Citation Nr: 21027029 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 08-08 984 DATE: May 4, 2021 ORDER Service connection for hypertension is granted. FINDING OF FACT It is at least as likely as not that the Veteran's hypertension is related to his presumed exposure to herbicide agents during service in Vietnam. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from January 1965 to August 1975. His decorations include the Vietnam Service Medal, the Republic of Vietnam Campaign Medal, the Combat Infantryman Badge, the Senior Parachute Badge, the Ranger Tab, and the Bronze Star Medal with "V" device. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Waco, Texas. The issue on appeal was previously before the Board in April 2013, October 2016, March 2019, April 2020, and December 2020, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. On each occasion, after taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Service connection for hypertension is granted. The Veteran contends that his hypertension is related to exposure to herbicide agents during service in the Republic of Vietnam. Alternatively, he contends that his hypertension is secondary to his service-connected posttraumatic stress disorder and/or diabetes mellitus. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). A Veteran who served on active duty 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 to an herbicide agent, absent affirmative evidence to the contrary. See 38 C.F.R. § 3.307(a)(6)(iii). VA regulations further provide that service connection is warranted for certain diseases as presumptively due to herbicide exposure. 38 C.F.R. § 3.309(e). Hypertension is not among those diseases. However, a claimant is not precluded from establishing service connection for other, unlisted disabilities with proof of actual direct causation (i.e. evidence of a link between the current disability and in-service exposure to herbicide agents). Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As an initial matter, the Board finds that there is no dispute that the Veteran has a current diagnosis of hypertension. A May 2019 VA examination report confirms the diagnosis. He is also presumed to have been exposed to herbicide agents during his service in Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii). In January 2021, an addendum opinion was procured in accordance with the Board's December 2020 remand. The examiner addressed the Veteran's contention that his hypertension was related to active service, to include as due to exposure to herbicide agents. The examiner also considered a November 2018 National Academy of Sciences (NAS) report, as instructed by the Board's December 2020 remand. The examiner ultimately opined that it was at least as likely as not that the Veteran's hypertension was the result of his military service and exposure to herbicide agents. The Board finds the favorable nexus opinion from the January 2021 VA examiner to be of significant probative value. It was based on a review of the Veteran's service treatment records and other evidence, including supportive medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The January 2021 VA addendum opinion also affirms the conclusions reached in a September 2020 by the same examiner. In the September 2020 VA opinion, the examiner found that the Veteran's hypertension was likely due to military service, including herbicide exposure. The examiner also found that the Veteran's hypertension was at least as likely as not aggravated beyond its natural progression by his service-connected diabetes mellitus. Although a December 2015 VA examination report is unfavorable with respect to the conclusion that the Veteran's hypertension has been aggravated by his diabetes mellitus, and a May 2019 VA examination report is unfavorable with respect to the conclusion that his hypertension is related to exposure to herbicides, the Board finds those opinions no more probative than the favorable opinions from the September 2020/January 2021 VA examiner. In light of the foregoing, the Board is satisfied that the requirements for an award of service connection for hypertension have been satisfied. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal is granted. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, 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.