Citation Nr: 21027011 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 15-43 867 DATE: May 4, 2021 ORDER Entitlement to service connection for essential hypertension is denied. FINDING OF FACT The Veteran's hypertension was not manifest in service, within one year of separation from service, and is not otherwise related to the Veteran's active service. CONCLUSION OF LAW The criteria for service connection for hypertension, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from August 1965 to June 1969, including service in Vietnam. The Board of Veterans' Appeals (BVA) remanded this issue in their decision dated May 3, 2019, for development and VA medical opinions. These actions have been taken and the following decision has been made. Entitlement to service connection for essential hypertension. In order to establish service connection for a claimed disorder, the following must be shown: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 U.S.C. § 1110. Service connection for some chronic diseases, including essential hypertension, may be presumed to have been incurred in service if manifested to a compensable degree within 1 year following separation from qualifying service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. VA shall consider all information and lay and medical evidence of record in a case and make appropriate determinations as to competence, credibility, and weight. 38 U.S.C. § 5107; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); 38 C.F.R. § 3.303. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Competent lay evidence also means any evidence not requiring that the proponent have specialized education, training, or experience. 38 C.F.R. § 3.159. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. When the preponderance of the evidence weighs against the claims of the Veteran, the claim will be denied on its merits, and when the preponderance of the evidence weighs for the claims of the Veteran, the claim will be granted on its merits; in such cases, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107. The Veteran contends that he has had high blood pressure since serving in Vietnam, although he does not have the records to support his contention. It was indicated that the physician who treated him passed away and there were no available records. Alternatively, the Veteran's representative argued in a March 2019 Informal Hearing Presentation that the Veteran should receive service connection for hypertension because he served in Vietnam and has presumed exposure to herbicide agents. Veterans who served in specific locations, such as the Republic of Vietnam during the Vietnam era, are presumed to have been exposed to certain herbicide agents (e.g., Agent Orange). 38 U.S.C. § 1116; 38 C.F.R. § 3.307. As such, service connection may be presumed for certain diseases if a veteran was exposed to an herbicide agent during service, and the disease manifested to a degree of ten percent or more any time after service. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Hypertension is not currently among the disorders that get this presumption. The March 2020 VA medical opinion states that the Veteran's essential hypertension condition is less likely than not (less than 50 percent probability) caused by herbicide agents. The examiner cited recent studies that have shown an association with hypertension and veterans specifically assigned to the Chemical Corps who had a high exposure to herbicides. The examiner further noted that it is important to note that there has not yet been an association made between hypertension and veterans with other MOS. Further, per the examiner, the prospect of exposure to Tetrachlorodibenzodioxin (TCDD) from Agent Orange in ground troops in Vietnam seems unlikely in light of the environmental dissipation of TCDD, little bioavailability, and the properties of the herbicides and circumstances of application that occurred. Laboratory and field data reported in the literature provide compelling evidence on the fate and dislodge ability of herbicide and TCDD in the environment. The examiner noted that this evidence of the environmental fate and poor bioavailability of TCDD from Agent Orange is consistent with the observation of little or no exposure in the veterans who served in Vietnam. Appreciable accumulation of TCDD in veterans would have required repeated long-term direct skin contact of the type experienced by United States (US) Air Force RANCH HAND and US Army Chemical Corps personnel who handled or otherwise had direct contact with liquid herbicide, not from incidental exposure under field conditions where Agent Orange had been sprayed. The examiner further noted that the National Academy of Sciences committee came to this conclusion in a November 15, 2018 report, in part based on a recent study of U.S. Vietnam veterans by researchers from the VA, which found that self-reported hypertension rates were highest among former military personnel who had the greatest opportunity for exposure to these chemicals. There is no evidence here that the Veteran was a member of either US Air Force RANCH HAND or US Army Chemical Corps personnel. Nevertheless, when service connection cannot be granted on a presumptive basis, a veteran may still establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). There is no evidence here to support the Veteran's claim of being treated for hypertension on or during active duty. The Board notes an isolated diastolic reading of 100 (systolic 124) during his June 1969 separation examination. Other recorded readings in service were normal. However, a single isolated reading does not constitute a diagnosis of hypertension. His service treatment records (STRs) are otherwise silent as to any complaints or treatment for high blood pressure or hypertension. It is noted that the Veteran filed a claim for VA benefits in May 1970 for eye problems. At that time no mention of hypertension was recorded. The Veteran exhibited an elevated blood pressure reading (181/100) during a January 2014 VA Medical examination. At the time, this was the Veteran's first visit with a (VA) medical provider in several years. The Veteran was not on medications at the time and was assessed with hypertension. Contemporary notes from the 2014 VA Medical examination indicate that the Veteran worked for American Airlines until 2010, and references a past colonoscopy procedure. These and all other available records fail to show any chronicity of hypertension until the 2014 diagnosis, which was well after 1 year post active duty. Conclusion The Board determines that the preponderance of the evidence shows that the Veteran's current diagnosis of hypertension was not incurred in or related to service nor was it caused any event or in-service occurrence. The Board finds the reasoning of the March 2020 examiner to be highly probative, as the examiner indicated a detailed review of the evidence, provided a fully supported rationale consistent with the evidence, and considered the Veteran's complete medical history. The Board notes that Veteran is competent to report his observable symptoms; however, making a determination regarding the etiology of a disability requires medical expertise and knowledge which is beyond the scope of a lay person's knowledge. A bulk of the evidence supporting service connection rests on contentions made by the Veteran; such etiological conjecture is given less probative weight absent the corroboration of medical expertise. Thus, the Veteran's assertions are not competent evidence of a nexus between his current diagnosis of hypertension and service or a service-connected disability. 38 C.F.R. § 3.159(a)(1), (2). Therefore, no nexus to active duty exists and entitlement to service connection to essential hypertension is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. 38 U.S.C. § 5107. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Omosegbon, Babalakin O. 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.