HYPERTENSION

Summary

The Veteran, a U.S. Navy Vietnam Veteran, appeals the denial of service connection for hypertension and bilateral peripheral neuropathy, and the remand of his claim for a tremor-related disorder. The Board granted service connection for hypertension, finding it presumptively linked to herbicide exposure in Vietnam, despite the initial denial by the agency of original jurisdiction (AOJ) based on blood pressure readings. The Board noted the Veteran's long history of hypertension and medication use, and applied the benefit of the doubt, finding the condition met the disability threshold. For bilateral peripheral neuropathy, the Board found the AOJ's initial denial inadequate, as the VA examiner's opinion was based solely on the PACT Act and did not consider other factors or provide a reasoned explanation. The Board found a private medical opinion from Dr. K.G. to be highly probative, citing scientific research linking TCDD in Agent Orange to nerve fiber deterioration and neuropathy. This opinion, combined with the Veteran's history and conceded herbicide exposure, led the Board to grant service connection for the neuropathy on a facts-found basis, resolving reasonable doubt in the Veteran's favor. The claim for a tremor-related disorder (Parkinsonism) was remanded because the Veteran, while experiencing tremors, lacked a formal diagnosis, and the VA examiner's opinion was insufficient, failing to provide a diagnosis or explain the etiology of the tremor in relation to service or herbicide exposure.

Rationale

PACT Act presumptive service connection for hypertension; Conceded herbicide exposure in Vietnam; Benefit of the doubt applied; Hypertension meets disability threshold despite medication use

Full Decision Text

Citation Nr: A26039036
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 260105-625998
DATE: April 27, 2026

ORDER

Entitlement to service connection for hypertension is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) is granted.

Entitlement to service connection for left lower extremity non-diabetic peripheral neuropathy is granted.

Entitlement to service connection for right lower extremity non-diabetic peripheral neuropathy is granted.

REMANDED 

Entitlement to service connection for a tremor-related disorder (claimed as Parkinsonism) is remanded. 

FINDINGS OF FACT

1. The Veteran served on active duty as a member of the U.S. Navy in the Republic of Vietnam and has a current diagnosis of hypertension; the Veteran's hypertension did not manifest in service or within a year of service. 

2. Resolving reasonable doubt in the Veteran's favor, his non-diabetic peripheral neuropathy of the left lower extremities is at least as likely as not related to conceded exposure to herbicide agent during his active duty service. 

3. Resolving reasonable doubt in the Veteran's favor, his non-diabetic peripheral neuropathy of the right lower extremities is at least as likely as not related to conceded exposure to herbicide agent during his active duty service. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for hypertension on a presumptive basis under the PACT Act have been met. 38 U.S.C. §§ 1100, 1116, 1116B, 5103A, 5017; 38 C.F.R. §§ 3.303, 3.307, 3.309.

2. The criteria for service connection for left lower extremity non-diabetic peripheral neuropathy have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for right lower extremity non-diabetic peripheral neuropathy have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Navy from October 1964 to October 1968, with service in the Republic of Vietnam; his awards include the Vietnam Service Medal with Bronze stars.

The rating decisions on appeal were  issued in July 2025 (hypertension) and October 2025 (peripheral neuropathy of the bilateral lower extremities and Parkinsonism). Both decisions constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

With respect to the claim of service connection for hypertension, in March 2025, the agency of original jurisdiction (AOJ) denied entitlement to service connection for hypertension. In March 2025, the Veteran requested Higher-Level Review by submitting VA Form 20-0996, Decision Review Request: Higher-Level Review. In June 2025, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. In July 2025, the AOJ issued the decision on appeal, which readjudicated the claim, again denying service connection.

For the claims of service connection for bilateral non-diabetic peripheral neuropathy and Parkinsonism, the Veteran submitted a new VA Form 21-626EZ in May 2025 and the AOJ, in pertinent part, denied the claims.

