 2021 ORDER Entitlement to service connection for hypertension, to include as due to herbicide exposure, is granted. FINDING OF FACT Affording the Veteran the benefit of the doubt, his hypertension is relayed to his service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1968 to March 1971, to include service in the Republic of Vietnam. The Veteran also has additional service in the Army Reserves and Alabama National Guard. The claim was most recently before the Board in November 2020 when it was remanded for further development. There has been substantial compliance with the remand and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for hypertension, to include as due to herbicide exposure. The Veteran contends that his hypertension is caused by his active service, to include exposure to herbicides. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, is presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a)(6)(iii). Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116 (a)(1); 38 C.F.R. § 3.307(a)(6). Hypertension is not listed as one of the diseases under this presumption. Nonetheless, the Veteran may still establish service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran's service treatment records (STRs) do not show any complaint, diagnosis, or treatment for hypertension. However, VA medical treatment records document that the Veteran was diagnosed with and treated for hypertension. Pursuant to the Board remands, the Veteran was afforded VA examinations in June 2017, November 2019, and December 2020. The VA examiners provided negative nexus opinions stating that the Veteran's current hypertension disability was not related to service, to include exposure to herbicide agents. The examiners based their negative opinions on the lack of evidence demonstrating a causal link between Agent Orange and hypertension. However, the examiners did not adequately address why the 2018 National Academies of Sciences, Engineering and Medicine Report does not support the claim. See Veterans and Agent Orange: Update 11 (2018), the National Academies of Sciences, Engineering and Medicine (NAS). Moreover, the examiners did not adequately address the secondary service connection contentions raised by the Veteran and the Veteran’s representative. The Board finds these opinions inadequate and therefore, not probative. The Veteran served in Vietnam and is presumed to be exposed to herbicides. See 38 C.F.R. § 3.307(a)(6)(iii). Hypertension is not as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e). However, the 2018 NAS report upgraded hypertension from a previous classification in the category of limited or suggestive evidence of an association to the category of sufficient evidence of an association. According to the NAS report, the “sufficient” category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide agent exposure. The Board finds the evidence to be in relative equipoise, that the Veteran's hypertension is causally related to his service, to include as due to herbicide exposure. Evidence against the claim are the inadequate VA medical opinions claiming that the Veteran's current hypertension is not related to service, to include exposure to herbicide agents. Evidence in support of the claim is that the Veteran is currently diagnosed with hypertension. Additionally, the Veteran was also exposed to herbicides during service, which the 2018 NAS report considers to be sufficient evidence that the Veteran's hypertension could be associated with his herbicide exposure. As the competent, credible and probative evidence is in relative equipoise. Accordingly, affording all reasonable doubt to the Veteran, he is entitled to service connection for his hypertension disability. Combee, 34 F.3d at 1039; 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.