Citation Nr: 21030485 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 12-31 453A DATE: May 19, 2021 ORDER Entitlement to service connection for hypertension to include as due to Agent Orange exposure, or secondary to service-connected post-traumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran's hypertension is proximately due to, or aggravated by, his service-connected PTSD. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for hypertension to include as due to Agent Orange exposure, or secondary to service-connected PTSD have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1963 to December 1965 and from January 1966 through January 1984. The Veteran died in February 2017. The Appellant is the Veteran's surviving spouse. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in July 2020, it was remanded for additional development. Specifically, the RO was instructed to obtain an addendum medical opinion regarding the etiology of the Veteran's claimed disabilities. A relevant medical opinion was obtained. As such, the Board finds that the AOJ substantially complied with the directives in the July 2020 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service ConnectionLegal Criteria Establishing service connection generally requires 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 Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Presumptive service connection on the basis of herbicide exposure is authorized for specified diseases. 38 U.S.C. § 1116; 38 C.F.R. § 3.309. When a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease is related to service, to include the in-service herbicide exposure. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Hypertension The Appellant contends that the Veteran's claimed hypertension is the result of his active duty service, to include as due to his conceded in-service herbicide exposure or secondary to his service-connected PTSD. The Board notes that hypertension is not a condition presumptively related to Agent Orange exposure. However, the Appellant can still prove service-connection on a direct basis. The Board also notes that the Veteran had a current diagnosis of hypertension. See October 2018 Medical Advisory Opinion; see also July 2020 VA Addendum opinion. Therefore, the central issue that must be resolved is whether the Veteran's current disability originated in service or is otherwise related to service. See Newhouse v. Nicholson, 497 F.3d 1298 (Fed. Cir. 2007); Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Initially, the Board notes that since the Veteran had a current diagnosis of hypertension, and was service connected for PTSD, the first two requirements of secondary service connection are met. See Wallin, 11 Vet. App. at 512. All that remains to be resolved is whether the medical evidence of record establishes a link between the Veteran's hypertension and his PTSD. By way of history the Board notes that entitlement to service connection for hypertension was previously denied in a February 2019 Board decision on the basis of an October 2018 Medical Advisory Board opinion. In January 2020, the Court of Appeals for Veteran's Claims (Court) remanded the issue of entitlement to service connection for hypertension. The Court noted that the October 2018 medical opinion was inadequate, and Board failed to adequately address the Appellant's arguments regarding hypertension secondary to PTSD and herbicide exposure. As such, the Court granted a joint motion for remand sending the claim back to the Board. In July 2020, the Board remanded the Appellant's claim for further development; specifically, an addendum to the October 2018 medical opinion. In response to the Board remand, the RO obtained a July 2020 VA Addendum Medical Opinion regarding the etiology of the Veteran's hypertension. The examiner opined that the Veteran's diagnosed hypertension was less likely than not (less than a 50 percent probability) etiologically related to his in-service Agent Orange exposure. The examiner additionally noted that the Veteran's hypertension was less likely than not (less than a 50 percent probability) proximately due to, or aggravated by, the Veteran's service-connected coronary artery disease. However, the examiner did opine that the Veteran's hypertension was at least as likely as not (a 50 percent probability or greater) aggravated beyond the course of its natural progression by his service-connected PTSD. The rationale provided was that the Veteran's medical records documented diagnosis of hypertension in 2005 while the Veteran's PTSD treatment began in 2012 with continued medication and therapy documented. The examiner continued that chronic stress, like PTSD, increases risk for hypertension. The examiner concluded that the Veteran's hypertension is more likely than not related to his age and PTSD. In this case, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 (2007) (Observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. The Board also notes that under certain circumstances, lay evidence may be sufficient to establish a nexus. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay evidence has been found to be competent with regard to a disease that has "unique and readily identifiable features" that are "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007); see also Petitti v. McDonald, 27 Vet. App. 415, 427-28 (2015) (where the Court of Appeals for Veterans Claims found objective evidence of pain need not come from a medical professional; a lay person may provide the requisite confirmation). The Board has considered the evidence of record. The Board notes that the July 2020 VA examiner is a medical professional competent to opine as to the etiology of the Veteran's hypertension. There is no evidence that the examiner is not credible. Moreover, the examiner provided an analysis based upon both subjective and objective information to form an opinion based upon medical expertise. As such, the Board affords this examination significant probative weight. In light of the July 2020 VA medical opinion, the most probative evidence of the record establishes that the Veteran's hypertension was proximately due to, or aggravated by, his service-connected PTSD. As such, the third prong of secondary service connection is met. See Wallin, 11 Vet. App. at 512. Accordingly, service connection for the Veteran's hypertension is granted secondary to his service-connected PTSD. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.