In the January 2026 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 July 2025 (hypertension) and October 2025 (bilateral peripheral neuropathy and Parkinsonism) decisions on appeal, as well as any evidence submitted by the Veteran, or his attorney 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 decisions on appeal 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.
 July 2025 (hypertension) and October 2025 (bilateral peripheral neuropathy and Parkinsonism) decisions on appeal, as well as any evidence submitted by the Veteran, or his attorney 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 decisions on appeal 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. 

However, because the Board is remanding entitlement to service connection for a tremor-related disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). 

As a final preliminary matter, the Board acknowledges that the Veteran's May 2025 claim was for service connection for Parkinsonism. See May 2025 VA Form 21-526EZ. However, based on the medical evidence of record during both the period on appeal and associated during the valid 90 day window following submission of the VA Form 10182, the Board finds that it is more appropriate to characterize the Veteran's May 2025 claim broadly, as a claim of entitlement to service connection for a tremor-related condition. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (holding that when a claimant makes a claim, the claimant is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled).

This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.800(c).

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. Generally, establishing 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).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service connection may also be established on a presumptive basis for certain enumerated diseases if a Veteran was exposed to an herbicide agent, such as Agent Orange, during service. With the passage of the PACT Act on August 10, 2022, hypertension is now one of the listed diseases presumed to be due to Agent Orange exposure, absent affirmative evidence to the contrary. See Honoring Our PACT Act of 2022, Pub. L. 117-168 (2022), 38 U.S.C. § 1116 (a)(1); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e).

Under 38 U.S.C. § 5107 (b), the VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of
 of the PACT Act on August 10, 2022, hypertension is now one of the listed diseases presumed to be due to Agent Orange exposure, absent affirmative evidence to the contrary. See Honoring Our PACT Act of 2022, Pub. L. 117-168 (2022), 38 U.S.C. § 1116 (a)(1); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e).

Under 38 U.S.C. § 5107 (b), the VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 ; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Service connection for hypertension.

The Veteran contends he developed hypertension as a result of herbicide agent exposure while serving in the Republic of Vietnam. Thus, he asserts he is entitled to presumptive service connection for the condition. See October 2024 VA Form 21-526EZ; March 2025 VA Form 20-0996; March 2025 VA Form 21-4138; March 2025 Correspondence; March 2026 Appellate Brief. 

As an initial matter, in the July 2025 rating decision, the AOJ favorably established that the Veteran has a diagnosis of hypertension and that he was exposed to herbicide agent during his active service in the Republic of Vietnam. 

The Board acknowledges that the AOJ, in the July 2025 rating decision on appeal, determined that the Veteran's diagnosed hypertension did not meet the VA regulatory definition of the condition. This conclusion was based on a March 2025 VA examination wherein the examiner confirmed the Veteran's pre-existing diagnosis of hypertension but the Veteran's blood pressure readings at that time did not rise to the level of a hypertension disability under 38 CFR § 4.104, Diagnostic Code 7101, Note (1). However, the Board notes that the Veteran has a long history of diagnosed hypertension and has been on medication for it for many years. See e.g., June 2014 VA treatment record. Furthermore, the Board is cognizant that it may not consider the ameliorative effects of medications. See Ingram v. Collins, 30 Vet. App. 130 (2025). Thus, the Board has determined that, even considering the Veteran's continuous use of antihypertensive medication to control his high blood pressure, his diastolic pressure may still rise to levels approximate to 90 mmHg. See e.g., March 2024 VA treatment record (blood pressure of 138/85 mm Hg). Therefore, the Board concludes that the medical evidence of record persuasively weighs in favor of finding that the Veteran's diagnosis of hypertension rises to the level of a disability under 38 C.F.R. § 4.104, DC 7101, Note (1).

As it has been established that the Veteran served on active duty in the Republic of Vietnam and is presumed to have been exposed to herbicide agent during that service, and he has a current diagnosis of hypertension, presumptive service connection for hypertension is warranted. 

