Citation Nr: 21013929 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 11-18 463 DATE: March 10, 2021 ORDER Service connection for hypertension is granted. FINDING OF FACT Resolving all doubt in favor of the Veteran, his hypertension has been aggravated by his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for hypertension have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1966 to April 1968, including service in Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue was most recently remanded by the Board in August 2020 and has since been returned for further adjudication. Service Connection Generally, to establish service connection, a claimant 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran filed his service connection claim for hypertension in August 2009. He asserts that his hypertension was either due to his active service or due to a service-connected disability. The Veteran’s service treatment records are silent for any complaints, treatment, or diagnosis of hypertension during his active service. In May 2014, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s hypertension was less likely than not caused by his coronary artery disease (CAD), renal insufficiency, or diabetes. In January 2016, a private examination stated that the Veteran’s anxiety creates a hypertension loop when exacerbated by stress. In September 2017, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s hypertension was less likely than not due to his active service, to include his presumed herbicide agent exposure and exposure to contaminants at Camp Lejeune, or secondary to his service-connected CAD, renal insufficiency, or diabetes. In April 2018, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s hypertension was less likely than not due to herbicide agent exposure. In December 2019, the Veteran’s physician reported that the Veteran’s hypertension was associated with his CAD. In December 2019, the Veteran was afforded a VA examination. The examiner reported that although there may be a positive association between hypertension and herbicide exposure, there was no clear evidence in peer reviewed medical literature that benign essential hypertension was caused by herbicide exposure. In September 2020, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s hypertension was less likely than caused by his active service. However, the examiner opined that the Veteran’s hypertension was at least as likely as not aggravated beyond its normal progression by the Veteran’s anxiety disorder. The examiner reported that anxiety caused the release of catecholamines like adrenalin, which increased blood pressure temporarily. The examiner reported that anxiety chronically increased the level of cortisol which causes the retention of sodium which could exacerbate hypertension more over the long term. As such, the Board finds that at most the medical evidence of record shows that the evidence for and against the Veteran’s claim is in relative equipoise. In such circumstances, the regulations dictate that reasonable doubt is to be resolved in the Veteran’s favor. Accordingly, the Veteran’s claim for service connection for hypertension is granted. See 38 C.F.R. § 3.102. Timothy Berryman Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hofmeister, Attorney Advisor 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.