HYPERTENSION

Summary

The Veteran served in the Army National Guard from May 1991 to December 1991 and in the Air Force Reserve from September 1999 to January 2000. The Veteran appeals the denial of service connection for a psychiatric condition, including depression, and seeks service connection for hypertension, kidney disease, prostate cancer, and non-Hodgkin's lymphoma. The Board granted service connection for hypertension, kidney disease, prostate cancer, and non-Hodgkin's lymphoma. For hypertension, the Board found the evidence in equipoise, resolving doubt in the Veteran's favor, citing a private medical opinion from Dr. S.R.B. that linked it to TERA exposure, which outweighed a negative VA opinion. For kidney disease, prostate cancer, and non-Hodgkin's lymphoma, the Board relied on favorable AOJ findings for current diagnosis and TERA exposure, and then applied the benefit of the doubt to a private medical opinion from Dr. S.R.B. that linked these conditions to TERA, finding it more probative than a negative VA opinion. The claim for a psychiatric condition, including depression, as secondary to service-connected disabilities was remanded. The VA examiner provided a negative nexus opinion for the psychiatric condition, failing to address aggravation, which was deemed a predecisional error. The case will be remanded for addendum opinions addressing both causation and aggravation of the psychiatric condition.

Rationale

Evidence in equipoise; Benefit of the doubt resolved in Veteran's favor; Private opinion more probative than VA opinion

Full Decision Text

Citation Nr: A26038491
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 250819-574885
DATE: April 24, 2026

ORDER

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for kidney disease is granted.

Entitlement to service connection for prostate cancer is granted.

Entitlement to service connection for non-hodgkin's lymphoma is granted.

REMANDED

Entitlement to service connection for psychiatric condition to include depression, as secondary to service-connected disabilities, is remanded.

FINDINGS OF FACT

1. The Veteran's hypertension is related to his military service.

2. The Veteran's kidney disease is caused by, or otherwise related to, his military service.

3. The Veteran's prostate cancer is caused by, or otherwise related to, his military service.

4. The Veteran's non-hodgkin's lymphoma is caused by, or otherwise related to, his military service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for entitlement to service connection for kidney disease are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for entitlement to service connection for prostate cancer are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

4. The criteria for entitlement to service connection for non-hodgkin's lymphoma are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army National Guard from May 1991 to December 1991 and in the Air Force Reserve from September 1999 to January 2000.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2024 and February 2025 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO), also known as the Agency of Original Jurisdiction (AOJ).

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 and February 2025 AOJ decisions, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

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, 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.  See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 

Service connection for a disability may also be granted on a secondary basis if a Veteran has: (1) a current disability; and (2) the
 active service.  38 U.S.C. §§ 1110, 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.  See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 

Service connection for a disability may also be granted on a secondary basis if a Veteran has: (1) a current disability; and (2) the current disability was either (a) caused or (b) aggravated beyond its natural progression by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

In addition to the laws and regulations outlined above, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b).

If the disorder was not "noted" at the time of induction, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304; Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); VAOPGCPREC 3-03 (July 16, 2003).

When no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the veteran's disability was both preexisting and not aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" preexisting condition. 38 U.S.C. § 1153. If this burden is met, then the veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under section 1111, the veteran's claim is one for service connection. See 38 C.F.R. § 3.322. Wagner, supra.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, 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 the evidence is persuasively against the claim, in which case the claim is denied. Id.

1. Entitlement to service connection for hypertension is granted.

The Veteran contends that he suffers from hypertension as a result of his military service.  See August 2024 NOD; November 2025 Representative Brief.

The presumption of soundness applies only when a disease or injury not noted upon entry to service manifests in service, and a question arises as to whether it preexisted service.  Gilbert v. Shinseki, 26 Vet. App. 48, 55 (2012), aff'd 749 F.3d 1370 (Fed. Cir. 2014).  In this case, there is a question as to whether the claimed hypertension preexisted the Veteran's military service from May 1991 to December 1991 and from September 1999 to January 2000.  Specifically, the Veteran's November 1990 entrance examination recorded a blood pressure reading of 140/88, which a VA examiner later described as meeting the definition of hypertension.  See December 2024 VA hypertension examination and opinion.