2. Service connection for left lower extremity non-diabetic peripheral neuropathy. 

3. Service connection for right lower extremity non-diabetic peripheral neuropathy. 

The Veteran contends he developed non-diabetic peripheral neuropathy of the bilateral lower extremities due to exposure to toxins, specifically Agent Orange, in Vietnam. See May 2025 VA Form 21-526EZ; March 2026 Appellate Brief.

In the October 2025 rating decision, the AOJ favorably established that the Veteran has a current diagnosis of non-diabetic peripheral neuropathy of the left and right lower extremities as well as conceded exposure to herbicide agent and asbestos in service. Absent clear and unmistakable evidence to the contrary, the Board is bound by that favorable finding. 38 C.F.R. § 3.104 (c).

The Board notes that peripheral neuropathy of the lower extremities is not among the conditions recognized to be associated with exposure to herbicide agent; thus, the disability does not warrant presumptive service connection under 38 U.S.C. § 1116, 38 C.F.R. § 3.309 (e), or the PACT Act. However, where presumptive service connection is not warranted, a veteran is not precluded from establishing service connection for disability due to exposure to herbicide agent with evidence of direct causation. Combee v. Brown, 34
 Absent clear and unmistakable evidence to the contrary, the Board is bound by that favorable finding. 38 C.F.R. § 3.104 (c).

The Board notes that peripheral neuropathy of the lower extremities is not among the conditions recognized to be associated with exposure to herbicide agent; thus, the disability does not warrant presumptive service connection under 38 U.S.C. § 1116, 38 C.F.R. § 3.309 (e), or the PACT Act. However, where presumptive service connection is not warranted, a veteran is not precluded from establishing service connection for disability due to exposure to herbicide agent with evidence of direct causation. Combee v. Brown, 34 F.3d 1039, 1041 (Fed. Cir. 1994).  In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure.

Here, service treatment records (STRs) are silent as to any complaints of, or treatment for, peripheral neuropathy or neuropathic symptoms during the Veteran's active service. 

In March and April 2024, the Veteran complained of "persistent tingling in the bilateral feet and calf" to his VA provider. 

At a June 2024 private neurology consultation, the Veteran reported the onset of his neuropathic symptoms to be gradual, constant, and severe. Specifically, it was noted that the Veteran had been experiencing paresthesias for approximately 8-10 years prior to the consultation, but it was becoming progressively worse. At that time, he was assessed as having chronic paresthesia of skin, weakness, and abnormality of gait. After noting that the Veteran was a Vietnam Veteran, the provider ordered additional metabolic lab screenings in a search for an etiological source of the symptoms. See June 2024 treatment records from Little Rock Diagnostic Clinic (associated with claims file in September 2025). 

At a September 2025 VA examination of the peripheral nerves in his bilateral lower extremities, the Veteran reported that his symptoms onset 7-8 years prior and had been progressing. In his opinion, the VA examiner asserted that the Veteran reported a diagnosis of idiopathic peripheral neuropathy, which, he explained, implies an unknown etiological source. He also noted that the PACT Act does not recognize an association between peripheral neuropathy and herbicide agent for purposes of presumptive service connection. Finally, the examiner asserted that the Veteran's symptoms did not start within a year of his separation from service. Thus, he opined it less likely than not that the Veteran's neuropathy is due to his service, including exposure to herbicide agent. See September 2025 VA examination; September 2025 VA opinion

The Board finds the September 2025 opinion to be inadequate. The examiner relied solely on the PACT Act to determine that the Veteran's neuropathy was not associated with exposure to herbicide agent. He did not consider any external scientific research or address the Veteran's prior medical history to reach his conclusion. See generally Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018). As such, the September 2025 VA opinion as to the nature and etiology of the Veteran's peripheral neuropathy of the bilateral lower extremities is not probative. 

