HYPERTENSION

Summary

The veteran served in the Marine Corps from July 1973 to December 1975. The veteran appeals the denial of service connection for hypertension and the remand of service connection for chronic obstructive pulmonary disease (COPD). Regarding hypertension, the Board acknowledged favorable findings for the existence of a current disability and participation in a toxic exposure risk activity (TERA) at Camp Lejeune. However, the Board found that the evidence did not establish a nexus to service. The veteran's own statements placed the onset of hypertension around 1995, approximately 20 years after service, and the service treatment records did not indicate any complaints or treatment for hypertension during service. A January 1974 report showed normal blood pressure. A VA examiner's initial opinion in September 2023 favored service connection based on Agent Orange exposure, but this was later deemed erroneous as the veteran was not exposed to Agent Orange. A subsequent VA examination in April 2024 concluded that hypertension was less likely than not caused by Camp Lejeune water contamination, citing a lack of objective evidence linking hypertension to TCE, benzene, or PCE exposure. The Board found this latter opinion adequate and more probative than the veteran's lay statements regarding etiology. The Board denied service connection for hypertension. The claim for COPD was remanded due to a duty to assist error. The AOJ had made a favorable finding for TERA participation for COPD, but the VA examiner noted the veteran had never been diagnosed with COPD and failed to attend scheduled diagnostic testing. The Board found that the VA did not adequately reschedule testing after the veteran attempted to comply, necessitating a remand for further diagnostic testing and an updated opinion.

Rationale

No nexus to service established; Hypertension onset long after service; VA examination found less likely than not caused by TERA

Full Decision Text

Citation Nr: A26039052
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250403-547761
DATE: April 27, 2026

ORDER

Entitlement to service connection for hypertension is denied.

REMANDED

Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded.

FINDING OF FACT

The weight of the persuasive lay and medical evidence shows that hypertension had its onset many years after separation from service. The evidence of record does not establish a causal relationship between an in-service toxic exposure and the Veteran's hypertension. The evidence of record persuasively weighs against finding that the Veteran's hypertension is related to exposure to water contamination at Camp Lejeune.

CONCLUSION OF LAW

The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from July 1973 to December 1975.

In April 2024, the Agency of Original Jurisdiction (AOJ) issued one of the rating decisions on appeal, which, in relevant part, denied service connection for COPD.

In April 2024, the AOJ issued the other rating decision on appeal, which denied service connection for hypertension.

In April 2025, the Veteran submitted an unsigned VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD). Thus, in May 2025, the Veteran was sent a BVA NOD clarification letter, informing the Veteran that he needed to submit a new VA Form 10182 that contained a signature. Thereafter, in May 2025, the Veteran submitted a signed VA Form 10182, Decision Review Request: Board Appeal (NOD), and elected the Evidence Submission option. Accordingly, the Board may only consider the evidence of record at the time of the April 3, 2024 rating decision for the issue of entitlement to service connection for COPD, as well as any evidence submitted by the Veteran or his attorney with the VA Form 10182 or within 90 days of receipt of the May 2025 VA Form 10182. The Board may only consider the evidence of record at the time of the April 18, 2024 rating decision for the issue of entitlement to service connection for hypertension, as well as any evidence submitted by the Veteran or his attorney with the VA Form 10182 or within 90 days of receipt of the May 2025 VA Form 10182. If evidence was submitted either (1) during the period after the AOJ issued the April 3, 2024 rating decision 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 for the issue of entitlement to service connection for COPD. 38 C.F.R. §§ 20.300, 20.303, 20.801. If evidence was submitted either (1) during the period after the AOJ issued the April 18, 2024 rating decision 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 for the issue of entitlement to service connection for hypertension. Id.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the claims. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file 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. As the Board is remanding the claim of entitlement to service connection for COPD, any evidence the Board could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

In seeking VA disability compensation, a Veteran generally seeks to establish that
 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. As the Board is remanding the claim of entitlement to service connection for COPD, any evidence the Board could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303.

Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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 or aggravated during service. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases, including hypertension, 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. §§ 1110, 1131, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Entitlement to service connection for hypertension

The Veteran claims entitlement to service connection for hypertension. Following a thorough review of the Veteran's medical records, the Board finds that an award of service connection is not warranted.

In the April 2024 rating decision, the AOJ made favorable findings that established the first and second elements of service connection for hypertension. Specifically, the Veteran was diagnosed with hypertension in a September 2023 VA contract hypertension disability benefits questionnaire (DBQ). Additionally, the evidence of record showed participation in a toxic exposure risk activity (TERA). Specifically, the Veteran was exposed to Camp Lejeune contaminated water. As the Board is bound by these favorable findings, the analysis will focus on whether a nexus exists between the Veteran's current hypertension and his active duty service.

In the April 2023 claim, the Veteran wrote, "I was stationed at Camp Lejeune in 1973." In correspondence received in May 2025, the Veteran wrote, "I have had uncontrollable high blood pressure for over three decades, it's in my medical record." This places the onset of high blood pressure circa 1995, or about 20 years after separation from service.

Under 38 C.F.R. §§ 3.307 and 3.309, there is a presumption of service connection for certain diseases based on exposure to contaminants present in the water supply at Camp Lejeune. To qualify for presumptive service connection, there must be evidence of: (1) a diagnosis of one of the enumerated diseases under 38 C.F.R. § 3.309(f), if it manifests to a degree of 10 percent or more at any time after service; and (2) service of at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987.

Pursuant to 38 C.F.R. § 3.309(f), diseases subject to presumptive service connection based on exposure to contaminated water are: kidney cancer, liver cancer, non-H
 Camp Lejeune. To qualify for presumptive service connection, there must be evidence of: (1) a diagnosis of one of the enumerated diseases under 38 C.F.R. § 3.309(f), if it manifests to a degree of 10 percent or more at any time after service; and (2) service of at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987.

Pursuant to 38 C.F.R. § 3.309(f), diseases subject to presumptive service connection based on exposure to contaminated water are: kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic myeloma with other myelodysplastic syndromes and bladder cancer. Hypertension is not an enumerated disease under 38 C.F.R. § 3.309(f). Thus, the Board finds that a presumption of service connection based on exposure to contaminants present in the water supply at Camp Lejeune is not warranted in this case.

VA regulations require that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, note 1. A compensable evaluation for hypertension is assigned when diastolic pressure is predominantly 100 or more, or; systolic pressure is predominantly 160 or more, or; for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. See 38 C.F.R. § 4.104, Diagnostic Code 7101.

The Board finds that entitlement to presumptive service connection for a chronic disease is not warranted because the persuasive weight of the evidence does not show that hypertension had its onset in service or within a year of separation. In this case the record does not indicate, and the Veteran has not argued, that hypertension had its onset during service. The Veteran's service treatment records (STRs) do not show any complaints of or treatment for hypertension in service. A January 1974 Report of Medical Examination shows that the Veteran did not have high blood pressure. His blood pressure at the time was 96/60. 

The Veteran's statement on his claim form places the onset of high blood pressure around 1995, and medical evidence of record establishes the onset of hypertension in 2008, giving a range of about 20-33 years after separation from service for high blood pressure readings and eventual diagnosis. The Veteran is not claiming it began during service or within one year, and the evidence of record supports an onset long after service.

Thus, the Board finds that entitlement to presumptive service connection for a chronic disease under 38 C.F.R. §§ 3.307 and 3.309 is not warranted because the persuasive weight of the evidence does not show that hypertension had its onset in service or within a year of separation.

Turning to evidence of a causal relationship between the present disability and a disease or injury during service, in September 2023, an examiner determined that the Veteran's high blood pressure was at least as likely as not caused by the indicated TERA(s), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. She wrote, "He was exposed to Agent Orange while living at Camp Lejeune in the Marine Corps. Hypertension is a presumed condition as being caused by Agent Orange per the VA."

