Citation Nr: 21030533 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-15 868 DATE: May 19, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure and/or secondary to hypertension is denied. Entitlement to service connection for residuals of stroke, to include secondary to hypertension and/or diabetes mellitus is denied. FINDINGS OF FACT 1. Hypertension is not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. Diabetes mellitus is not related to active service, to include herbicide exposure, nor is it secondary to a service-connected disorder. 3. Residuals of stroke are not related to active service, nor are they secondary to a service-connected disorder. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for diabetes mellitus due to service or a service-connected condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. 2. The criteria for service connection for residuals of stroke due to service or a service-connected condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from February 1970 to August 1972. In January 2019, the Veteran and a witness testified at a Board hearing. The transcript is of record. In June 2019, the Board remanded the case for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Board notes that the Veteran claims that some of his records were destroyed in a fire. However, there is no indication in the claims file that any of his records are missing. The response for the request for information submitted February 20, 2015 indicated all available records were shipped. There are no reports of missing or damaged records due to fire. 1. Entitlement to service connection for hypertension The Veteran contends he is entitled to service connection for hypertension as he went to the hospital two times for high blood pressure in service. Certain chronic diseases, such as hypertension, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). If the criteria for presumptive service connection is not met, service connection may still be granted on a direct basis for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. "To establish a right to compensation for a present disability, a veteran must show: '(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' the so-called "nexus" requirement." Holton v. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran underwent a VA examination for hypertension in February 2020 and reported that he went to sick bay for headaches in 1971 and received medication for elevated blood pressure after service with an approximate date of diagnosis of 1978. The medical examination report listed a diagnosis of hypertension from 2009 and a diagnosis of orthostatic hypotension. The examiner reviewed the service treatment records and noted the following: a February 10, 1969 medical examination with blood pressure of 110/74; a February 16, 1970 medical report with normal blood pressure of 120/62; a June 15, 1970 medical report with normal blood pressure of 132/70; the September 20, 1971 diagnosis of frontal headaches with no blood pressure vital signs noted; a July 27, 1972 medical report with normal blood pressure of 110/78; and the May 10, 1973 medical history with a self-report of high or low blood pressure and a report of high blood pressure at work two weeks prior. The examiner also noted the Veteran's testimony that his blood pressure was 240 over 160 or 170 during the military and he was started on medication as well as the post-service records revealing a November 17, 2009 treatment note reporting a diagnosis of hypertension post-stroke and history of smoking since 1993. Based on the review of records and in-person examination, the examiner opined that it is less likely than not that hypertension incurred in or was caused by the Veteran's claimed treatment for high blood pressure in service. The examiner noted that the May 1973 examination includes a self-report of high or low blood pressure and a note of high blood pressure two weeks earlier but no actual diagnosis or mention of medications or treatments. Additionally, the blood pressures contained in the service treatment records (as listed above) were all within normal range. For the Veteran's contention regarding the September 20, 1971 complaint of headaches, the diagnosis was frontal headaches with questionable migraines and there were no vital signs noted on the record. The examiner reported that a thorough search of the service treatment records failed to show any diagnoses or treatments for high blood pressure and the records did not show any abnormal blood pressures to warrant a diagnosis of hypertension in service. Furthermore, the post-service medical records from 2009 reveal a diagnosis of hypertension post-stroke with a history of smoking and family history of heart disease. Additionally, the examiner specifically addressed the contention that the Veteran's blood pressures were 240-250 over 160-170 and required medication during active duty. The examiner noted that on the day of the May 10, 1973 medical examination the Veteran's blood pressure was normal with no record of any medications. Notably, the Veteran wrote "good, no medications" for the statement of present health. The Veteran testified that he complained of headaches and was seen by sick call on September 20, 1971 and after a couple days he returned to sick call at which time he was told his blood pressure was too high and started on medication. While the service treatment records contain the September 20, 1971 visit, there is no mention of blood pressure in that particular record. Additionally, he did not report it on May 10, 1973 and his blood pressure was normal. The examiner also explained that the blood pressures reported by the Veteran would be considered urgent and require immediate care and a thorough examination would be necessary to determine the etiology of such high blood pressures in an otherwise healthy soldier in his early 20s. The examiner also noted that headaches in addition to such high blood pressures would quickly become an emergent condition requiring intensive care in a hospital. The service records reveal that the Veteran did not report any medications in May 1973, which is two years after the event with the headaches and his blood pressures were normal. Thus, there is no evidence to support that he had elevated blood pressure in service as he would likely would have continued to be on medication if he actually had blood pressures as high as he reported. When making a decision, the Board must consider all the evidence of record, to include lay statements. 