Citation Nr: A21005515 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 200213-69189 DATE: March 11, 2021 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for renal disease is granted. Entitlement to service connection for eye condition to include glaucoma is granted. FINDINGS OF FACT 1. The Veteran’s hypertension is proximately due to his service-connected diabetes mellitus. 2. The Veteran’s renal disease is proximately due to his service-connected diabetes mellitus. 3. The Veteran’s eye condition to include glaucoma is proximately due to his service-connected diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension as secondary to diabetes mellitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for renal disease as secondary to diabetes mellitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for eye condition to include glaucoma as secondary to diabetes mellitus are 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 Army from August 1958 to December 1978. This matter comes before the Board of Veterans' Appeals (Board) from a March 2020 Appeals Modernization Act (AMA) rating decision that considered the evidence of record on that date. In the February 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Veteran appeared before the undersigned Veterans Law Judge in a hearing in September 2020. A transcript of the hearing is of record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In addition to service connection on a direct basis, service connection may be granted on a secondary basis for a disability that is proximately due to or aggravated beyond its natural progression by a service-connected disease or injury. 38 C.F.R. § 3.310. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 4 (1990). Furthermore, 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 of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Under the AMA, the Board is bound by favorable findings by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c). 1. Entitlement to service connection for hypertension The Veteran seeks entitlement to service connection for hypertension. In a January 2020 rating decision, the RO found the Veteran’s service treatment records did not show complaints or diagnosis of hypertension. Further, the RO found no entitlement to hypertension related to agent orange exposure. The RO made a favorable finding conceding the Veteran’s herbicide exposure during service in Vietnam. The RO made an additional favorable finding of the Veteran being diagnosed with a current disability, shown by VA medical records. The Board notes, no VA examination was afforded to the Veteran for his claim of hypertension. During a September 2020 hearing, the Veteran’s representative argued the positive association between agent orange and hypertension. Following the hearing, the Veteran’s representative timely submitted private medical evidence with opinion and rationale in October 2020. The physician opined that it is as likely as not the Veteran’s hypertension is a result of Agent Orange exposure. In coming to an opinion, the physician reviewed the evidence of record to include the Veteran’s military, VA, and civilian medical records along with the Veteran’s personnel records. In considering the facts of the Veteran’s case, the physician cited to relevant medical treatises evidence showing a link between hypertension and Agent Orange exposure. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This examiner reviewed the claims file and provided opinions that were sufficiently clear and had well-reasoned rationales. See Bloom v. West, 12 Vet. App. 185, 187 (1999). The Veteran has a current disability of hypertension, has been exposed to Agent Orange during service, and a competent and probative positive medical link associating the Veteran’s hypertension and Agent Orange exposure has been made. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. 2. Entitlement to service connection for renal disease The Veteran seeks entitlement to service connection for renal disease. In a January 2020 rating decision, the RO found the Veteran’s service treatment records did not show complaints or diagnosis of renal disease. Further, the RO found no entitlement to hypertension related to agent orange exposure. The RO made a favorable finding conceding the Veteran’s herbicide exposure during service in Vietnam. The RO made an additional favorable finding of the Veteran being diagnosed with a current disability, shown by VA medical records. The Board notes, no VA examination was afforded to the Veteran for his claim of renal disease. During a September 2020 hearing, the Veteran’s representative argued the positive association between agent orange and renal disease. Following the hearing, the Veteran’s representative timely submitted private medical evidence with opinion and rationale in October 2020. The physician states the Veteran developed renal insufficiency with an elevated creatinine and decreased eGRR. The physician explains “[p]atients with diabetes often develop nephrosclerosis, which is narrowing and clogging of the renal blood vessels.” The physician opined that it is as likely as not the Veteran’s nephrosclerosis and renal insufficiency is secondary to the Veteran’s service connected diabetes. In coming to an opinion, the physician reviewed the evidence of record to include the Veteran’s military, VA, and civilian medical records along with the Veteran’s personnel records. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This examiner reviewed the claims file and provided opinions that were sufficiently clear and had well-reasoned rationales. See Bloom v. West, 12 Vet. App. 185, 187 (1999). The Veteran has a current disability of renal disease, has been exposed to Agent Orange during service, is service-connected for diabetes, and a positive medical link associating the Veteran’s renal disease and diabetes has been made. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for renal disease is warranted. 3. Entitlement to service connection for eye condition to include glaucoma The Veteran seeks entitlement to service connection for eye condition to include glaucoma. In a January 2020 rating decision, the RO found the Veteran’s service treatment records show complaint of eye pain. The Veteran was provided a VA examination in November 2019, noted by the rating decision. The examiner opined the eye condition is less likely than not incurred in or caused by the claimed in-service eye pain. The examiner stated the pain resolved spontaneously and there has been no further recurrence. The RO further found no entitlement to hypertension related to agent orange exposure. The Board notes, the RO did not request the VA examiner to opine to the Veteran’s eye condition in relation to Agent Orange exposure. The RO made a favorable finding conceding the Veteran’s herbicide exposure during service in Vietnam. The RO made an additional favorable finding of the Veteran being diagnosed with a current disability, shown by VA medical records. During a September 2020 hearing, the Veteran’s representative argued the positive association between agent orange and hypertension. Following the hearing, the Veteran’s representative timely submitted private medical evidence with opinion and rationale in October 2020. The physician opined that it is as likely as not the Veteran’s glaucoma is secondary to his diabetes. The examiner noted patients with diabetes develop varying degrees of retinopathy resulting in glaucoma. In coming to an opinion, the physician reviewed the evidence of record to include the Veteran’s military, VA, and civilian medical records along with the Veteran’s personnel records. In considering the facts of the Veteran’s case, the physician cited to relevant medical treatises evidence showing a link between hypertension and Agent Orange exposure. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This examiner reviewed the claims file and provided opinions that were sufficiently clear and had well-reasoned rationales. See Bloom v. West, 12 Vet. App. 185, 187 (1999). The Veteran has a current disability of an eye condition to include glaucoma, has been exposed to Agent Orange during service, is service-connected for diabetes, and a positive medical link associating the Veteran’s eye condition and diabetes has been made. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lang, 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.