Thereafter, in April 2024, the September 2023 opinion was returned to the examiner who provided it because the opinion was erroneous and insufficient for rating purposes. Specifically, the September 2023 examiner provided a positive opinion for the Veteran's hypertension based on Agent Orange exposure; however, the Veteran was never exposed to Agent Orange. Therefore, the September 2023 opinion was determined to be erroneous and the examiner was asked to provide an addendum opinion based only on what VA conceded, specifically, Camp Lejeune contaminated water. 

The examiner determined that the Veteran's high blood pressure was less likely than not caused by Camp Lejeune water contamination - perchloroethylene (PCE), trichloroethylene (TCE), vinyl chloride, and benzene after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERAs of the Veteran. She wrote,
 September 2023 examiner provided a positive opinion for the Veteran's hypertension based on Agent Orange exposure; however, the Veteran was never exposed to Agent Orange. Therefore, the September 2023 opinion was determined to be erroneous and the examiner was asked to provide an addendum opinion based only on what VA conceded, specifically, Camp Lejeune contaminated water. 

The examiner determined that the Veteran's high blood pressure was less likely than not caused by Camp Lejeune water contamination - perchloroethylene (PCE), trichloroethylene (TCE), vinyl chloride, and benzene after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERAs of the Veteran. She wrote, "He was exposed to ethylenes in the water while living at Camp Lejeune in the Marine Corps. There is no objective evidence that hypertension is related to TCE, benzene, or PCE exposure." She then cited to relevant medical literature in support of her opinion. The April 2024 VA examiner's addendum opinion provides clear conclusions with supporting data and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Thus, the Board finds this opinion adequate and probative regarding the Veteran's toxic exposures and hypertension.

The Board acknowledges the Veteran's lay statements; however, the evidence persuasively weighs against finding that the Veteran's hypertension is directly related to any in-service exposure to contaminated water. To the extent the Veteran believes his hypertension is related to his active-duty service, he is not medically competent to provide an opinion in this regard. While the Veteran is competent to report on certain observable medical issues, he is not competent in this case to link his current hypertension to his active service, to include exposure to contaminated water. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson and the Veteran does not have relevant medical training, experience, or education. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007). Therefore, he is not medically competent to provide an etiology opinion in this case. In contrast, the April 2024 examiner is competent to do so and has provided an adequate opinion supported by medical reasoning. Thus, the medical evidence of record is afforded more probative weight than the lay evidence of record on the question of nexus.

Based on analyses of potential exposures at Camp Lejeune and scientific studies involving these chemicals conducted by the National Academy of Sciences National Research Council (NRC), fifteen diseases were identified as having limited/suggestive evidence of an association with trichloroethylene, perchloroethylene, or a solvent mixture exposure. These include esophageal cancer, lung cancer, breast cancer, bladder cancer, kidney cancer, leukemia, multiple myeloma, myelodysplastic syndromes, renal toxicity, hepatic steatosis, female infertility, miscarriage, scleroderma, neurobehavioral effects, and non-Hodgkin's lymphoma. However, this research does not include hypertension. 

After sympathetic review of the record in this case, the Board finds that there is no competent evidence of record supporting a finding that the Veteran's current hypertension is due to his toxic exposure.

Therefore, the Board has reviewed all medical and lay evidence, but finds there is no probative evidence of record which establishes a causal relationship between the Veteran's hypertension and an in-service event or exposure. Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to service connection for hypertension is warranted. Rather, the evidence persuasively weighs against this. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch, 21 F.4th at 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied.

REASONS FOR REMAND

Entitlement to service connection for COPD is remanded.

The Veteran is also claiming entitlement to service connection for COPD. In an April 2023 claim, the Veteran wrote, "I was stationed at Camp Lejeune in 1973."