Notwithstanding the above, the Veteran submitted a private opinion from Dr. K.G. in March 2026, within the 90 day evidentiary window available for his appeal. Therein, Dr. K.G. explained that Agent Orange, the most prevalent herbicide agent used in Vietnam, contains a chemical known as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a highly toxic dioxin and arsenic. In short, Dr. K.G. cited research that noted the hydrophobic nature of the TCDD means the dioxin can "quickly penetrate into lipid membranes...allowing faster aggregation and consumption of the toxic chemical." Thus, the toxin can be stored in the fat of the body and "the speed of metabolism can vary, the latency period for both malignant and non-malignant conditions can be up to 50 years." See March 2026 private opinion by Dr. K.G., M.D.

Dr. K.G. noted that the Veteran first started exhibiting symptoms of neuropathy in the 2010s; however, causes of the condition remained uncertain, especially since the Veteran did not have a diagnosis of diabetes. He noted that "pathology and blood work did not reveal any protein abnormalities or recent toxin or chemical exposure that could cause" the neuropathy, nor was there anything in his medical history that would be responsible for the initial development of the condition.
, the toxin can be stored in the fat of the body and "the speed of metabolism can vary, the latency period for both malignant and non-malignant conditions can be up to 50 years." See March 2026 private opinion by Dr. K.G., M.D.

Dr. K.G. noted that the Veteran first started exhibiting symptoms of neuropathy in the 2010s; however, causes of the condition remained uncertain, especially since the Veteran did not have a diagnosis of diabetes. He noted that "pathology and blood work did not reveal any protein abnormalities or recent toxin or chemical exposure that could cause" the neuropathy, nor was there anything in his medical history that would be responsible for the initial development of the condition. Thus, he concluded it at least as likely as not that the Veteran's peripheral neuropathy of the bilateral extremities was caused by his exposure to herbicide agent in service; dioxins of which led to initial deterioration of the nerve fibers which eventually led to neuropathy. Id.

The Board finds Dr. K.G.'s opinion to be highly probative. It was not only based on his own training, experience, and review of the Veteran's medical history; but also, on the sum of several scientific articles associating the development of peripheral neuropathy with exposure to TCDD. See id.; March 2024 Correspondence. The Board is fully cognizant that VA has not associated exposure to herbicide agent with development of non-diabetic peripheral neuropathy; however, in viewing the sum of the evidentiary record in the light most favorable to the Veteran, the Board resolves any reasonable doubt in his favor and finds it at least as likely as not that his peripheral neuropathy of the bilateral lower extremities is due to exposure to herbicide agent. Thus, service connection for non-diabetic peripheral neuropathy of the left and right lower extremities is warranted on a facts-found basis as due to conceded exposure to herbicide agent in Vietnam and the claim is granted. 38 U.S.C. §5107(b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for a tremor-related disorder is remanded.  

The Veteran contends he experiences symptoms of Parkinsonism, specifically a tremor, due to exposure to herbicide agent during his active duty service. See May 2025 VA Form 21-526EZ.

Under the AMA, the Board may only remand an issue for the correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors) and (2)?AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. ?See?38?C.F.R. §?20.802(a).? Having reviewed the evidence of record, the Board finds that remand for a pre-decisional duty to assist error is required.

In the October 2025 rating decision, the AOJ favorably established that the Veteran participated in a toxic exposure risk activity including exposure to herbicides and asbestos.

Parkinsonism and Parkinsons's disease are conditions on the list of presumptive diseases associated with herbicide agent exposure.  38 U.S.C. §1116; 38 C.F.R. § 3.309.  However, the Veteran has not been diagnosed with either Parkinsonism or Parkinson's Disease. See October 2025 VA examination; Private Treatment records received March 19, 2026.

When a Veteran does not have a medical diagnosis that meets the requirements for presumptive service connection, he or she may nevertheless establish service connection on a "facts found" basis. 38 C.F.R. § 3.303; see also Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994) (a presumption is intended to provide veterans with an alternative means of proof rather than limiting them to an exclusive means of proof).

