HYPERTENSION

Summary

The veteran, who served in the Army National Guard of Oklahoma from January 1962 to April 1964, with active duty training from March 1962 to September 1962, appeals the denial of service connection for hypertension and obstructive sleep apnea. The veteran claimed exposure to various toxins, including fuel, benzene, and gunpowder byproducts, for both conditions. Regarding hypertension, the Board found no presumptive service connection as it did not manifest in service or within the presumptive period, and the veteran acknowledged its onset post-service. A private medical opinion linking hypertension to toxic exposure was afforded little probative value due to its failure to address the veteran's full medical history, including renal transplant, polycystic kidney disease, and smoking history. A VA examiner opined that the hypertension was most plausibly explained by lifestyle factors like poor diet and smoking, citing medical literature, and afforded this opinion high probative value. The Board denied hypertension. For obstructive sleep apnea, the Board found no presumptive service connection and denied direct service connection, noting the veteran's post-service diagnosis and the VA examiner's opinion that it was more likely due to anatomical factors than toxic exposure. A private opinion suggesting a link to COPD and subsequent sleep apnea was not considered as COPD was denied in a separate decision. The Board denied both claims.

Rationale

No presumptive service connection (not chronic in service, outside presumptive period, no continuity); Private opinion afforded little probative value (failed to address full medical history, smoking, renal issues); VA examiner found hypertension most plausibly explained by lifestyle factors (poor diet, smoking); VA opinion considered TERA exposure and synergistic effects, found no established etiology for hypertension

Full Decision Text

Citation Nr: A26040473
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 251024-592825
DATE: April 30, 2026

ORDER

Service connection for hypertension is denied.

Service connection for obstructive sleep apnea is denied.

FINDINGS OF FACT

1. The Veteran's hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease.

2. The competent and probative evidence of record persuasively weighs against finding that the Veteran's obstructive sleep apnea began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for obstructive sleep apnea have not 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 had service in the Army National Guard of Oklahoma from January 1962 to April 1964, with a period of active duty training from March 1962 to September 1962 that is now considered active duty service based on a grant of service connection for bilateral hearing loss.

The rating decision on appeal was issued in September 2025, following a Board remand issued in July 2025, and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the October 24, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 15, 2025. 

Given that procedural history, the Board may only consider the evidence of record at the time of the September 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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, 1131, 5107; 38 C.F.R. § 3.303. The three-element test 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, to include 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. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708
 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases, to include 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. §§ 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).

Pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed related to service for veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

The Veteran's military personnel records do not show he had service in a location with presumed BPOT exposure. Therefore, the Veteran is not a "covered veteran" for whom BPOT exposure is presumed pursuant to 38 U.S.C. § 1119. However, the record contains VA memoranda dated in January 2024, June 2025, and July 2025 that establish the Veteran participated in a toxic exposure risk activity (TERA) based on his military occupation specialty; therefore, service connection may be established with proof of actual direct causation. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Service connection may be established on a secondary basis for a disability which is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding that "but for" causation or aggravation is sufficient to show entitlement to secondary service connection).

1. Service connection for hypertension.

The Veteran filed a claim in August 2023 seeking service connection for hypertension but did not provide any contentions regarding how the disability is related to service. See VA Form 21-526EZ. He testified in March 2025 that he was basing his claim for service connection on in-service exposure to toxins, to include fumes/exhaust, fuels, and gunpowder, and that he had been diagnosed with hypertension in approximately 1973. See hearing transcript; see also June 2025 post hearing memorandum. At the time of an August 2025 VA hypertension Disability Benefits Questionnaire (DBQ), the Veteran reported that hypertension had its onset in the 2000s and that the onset was gradual.

The favorable finding made in conjunction with this claim is that the Veteran has been diagnosed with hypertension. See rating decisions dated March 2024
 how the disability is related to service. See VA Form 21-526EZ. He testified in March 2025 that he was basing his claim for service connection on in-service exposure to toxins, to include fumes/exhaust, fuels, and gunpowder, and that he had been diagnosed with hypertension in approximately 1973. See hearing transcript; see also June 2025 post hearing memorandum. At the time of an August 2025 VA hypertension Disability Benefits Questionnaire (DBQ), the Veteran reported that hypertension had its onset in the 2000s and that the onset was gradual.

The favorable finding made in conjunction with this claim is that the Veteran has been diagnosed with hypertension. See rating decisions dated March 2024 and September 2025. The Board is bound by this finding. See 38 C.F.R. § 3.104(c). The question for the Board to resolve is whether the Veteran's hypertension is presumptively or directly related to service, to include as a result of his participation in a TERA.

Hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. In fact, the Veteran testified in March 2025 that he was diagnosed with hypertension in approximately 1973, which is approximately 11 years after separating from active service and approximately a decade outside of the applicable presumptive period. Moreover, the Veteran and his attorney made clear at the December 2025 Board hearing that there was no assertion the condition began within a year of the Veteran's discharge from service. For these reasons, service connection for hypertension is not warranted on a presumptive basis. 

Service connection for hypertension may still be granted on a direct basis; however, the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's hypertension and an in-service injury, event, or disease, to include his participation in a TERA. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The Board points out that at the December 2025 hearing, the Veteran's attorney made it clear that there was no assertion that the condition began in service. That leaves the Board to determine whether the Veteran's hypertension is directly related to his participation in a TERA.

As it did in the July 2025 remand, the Board acknowledges the March 2025 private opinion by Dr. R.P. which found that "[g]iven [the Veteran's] documented exposures during service - including fuel, benzene, lead, and gunpowder combustion byproducts - and the medical literature supporting the long-term impact of these substances on cardiovascular health, it is as least as likely as not that his hypertension is service-connected." The Board notes as it did in July 2025 that Dr. R.P. bases this finding on medical literature showing an increased likelihood for developing hypertension due to "higher, "prolonged," or "long-term" exposure to such toxins; however, Dr. R.P. did not explain what the medical literature considers to be higher, prolonged, or long-term exposure to these toxins or sufficiently relate the medical literature to the Veteran's specific circumstances. The Board also notes as it did in July 2025 that Dr. R.P. also did not address the Veteran's medical history, which includes renal transplant and polycystic kidney disease, as well as an extensive smoking history. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Since the Board finds that this opinion does not consider the Veteran's entire medical history and only considers his participation in a TERA, it is not afforded probative value.  

The Board remanded the claim in July 2025 for an opinion. The August 2025 VA examiner opined that the Veteran's hypertension is not at least as likely as not related to an in-service injury, event, or disease, including his participation in a TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The rationale was that the Veteran's hypertension was not caused by remote exposure of approximately six months during military service in 1962 to fuel, benzene, lead, gunpowder combustion byproducts, polyc
 history and only considers his participation in a TERA, it is not afforded probative value.  

The Board remanded the claim in July 2025 for an opinion. The August 2025 VA examiner opined that the Veteran's hypertension is not at least as likely as not related to an in-service injury, event, or disease, including his participation in a TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The rationale was that the Veteran's hypertension was not caused by remote exposure of approximately six months during military service in 1962 to fuel, benzene, lead, gunpowder combustion byproducts, polycyclic aromatic hydrocarbons, sulfur oxides, or volatile organic compounds, since current medical literature, with citation, does not support these environmental exposures as established etiologies of hypertension. The examiner noted that instead, review of the Veteran's medical history reveals a long-standing poor diet and a significant smoking history of more than 40 pack-years, both of which are well-established risk factors for the development of essential hypertension. The examiner cited to medical literature that establishes tobacco use contributes to vascular damage, endothelial dysfunction, and increased arterial stiffness, all of which promote elevated blood pressure, and also cited to medical literature that establishes dietary patterns high in sodium and processed foods and low in fruits and vegetables are similarly strongly associated with hypertension. The examiner concluded that the Veteran's hypertension is most plausibly explained by lifestyle factors rather than brief, remote environmental exposures during military service. This opinion, which considers the assertions raised in conjunction with the claim and the medical evidence specific to this Veteran, and provides an explanation that contains clear conclusions and supporting data, is afforded high probative value. Id. 

The Board notes at this juncture that at the time of the December 2025 hearing, the Veteran's attorney indicated that he was not qualified to address the issue of the cause of the Veteran's hypertension and that a medical opinion to support the claim would be submitted within the evidentiary window of this appeal. No such opinion has been received within the applicable timeframe. In short, the only opinions of record are the private opinion from Dr. R.P., which has not been afforded any probative value, and the VA examiner's opinion, which has been afforded high probative value.

While the Veteran believes the claimed hypertension is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent and probative medical evidence provided by the VA examiner.

In sum, the weight of the competent and probative evidence does not support the claim for service connection for hypertension on a presumptive or direct basis. The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied.

2. Service connection for obstructive sleep apnea.

The Veteran filed a claim in August 2023 seeking service connection for obstructive sleep apnea but did not provide any contentions regarding how the disability is related to service. See VA Form 21-526EZ. He testified in March 2025 that he was diagnosed with sleep apnea after service and was prescribed a CPAP machine in 2020. See hearing transcript; see also June 2025 post-hearing memorandum. At the time of an August 2025 VA sleep apnea DBQ, the Veteran reported that sleep apnea had its onset in 2022 and that the onset was gradual.