In the April 2024 rating decision, the AOJ made a favorable finding that established the second element of service connection for COPD. Specifically, the evidence of record showed participation in a TERA. Specifically, the Veteran was exposed to Camp Lejeune contaminated water
.4th at 776 (holding the benefit-of-the-doubt doctrine is not for application when the evidence is persuasively for or against the claim). The claim is denied.

REASONS FOR REMAND

Entitlement to service connection for COPD is remanded.

The Veteran is also claiming entitlement to service connection for COPD. In an April 2023 claim, the Veteran wrote, "I was stationed at Camp Lejeune in 1973."

In the April 2024 rating decision, the AOJ made a favorable finding that established the second element of service connection for COPD. Specifically, the evidence of record showed participation in a TERA. Specifically, the Veteran was exposed to Camp Lejeune contaminated water. The Board is bound by this favorable finding.

In a September 2023 examination for respiratory conditions, an examiner determined that the Veteran did not currently have, nor had he ever been diagnosed with, a respiratory condition. A Veterans Evaluation Service addendum provided the following additional report information: "Veteran...was scheduled for diagnostic testing on October 26, 2023 and was sent an appointment confirmation letter on October 16, 2023. They did not attend the scheduled diagnostic appointment and therefore the report was finalized without the additional testing." In the accompanying September 2023 opinion, the examiner wrote, "He has never been diagnosed with COPD and failed to get ordered imaging or testing for it both recently and in the past. There is no COPD diagnosis and therefore no opinion is warranted. The Veteran did not show for the testing."

Thereafter, in correspondence received in May 2025, the Veteran challenged the examiner's statement, writing that telephone records would prove that he called to reschedule his appointment because he had moved 200 miles away from the location of the diagnostic testing. He wrote that VA agreed to arrange transportation to the testing site or move the appointment to a closer location, but he never received a new appointment.

In this case, VA has determined that diagnostic testing is necessary to decide the Veteran's claim for service connection for COPD and they made initial efforts to schedule the Veteran for this testing. However, it also appears that the Veteran attempted to work with VA to reschedule the diagnostic testing. The Board finds a duty to assist error in not rescheduling the diagnostic testing when the Veteran made a good faith effort to comply but no longer lived in the area where the appointment was scheduled. Therefore, remand is required to correct this error with the necessary diagnostic testing and an updated opinion to be provided thereafter considering that testing. VA must document their attempts to notify the Veteran of this appointment in the claims file.

The matter is REMANDED for the following action:

1. Schedule the Veteran for all appropriate diagnostic testing to be conducted for his claimed COPD. Attempts to notify the Veteran of this appointment must be documented in the Veteran's claims file. The appointment should be scheduled at a location more convenient to his current residence, if possible. 

The examiner should conduct all appropriate diagnostic testing COPD. The examiner should then record all signs and reported symptoms, document all clinical findings, and provide a diagnosis for these symptoms if possible.

The examiner must then provide an opinion taking into consideration the results of the diagnostic testing for COPD. Based upon a review of the entirety of the claims file and the aforementioned diagnostic testing, the examiner is requested to provide an opinion as to the following questions:

(a.) Has the Veteran been diagnosed with COPD at any time close to or since April 2023?

If yes, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the COPD is related to the Veteran's toxic exposures (including Camp Lejeune water contamination - PCE, TCE, vinyl chloride, benzene)? Why or why not?

The examiner must consider the total potential exposure through all applicable military deployments and the synergistic, combined effect of all TERAs. The examiner must consider the Veteran's duties and any relevant lay statements in the record.

(b.) Were any non-COPD respiratory diagnoses present at any time close to or since April 2023?

For any such diagnosis, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the COPD is related to the Veteran's toxic exposures (including Camp Lejeune water contamination - PCE, TCE, vinyl chloride, benzene)? Why or why not?

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?

Explanations for all opinions must be provided. In providing the requested rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran's statements regarding the onset of his symptoms.

 

 

Laura E. Collins

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K.M.

The Board's decision in this case is binding only with