Here, the Veteran has competently reported to medical providers that he experiences tremors and falls. See e.g., January 2023 VA treatment record. In addition, the Veteran's spouse, C.D., a retired licensed practical nurse (LPN), has asserted that the Veteran experiences a tremor due to his exposure to in-service exposure to herbicide agent. See September 2025 Correspondence. Additional medical evidence of record supports both the Veteran's and C.D.'s reports. See September 2025 Correspondence; February 2023, April 2025 VA treatment records.

The Board observes that, as lay persons, both the Veteran and C.D. are competent to report on matters observed or within their
 exclusive means of proof).

Here, the Veteran has competently reported to medical providers that he experiences tremors and falls. See e.g., January 2023 VA treatment record. In addition, the Veteran's spouse, C.D., a retired licensed practical nurse (LPN), has asserted that the Veteran experiences a tremor due to his exposure to in-service exposure to herbicide agent. See September 2025 Correspondence. Additional medical evidence of record supports both the Veteran's and C.D.'s reports. See September 2025 Correspondence; February 2023, April 2025 VA treatment records.

The Board observes that, as lay persons, both the Veteran and C.D. are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). As such, they are competent to provide statements of symptoms that they personally experienced or witnessed. However, while the Veteran and C.D. are competent to report symptomatology, they have not demonstrated the requisite medical expertise to opine as to whether his symptoms rise to the level of a diagnosable condition. The Board acknowledges that C.D. is a retired LPN; however diagnosing a neurological condition, such as a tremor-related disability, is medically complex, as it requires knowledge of and skill in applying scientific and medical literature that C.D. has not been shown to possess. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007).

During an October 2025 VA examination, the VA examiner noted the Veteran had a tremor but concluded there was no evidence to establish a diagnosis for Parkinson's disease. See October 2025 VA examination. However, the examiner provided no additional explanation for her conclusion that the Veteran did not have Parkinson's disease nor did she explain whether the Veteran's tremor was a disability or provide an opinion as to whether the Veteran's tremor was related to his service, to include his conceded exposure to herbicides and asbestos. As such, the Board finds the October 2025 VA examination to be insufficient to use in adjudicating whether the Veteran has a tremor-related condition related to his active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301, 304 (2008) (explaining that a medical examination "must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two").

As the evidence shows the Veteran experiences persistent symptoms of a tremor and in consideration of the Veteran's conceded TERA participation, the Board finds that the AOJ erred in relying on the October 2025 examination in the October 2025 rating decision on appeal. Accordingly, remand is warranted to obtain an addendum medical opinion as to whether the Veteran's tremor is related to his active service, specifically his conceded exposure to herbicide agent and/or asbestos. 

The matter is REMANDED for the following:

Obtain an addendum medical opinion, with examination only if deemed necessary by the examiner, as to the nature and etiology of the Veteran's tremor.  The Veteran's entire claims file, including a copy of this remand, should be made available to the clinician and it should be reviewed in its entirety for the purpose of providing the requested opinion(s) below. All appropriate tests and studies must be accomplished, and all clinical findings should be detailed.

Thereafter the clinician should respond to the following:

(a.) Please identify any tremor or tremor-related disability by either (i) diagnosis or (ii) functional impairment.

(b.) For any tremor or tremor-related disability identified (other than Parkinson's disease or Parkinsonism), opine whether it is at least as likely as not (whether the likelihood is at least approximately balanced or nearly equal, if not higher) that disability had its onset in, or is otherwise related to the Veteran's active duty service. 

In doing so, the clinician must consider (1) the total potential exposure to herbicides and asbestos through all applicable military deployments of the Veteran and (2) the synergistic, combined effect of all toxic exposure risk activities (TERA) of the Veteran. 

Please provide a rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an adequate opinion cannot be provided, the clinician should indicate why.  

 

 

Tiffany Dawson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	O'Neil, A.

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.