The appellant established "veteran" status based on active duty service.  See Hill v. McDonald, 28 Vet. App. 243 (2016).  The Veteran's appeal is based on the periods of active duty from May 1991 to December 1991 and from September 1999 to January 2000
 whether the claimed hypertension preexisted the Veteran's military service from May 1991 to December 1991 and from September 1999 to January 2000.  Specifically, the Veteran's November 1990 entrance examination recorded a blood pressure reading of 140/88, which a VA examiner later described as meeting the definition of hypertension.  See December 2024 VA hypertension examination and opinion.

The appellant established "veteran" status based on active duty service.  See Hill v. McDonald, 28 Vet. App. 243 (2016).  The Veteran's appeal is based on the periods of active duty from May 1991 to December 1991 and from September 1999 to January 2000.  

The Veteran's November 1990 entrance examination is absent of any notations of defects, infirmities, or disorders; although a blood pressure reading of 140/88 was indicated, the significance of that finding was not noted nor was hypertension diagnosed.  The corresponding report of medical history shows the Veteran responded "Don't Know" for high or low blood pressure, and the remarks for that notation stated that blood pressure readings were high if a normal cuff was used but normal if a wide cuff was used.  Similarly, the December 1998 Air Force entrance examination indicated heart and vascular systems were clinically normal.  A BP reading of 139/89 was noted but there was no diagnosis of hypertension.  The corresponding report of medical history shows the Veteran endorsed high or low blood pressure, and the remarks note that BP was elevated three to four years ago.  

Notwithstanding these findings, the most competent and credible evidence of record shows that the Veteran's hypertension did not manifest during the relevant period military service.  In this regard, the Board observes that at no point was a diagnosis of hypertension rendered during either period of the Veteran's service, despite documentation of blood pressure checks during service.  See, e.g., June 1991 service treatment record.  Moreover, a handwritten notation in the Veteran's STRs, that appears to be dated on or about August 3, 2001, indicates the Veteran had hypertension for one year and was prescribed Lotrel.  Based on the foregoing, the Board concludes there is no clear evidence that the Veteran's hypertension existed prior to either period of service or that it manifested during service.  Therefore, the presumption of soundness does not attach.  See Gilbert, 26 Vet. App. 48, 52 (2012).  Instead, the Board will adjudicate the appeal as one for direct service connection.

In its February 2025 rating decision, the AOJ favorably found that the Veteran has a diagnosis of hypertension, and that the Veteran has conceded exposure to toxins because of his military occupational specialty (MOS) of aircraft armament / missile system repair and aerospace maintenance.  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).  The Board, therefore, finds that the first and second elements of service connection have been met.  38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim.

The evidence against the claim includes a December 2024 VA examination report.  The examiner opined that the Veteran's hypertension existed prior to service and suggested it may be due to the Veteran's "genetic ability to salt response."  The examiner did not comment on the Veteran's in-service exposures.

The evidence in favor of the claim includes a September 2025 private opinion from Dr. S.R.B., received in November 2025.  Dr. S.R.B. opined that the Veteran's hypertension was due to his in-service exposure to jet fuels and solvents, reasoning that organic solvents have been shown to exacerbate oxidative stress, and that prolonged exposure can disrupt autonomic nervous system regulation further contributing to blood pressure abnormalities.

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypertension is related to service.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for kidney disease is granted.

3. Entitlement to service connection for prostate cancer is granted.

4. Entitlement to service connection for non-hodgkin's
 reasoning that organic solvents have been shown to exacerbate oxidative stress, and that prolonged exposure can disrupt autonomic nervous system regulation further contributing to blood pressure abnormalities.

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current hypertension is related to service.  Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for kidney disease is granted.

3. Entitlement to service connection for prostate cancer is granted.

4. Entitlement to service connection for non-hodgkin's lymphoma is granted.

The Veteran contends that he suffers from kidney disease, prostate cancer, and non-hodgkin's lymphoma because of his military service.  See August 2024 NOD; November 2025 Representative Brief.

