Citation Nr: 25004483 Decision Date: 04/02/25 Archive Date: 04/02/25 DOCKET NO. 16-17 992 DATE: April 2, 2025 ORDER Entitlement to service connection for hypertension based on a theory of entitlement other than presumptive service connection under the PACT Act is granted. FINDING OF FACT The evidence is in approximate balance regarding whether the Veteran's current hypertension is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army on active duty from March 1966 to March 1968. The issue comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The above issue was previously before the Board in November 2019 and July 2021. The Board remanded for further development. In October 2023, the Board granted entitlement to service connection for hypertension pursuant to the PACT Act, and remanded the claim for service connection for hypertension based on a theory of entitlement other than presumptive service connection under the PACT Act. Thereafter, the RO issued a supplemental statement of the case (SSOC) in September 2024, denying the Veteran's claim. The matter is now before the Board once more. Entitlement to service connection for hypertension based on a theory of entitlement other than presumptive service connection under the PACT Act The Veteran contends that his hypertension is related to his active-duty service, to include as due to herbicide agent exposure during his service in the Republic of Vietnam. Service connection may be granted 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 (a). Service connection may be warranted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303 (d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310. Further, VA has a duty to provide the veteran a thorough medical examination, one which takes into account the veteran's prior medical history and describes the disability in sufficient detail so that the Board's evaluation of the claimed disability is fully informed. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A VA examination must contain clear conclusions with supporting data, and a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The Board recognizes that the Veteran has been diagnosed with hypertension. The December 2003 VA treatment records indicate that the Veteran was prescribed hypertension medication due to his persistent mild elevations in blood pressure. There are no private or VA treatment records that preexist this as it relates to hypertension, other than an elevated blood pressure reading in May 2002. See May 2002 VA treatment record. The record also showed that the Veteran has been taking continuous medication for his hypertension. See VA treatment records. Therefore, the first element of direct service connection is established. The Board also finds that the second element of service connection is met and finds that the Veteran experienced a qualifying in-service event. In January 2024, VA issued a memorandum confirming Veteran's herbicide agent exposure during his active-duty service in Vietnam. See January 2024 VA memorandum. The VA found that therefore the Veteran participated in a toxic exposure risk activity (TERA). Id. The Board now turns to the final element of service connection, whether there is a nexus between the Veteran's current hypertension diagnosis and his in-service herbicide agent exposure. The Board finds that record shows that this element has been met. The Board has previously found the December 2019 VA examination to be inadequate by failing to consider current relevant medical science regarding the association between hypertension and herbicide agent exposure. See July 2021 Board decision; see also, Barr, 21 Vet. App. at 311. The Board has also previously found the Veteran's October 2021 VA examination and medical opinion addressing his claimed hypertension to be inadequate. See October 2023 Board decision. While the examiner provided an opinion on how it was less likely that the hypertension was due to Agent Orange exposure in service, the examiner did not address the incurrence of elevated blood pressure indicating hypertension during service. The Veteran's blood pressure was recorded as 110/70 during his January 1966 enlistment examination, and as 130/80 at the time of his November 1967 separation examination. Therefore, the Board found the October 2021 examination to be inadequate. Barr, supra. A VA medical opinion was provided in May 2024 for a medical opinion for TERA. Initially in the medical opinion, the examiner checked off that the Veteran's condition was less likely than not due to service. However, in the rationale, the examiner noted the Veteran's exposure to herbicide agents, and stated "hypertension has been linked to Agent Orange exposure." See May 2024 VA examination. The examiner then concluded that the Veteran's hypertension was less likely than not caused by the indicated TERA. Thereafter, within the same opinion, the examiner stated twice more that "Agent Orange has been linked to development of hypertension. In my opinion, the Veteran's hypertension was at as least as likely as not related to his military service given history of Agent Orange exposure." Id. The Board concludes that given the totality of the May 2024 medical opinion, it is clear that the examiner found the Veteran's hypertension to be due to his TERA exposure, and the indications to the contrary were typographical errors. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter, specifically in consideration of the clear positive findings for nexus in the May 2024 medical opinion given the relationship between herbicide agent exposure and hypertension as well as the elevation in blood pressure readings in the Veteran's separation examination. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. §3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The Board notes that another medical opinion was provided in September 2024 for secondary service connection. However, as the Board is already granting service connection on a direct basis, the opinion is not relevant to adjudication. Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for hypertension on a direct basis. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Matta, Martina Y. 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.