Citation Nr: 22016608 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 16-15 084A DATE: March 22, 2022 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his hypertension is etiologically related to his exposure herbicides while serving in the Republic of Vietnam. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1112 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1969 to June 1973, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in July 2019, March 2021, and September 2021 when it was remanded for further development. It has since been returned to the Board for further appellate action. The Veteran has contended that his hypertension is related to his active service, to include as due to exposure to herbicides. VA has conceded the Veteran's exposure to herbicides while serving in the Republic of Vietnam. Alternatively, he proposed that his hypertension was secondary to his service-connected diabetes mellitus (DM), to include any prescribed DM medications. Service treatment records (STRs) are silent for any complaints, treatment, or diagnosis of hypertension or elevated blood pressure readings. Post-service medical records confirm the Veteran was diagnosed with hypertension in September 2007. In April 2010, January 2016, and December 2019, VA examiners opined that the Veteran's hypertension was not caused or aggravated by his service-connected DM. However, the Board found those opinions inadequate in the prior July 2019 and March 2021 Board remands. Pursuant to the September 2021 Board remand, the RO obtained a VA medical opinion in November 2021. The examiner opined that the Veteran's hypertension was not related to his service. In support of the opinion, the examiner noted that there was no evidence of hypertension in service and that periodic examinations, including examinations conducted in 1989 and 1994, showed normal blood pressure readings. Regarding whether the hypertension was related to herbicide agent exposure, the examiner noted that recent studies found an association between high levels of exposure (direct and sustained contact) to herbicide agents and hypertension but noted that the study was limited in that it did not include or consider other risk factors for the development of hypertension (which include age, race, obesity, physical inactivity, family history, tobacco use, diet, alcohol use, and male sex). The examiner also referenced another study that found 90 percent of people age 55 and over will develop hypertension eventually and concluded that, by definition ALL Vietnam era veterans have a 90 percent chance of developing hypertension, regardless of exposure to herbicide agents. Additionally, the examiner opined that the Veteran's hypertension was not likely due to or aggravated by his DM, noting that, in the absence of diabetic nephropathy, hypertension cannot be attributed to DM. However, the Board finds the November 2021 VA medical opinion is inadequate for adjudication purposes. The Board notes, however, that it is not necessary that herbicide exposure, alone, caused the Veteran's hypertension. It is only necessary that his hypertension was at least as likely as not caused by or related to service, either due to in-service herbicide exposure or service-connected diabetes mellitus or a combination of both. Notably, the examiner did not indicate that the Veteran's nonservice-related risk factors more likely caused his hypertension. Furthermore, the Board notes that there is not a temporal requirement inherent in 38 C.F.R. § 3.310(a) for claims for service connection on a secondary basis and that the "primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred." Frost v. Shulkin, 29 Vet. App. 131, 138-39 (2017). Lastly, the opinion is based on an inaccurate factual premised in that the Veteran was diagnosed with diabetic nephropathy at his September 2019 VA examination. As the opinion is inadequate, it cannot serve as the basis of a denial of entitlement to service connection. The Board acknowledges that hypertension is not a disability presumptively related to herbicide exposure. 38 C.F.R. § 3.309(e) (2020). However, the National Academy of Sciences (NAS) recently determined that there is "sufficient" epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. The Veteran is presumed to have been exposed to herbicides while serving in the Republic of Vietnam and has a current diagnosis of hypertension. Moreover, there is no probative VA medical opinion of record against the claim. (Continued on the next page) Accordingly, the Board finds that the evidence for and against the claim is in approximate balance. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for hypertension is warranted. 38 U.S.C. § 5107(b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). D. Ware Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Jiggetts 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.