38 U.S.C. § § 5107(b), 7104(a); 38 C.F.R. § 3.303(a). The Veteran's daughter provided a statement dated November 2011 stating that the Veteran's issues with hypertension date back to 1972 with treatment by a naval physician and again from 1987 to 1988. The Veteran provided a statement dated March 2012 alleging that he was admitted to sick back due to extremely high blood pressure in October 1970 and again in 1971. He described having a blood pressure of 240/183 and being given pills and sent back to work. At the hearing, the Veteran testified that his blood pressure was about 240 to 250 over 160 to 170 and he received medication and continues to have high blood pressure to this day. While the Veteran alleged elevated blood pressure in service, the examiner explained that a blood pressure reading at the levels reported by the Veteran, especially in conjunction with complaints of headaches, would require immediate intensive care in a hospital. Additionally, as the Veteran was otherwise healthy and only in his 20s the examiner noted that there would have been a thorough examination to determine the etiology. However, the service records reveal normal readings with no mention of blood pressure at the visit for headaches and a report of good health with no medications in May 1973. The lack of any appropriate follow up care or treatment weighs against a finding that the Veteran had the significantly elevated blood pressure readings during active duty as alleged. If, in fact, a health care professional had observed such readings, further action would have been taken and documented in the record. The Board places no probative value on the Veteran's allegation of significantly increased blood pressure readings being present during active duty. The Board finds the negative medical opinion to be more persuasive than the lay evidence and affords it probative weight. This opinion was conducted by a health care professional, who reviewed the record, conducted a physical examination, and considered and addressed the medical and lay evidence. This opinion is well supported by adequate rationale that contains clear conclusions with supporting data and a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, the claim for entitlement to service connection for hypertension is denied. 2. Entitlement to service connection for diabetes mellitus, type II, to include due to herbicide exposure and/or secondary to hypertension The Veteran contends he is entitled to service connection for diabetes. For the following reasons, the Board finds service connection is not warranted. If the veteran was exposed to an herbicide agent (to include Agent Orange) during active service, certain diseases, such as diabetes mellitus, shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 is presumed to have been exposed to an herbicide agent if a listed chronic disease manifests to a degree of 10 percent disabling or more, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a). Effective February 24, 2011, VA amended its regulations (38 C.F.R. § 3.307) to extend a presumption of herbicide exposure to certain Veterans who served in Korea. 76 Fed. Reg. 4245-01 (Jan. 25, 2011). Specifically, a Veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense (DoD), operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iv). Once exposure has been established by the evidence, the presumptions found at 38 C.F.R. § 3.309 (e) are applicable. The Veteran alleged serving 11 months in Vietnam and exposure to Agent Orange while stationed in Rota, Spain. In a statement dated March 2012, the Veteran stated that while in Spain he was ordered to clean equipment contaminated by Agent Orange and was required to drink a small cup of Agent Orange so he could get used to the taste of it. At the Board hearing, the Veteran testified that he was offered a beer while cleaning equipment in Spain and after drinking it was told it was Agent Orange. He also contends that five years ago he tested positive for Agent Orange. A request was made to the Joint Services Records Research Center (JSRRC) to corroborate the Veteran's reported herbicide exposure. The JSRRC reported that the Department of Defense (DOD) does not show any use, testing or storage of tactical herbicides, such as Agent Orange, at Rota, Spain. Additionally, it was noted that the use of tactical herbicides in Vietnam was terminated in early 1971 with the remaining stockpile incinerated. Thus, the JRSSC concluded that there is no evidence that tactical herbicides were transported to, used, stored, or buried at Rota Spain. As such, there is insufficient evidence to establish that the Veteran was exposed to herbicide agents at any time during active service as the JSRRC reported that there was no use, storage, spraying or transporting of herbicides in Rota, Spain. Additionally, there is no evidence of the Veteran serving in Vietnam. It is not apparent why the Veteran would allege such service. The Board considered the Veteran's lay statements regarding his exposure; however, the statements reveal inconsistent reporting and there is objective evidence which counters the allegations, which calls into question the reliability of the statements offered in support of his claim for benefits. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (the Board can consider bias in lay evidence and conflicting statements of the veteran in weighting credibility); Caluza v, 7 Vet. App. at 511. The allegation that the Veteran drank a cup of an herbicide agent is incredible. There is no indication of any ill effects from the consumption and no allegation or evidence that the Veteran took any action to punish the offender or offenders for the poisoning. The Board places no probative value on the Veteran's allegations of being exposed to an herbicide agent during active duty or having served in Vietnam. Alternatively, the Veteran contends entitlement to service connection secondary to hypertension. Secondary service connection may be established for a disability that is proximately due to, the result of, or aggravated beyond its natural progression by a service-connected condition and shall be service connected on a secondary basis. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the claimed disability was either caused or aggravated by the already service-connected disability. Id. While the Veteran has a current diagnosis of diabetes mellitus, for the reasons discussed above service connection for hypertension is not warranted. Therefore, as hypertension is not a service-connected disability, secondary service connection cannot be established. The Board notes that diabetes mellitus is also a chronic diseases which will be presumed related to service, absent an intercurrent cause, if shown as chronic in service; or, if manifested to a compensable degree within a presumptive period following separation from service; or, if noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). At the hearing the Veteran testified that he received a diagnosis of diabetes in 1972, which is within one year of discharge from service; however, this is inconsistent with the medical evidence of record. Review of the medical records reveals that in 2009 at a primary care visit the Veteran's only chronic condition was hypertension and the assessment did not list diabetes. In July 2010 the Veteran's bloodwork revealed blood sugar in the diabetic range. The clinician inquired as to whether the Veteran ever took medication for diabetes at which time, he indicated willingness to start medication and take diabetic classes. At a diabetology risk assessment screening consultation in January 2011 the Veteran reported a history of diabetes since 2008 and in December 2013 he reported a history since 2009. Thus, the medical evidence indicates that the Veteran did not receive a diagnosis until decades after active service. The July 2010 bloodwork and subsequent treatment notes as well as his statements at the diabetology risk assessment screening consultations reporting an onset in 2008 and/or 2009 are inconsistent with his testimony alleging an onset within the presumptive period. In weighing credibility, VA may consider internal inconsistency, facial plausibility, and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Board finds the medical evidence revealing a diagnosis of diabetes in approximately 2010 more credible than the Veteran's testimony of an onset with a year of discharge from service as his testimony is inconsistent with the other evidence of record. Not only may his memory have dimmed with time but the chance for pecuniary gain may have played a role in the more recent statements. No probative value is placed on the Veteran's allegation of being diagnosed with diabetes mellitus in 1972. As such, the Board finds that presumptive service connection for a chronic condition is not warranted. Additionally, entitlement to service connection is not warranted on a direct basis as the preponderance of the evidence is against finding that diabetes mellitus began during active service, or is otherwise related to an in-service injury, event, or disease. The service treatment records are silent as to any complaints, treatments or diagnoses related to diabetes mellitus. There is no evidence of an in-service injury, event or disease related to diabetes. There is no competent probative medical evidence linking diabetes mellitus to active duty on a direct basis. Accordingly, the claim is denied. 3. Entitlement to service connection for residuals of stroke secondary to hypertension The Veteran contends entitlement to service connection for residuals of stroke secondary to hypertension and/or diabetes. Again, while the Veteran has a current diagnosis, for the reasons discussed above service connection for hypertension and diabetes is not warranted. Therefore, as hypertension and/or diabetes are not service-connected disabilities, secondary service connection cannot be established. Additionally, entitlement to service connection is not warranted on a direct basis as the preponderance of the evidence is against finding that residuals of stroke began during active service, or are otherwise related to an in-service injury, event, or disease. The service treatment records are silent as to any complaints, treatments, or diagnoses of, or related to a stroke. At the hearing, the Veteran testified that his stroke was related to his blood pressure, diabetes, and cholesterol medicine, which are not service-connected conditions. As such, there is no evidence of an in-service injury, event, or disease related to a stroke. There is no competent medical evidence linking residuals of a stroke to active duty or to a service connected disability. Accordingly, the claim is denied. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.