In its December 2024 rating decision, the AOJ favorably found that the Veteran has a diagnosis of kidney disease, prostate cancer, and non-hodgkin's lymphoma.  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).  The Board, therefore, finds that the first element of service connection has been met.  38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

With respect to the second element of service connection, the Veteran avers that his kidney disease, prostate cancer, and non-hodgkin's lymphoma are a result of his exposure to toxic substances because of his MOS of aircraft armament/missile system repair and aerospace maintenance.  In its December 2024 rating decision, the AOJ favorably found that the Veteran participated in a toxic exposure risk activity (TERA) as a result of his MOS.  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).  The Board, therefore, finds that the second element of service connection has also been met.

Turning to the third element of a nexus, the Veteran underwent VA examinations for his kidney conditions and hematologic and lymphatic conditions in September 2024, with contemporaneous VA medical opinions.  The VA examiner opined that the Veteran's kidney disease, prostate cancer, and non-hodgkin's lymphoma are less likely than not a result of the Veteran's TERA exposure.  The VA examiner reasoned that there is no medically established nexus between these conditions and TERA exposure; rather, the examiner opined that these conditions are caused by other factors than TERA exposure.  As such, the examiner opined a negative nexus.

In November 2025, the VA submitted a private medical report from Dr. S.R.B., who opined that it is at least as likely as not that the Veteran's kidney disease, prostate cancer, and non-hodgkin's lymphoma are a result of his TERA.  Dr. S.R.B. cited substantial medical literature to support the proposition that these conditions are, indeed, connected to TERA.

Given the foregoing and resolving any reasonable doubt in favor of the Veteran, the Board finds that the record is at least approximately balanced as to whether the Veteran's kidney disease, prostate cancer, and non-hodgkin's lymphoma are related to his military service.  The Board acknowledges that the September 2024 VA examiner found a negative nexus for the Veteran's kidney disease, prostate cancer, and non-hodgkin's lymphoma. The Board finds, however, that the Veteran's lay statements have been credible and consistent with the medical record as a whole, and are corroborated by the positive nexus opinion of Dr. S.R.B.  Although the private medical opinion was not based upon a physical examination of the Veteran, the Board finds it sufficiently probative as to place the evidence at least in approximate balance when compared to the September 2024 VA medical opinion, particularly as Dr. S.R.B.'s opinion contains a far more extensive rationale and accurately cites to substantial medical literature to support his conclusions.

Accordingly, the claims for service connection for kidney disease, prostate cancer, and non-hodgkin's lymphoma are granted.

REASONS FOR REMAND

The Veteran contends that he suffers from a psychiatric condition as a result of his military service.  See August 2024 NOD; November 2025 Representative Brief.

The Veteran was afforded a VA opinion in September
 Although the private medical opinion was not based upon a physical examination of the Veteran, the Board finds it sufficiently probative as to place the evidence at least in approximate balance when compared to the September 2024 VA medical opinion, particularly as Dr. S.R.B.'s opinion contains a far more extensive rationale and accurately cites to substantial medical literature to support his conclusions.

Accordingly, the claims for service connection for kidney disease, prostate cancer, and non-hodgkin's lymphoma are granted.

REASONS FOR REMAND

The Veteran contends that he suffers from a psychiatric condition as a result of his military service.  See August 2024 NOD; November 2025 Representative Brief.

The Veteran was afforded a VA opinion in September 2024 to address secondary service connection for his psychiatric condition.  The Board finds, however, that the appeal must be remanded because the September 2024 VA medical opinion addressed secondary causation but not secondary aggravation, i.e., whether any service-connected disability aggravated the Veteran's psychiatric condition.  Both causation and aggravation should be addressed when a secondary service connection theory has been raised.  See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).  

Under the AMA, the Board's remand authority is generally limited to correcting predecisional duty to assist errors or to correct any other error in satisfying a regulatory or statutory duty. See 38 C.F.R. § 20.802(a).  For the reasons set forth above, the Board finds that a predecisional error was committed and remand is warranted.

This matter is REMANDED for the following action:

Obtain addendum VA medical opinions to determine the nature and etiology of the Veteran's psychiatric condition.  The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with this examination.  The Veteran should only be scheduled for another examination if it is deemed necessary by the clinician providing the opinion.

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?

Based on a review of the entire record, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's psychiatric condition is caused by, or aggravated by, the Veteran's service-connected disabilities.

A complete rationale for all opinions must be provided.  If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation.  The clinician must indicate whether there was any further need for information or testing necessary to make a determination.  Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner.

 

 

Luke Pelican

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Hillman, 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.