Citation Nr: 22018764 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 16-23 087 DATE: March 30, 2022 ORDER Service connection for hypertension (HTN) is denied. FINDINGS OF FACT 1. The Veteran served on active duty from June 1967 to March 1971, including service in the Republic of Vietnam. He died in October 2017 and his surviving spouse has been properly substituted as the claimant. 2. HTN was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; HTN was not causally or etiologically related to service, to include as due to herbicide exposure, and was not caused by or permanently worsened in severity by a service-connected disability. CONCLUSION OF LAW HTN was not incurred in service, was not presumed to have been incurred in service, and was not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the Board denied entitlement to service connection for HTN and a cardiovascular disorder in February 2020. The appellant appealed the decision to the Veterans Claims Court. In September 2020, the Court Clerk granted a Joint Motion for Partial Remand (JMPR) and returned the claims to the Board for readjudication. In May 2021, the Board remanded the claims of HTN and a cardiovascular disorder for further development. The Regional Office (RO) granted service connection for a cardiovascular disorder in January 2022. As such, this was a full grant of the benefits sought on appeal and only the claim of entitlement to service connection for HTN remains before the Board. All requested development has been completed and the claim is now ready for adjudication. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). 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). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for diseases associated with herbicide exposure under 38 C.F.R. § 3.309 if a veteran served in the Republic of Vietnam between January 1962 and May 1975. 38 C.F.R. § 3.307(a)(6). Service in the Republic of Vietnam includes veterans on ships that operated not more than 12 nautical miles from the coast of Vietnam and Cambodia. In 2019, Congress provided specific longitudes and latitudes that mark the boundary in the Blue Water Navy Vietnam Veterans Act, Pub. L. 116-23. Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the medical evidence, February 2004 private treatment records reflect a diagnosis of essential HTN. Accordingly, a diagnosis was shown and the first element of service connection was met. As to in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of HTN during service. Importantly, the February 1971 separation examination did not indicate that the Veteran had HTN. His blood pressure reading at the time of separation was 138/86. HTN for VA purposes is defined as a diastolic blood pressure predominantly 90 mm or greater. As such, the medical evidence does not support the in-service incurrence of HTN. Next, HTN is considered a chronic disease under 38 C.F.R. § 3.309(a) and presumptive service connection will be considered. While HTN was shown, it did not manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology was not established. First, HTN did not manifest to a compensable degree during service or within one year of separation. The Veteran's period of active service ended in 1971, but the clinical treatment records do not show a diagnosis of HTN until 2004. As such, the medical evidence does not support service connection for HTN based on the one-year presumptive period. Additionally, continuity of symptomatology has not been established. The February 1971 separation examination, one month prior to separation from service, did not show evidence of HTN. Further, the medical evidence shows that the Veteran did not seek treatment for HTN until 2004, more than 30 years after separation from service. While not dispositive, this lengthy period between separation and treatment weighs against the claim. As such, continuity of symptomatology has not been established and the medical evidence does not support service connection on a presumptive basis. Next, the Veteran contended that HTN was related to exposure to herbicides. While exposure was conceded based on nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Pub. L. 116-2, HTN is not a disease associated with herbicide exposure for presumptive service connection. Nonetheless, service connection may be established with evidence of direct causation. To that end, in January 2022, a VA clinician opined it was less likely than not that HTN was incurred in or caused by service, to include as due to herbicide exposure. The clinician explained that while there was a suggestion that HTN may be caused by herbicide exposure, HTN has not yet been established as a presumed condition by the medical literature. Further, the clinician noted that the Veteran had many risk factors for the development of HTN, including male gender, diabetes, kidney disease, obesity, and smoking. She also noted that there was a significant delay in the development of HTN as the Veteran was not diagnosed until approximately 30 years after separation from service. As such, she concluded that HTN was less likely than not related to service, to include as due to herbicide exposure. Accordingly, the medical evidence does not support service connection as due to herbicide exposure. As to secondary service connection, the January 2022 VA clinician opined it was less likely than not that HTN was proximately due to or the result of service-connected disabilities, to include diabetic chronic kidney disease, diabetes, neuropathy, hearing loss, and tinnitus. She explained that the Veteran was diagnosed with diabetes in 2013, which was many years after the initial diagnosis of HTN. Further she explained that there was no medical literature which supported a relationship between HTN and neuropathy, hearing loss, or tinnitus. Therefore, she concluded that HTN was less likely than not due to service-connected disabilities. In addition, the January 2022 clinician indicated that the Veteran's blood pressure was well-controlled with medication and there was no evidence that HTN was aggravated beyond its normal progression. As such, she concluded that it was less likely than not that HTN was aggravated beyond its natural progression by service-connected disabilities. Therefore, the medical evidence does not support service connection on a secondary basis. The appellant contends that the Veteran's private treatment records from KP have not been considered. The Board has reviewed these records and while they reflect treatment for HTN, the medical evidence does not show a nexus between HTN and service. As such, these records do not support a grant of service connection. Further, the Board has considered the lay statements that the Veteran's disorder was caused by service. He was competent to report symptoms because this requires only personal knowledge as it came to him through his senses. However, he was not competent to offer an opinion as to the etiology of his disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the appellant has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.