The favorable finding made in conjunction with this claim is that the Veteran has been diagnosed with obstructive sleep apnea. See rating decisions dated March 2024 and September 2025. The Board is bound by this finding. See 38 C.F.R. § 3.104(c). The question for the Board to resolve is whether the Veteran's obstructive sleep apnea is directly related to service, to include the Veteran's participation in a TERA. 

The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's obstructive sleep apnea began during service or is otherwise related to an in-service injury, event, or disease, to include his participation in a TERA. The Board points out that at the December 2025 hearing, the Veteran's attorney made it clear that there was no assertion that the condition began in service.

A September 2014 VA treatment record documents that
. The Board is bound by this finding. See 38 C.F.R. § 3.104(c). The question for the Board to resolve is whether the Veteran's obstructive sleep apnea is directly related to service, to include the Veteran's participation in a TERA. 

The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's obstructive sleep apnea began during service or is otherwise related to an in-service injury, event, or disease, to include his participation in a TERA. The Board points out that at the December 2025 hearing, the Veteran's attorney made it clear that there was no assertion that the condition began in service.

A September 2014 VA treatment record documents that the Veteran reported he was diagnosed and treated for sleep apnea in 2002, at which time he weighed 240 pounds. 

As it did in the July 2025 remand, the Board acknowledges the March 2025 private opinion by Dr. R.P., which essentially opined that the Veteran's obstructive sleep apnea was secondary to chronic obstructive pulmonary disease (COPD) "given our veteran's prolonged exposure to fuel exhaust, volatile organic compounds (VOCs), and other toxins during service, along with the well-established medical literature linking these exposures to COPD and COPD's direct role in the development of OSA..." However, the Veteran is not service connected for COPD, and the Board is denying that claim in a separate decision under a different docket number; therefore, service connection for obstructive sleep apnea on a secondary basis is not for application. Dr. R.P. did not address whether service connection for obstructive sleep apnea was warranted on a direct basis.

The Board remanded the claim in July 2025 for an opinion. The August 2025 VA examiner opined that the Veteran's obstructive sleep apnea is not at least as likely as not related to an in-service injury, event, or disease, including his participation in a TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The rationale was that the Veteran's obstructive sleep apnea is not related to six months of exposure in 1962 to fuel, benzene, lead, gunpowder combustion byproducts, polycyclic aromatic hydrocarbons, sulfur oxides, or volatile organic compounds since current medical literature, with citation, does not establish these substances as causative factors for obstructive sleep apnea. The examiner noted that instead, the Veteran's obstructive sleep apnea is more directly attributable to anatomical factors, specifically the presence of a narrow oropharynx, which is a well-documented and widely recognized risk factor for the disorder due to recurrent pharyngeal collapse during sleep, with citation to the medical literature. The examiner concluded that the most likely explanation for the Veteran's obstructive sleep apnea is structural airway narrowing rather than toxic exposures during military service. This opinion, which considers the assertions raised in conjunction with the claim and the medical evidence specific to this Veteran, is afforded high probative value. See Nieves-Rodriguez, 22 Vet. App. at 301.

During the December 2025 hearing, the Veteran's attorney indicated that the Veteran had been diagnosed with sleep apnea sometime between 2012 and 2017 and asserted that even if the Veteran had anatomical factors that pre-existed service, as noted by the VA examiner who provided an opinion after the Board's July 2025 remand, his exposure to certain inhaled toxins like solvents, degreasers, fumes, things of that nature, can predispose the oropharynx to be more susceptible to collapse and either cause or aggravate the development of sleep apnea. The Veteran and his attorney are not competent to make this assertion because neither has the necessary specialized medical education. Jandreau, 492 F.3d at 1377. And although the Veteran's attorney indicated that a nexus opinion addressing that contention would be submitted within the evidentiary window, no such opinion has been received by the Board. 

In short, the only opinion of record that addresses whether service connection for the Veteran's obstructive sleep apnea is warranted on a direct basis is that provided by the August 2025 VA examiner, which stands uncontroverted in the record.

While the Veteran believes the claimed obstructive sleep apnea is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Id. Consequently, the Board gives more probative weight to the competent and probative medical evidence provided by the VA examiner.

In sum, the weight of the competent and probative
 such opinion has been received by the Board. 

In short, the only opinion of record that addresses whether service connection for the Veteran's obstructive sleep apnea is warranted on a direct basis is that provided by the August 2025 VA examiner, which stands uncontroverted in the record.

While the Veteran believes the claimed obstructive sleep apnea is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Id. Consequently, the Board gives more probative weight to the competent and probative medical evidence provided by the VA examiner.

In sum, the weight of the competent and probative evidence does not support the claim for service connection for obstructive sleep apnea. The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied. 

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Van Wambeke, 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.