HYPERTENSION

L. STEPANICK · 2026 · Case ID: A26040707

DENIED

Summary

The veteran, who served in the Navy and Air Force across multiple periods between December 1990 and June 2018, appeals the denial of service connection for hypertension. The Board acknowledges favorable findings that the veteran has a current diagnosis of hypertension and that toxic exposure risk activity (TERA) is conceded. However, the Board found that the evidence did not support presumptive service connection for hypertension related to toxic exposures or demonstrate a nexus to military service. The earliest documented evidence of hypertension was from March 2012, during civilian employment, with no indication of hypertension during military service in March 2011. The Board noted a service treatment record from May 2014 mentioning hypertension treated with Lisinopril, but this was correlated with civilian employment, not military duty. The VA examiner concluded that the hypertension was less likely than not caused by service or TERA, attributing it to family history and lifestyle choices. The veteran argued that the VA limited the opinion to a 2018 onset, overlooking earlier evidence from 2013. The Board found the diagnosis occurred between March 2011 and March 2012, prior to any 2013 duty periods, and that the evidence persuasively indicated the hypertension was not incurred in service. Consequently, service connection for hypertension was denied.

Rationale

No presumptive service connection for hypertension due to TERA.; Earliest diagnosis occurred during civilian employment.; VA examiner found hypertension less likely than not caused by service or TERA.; Hypertension attributed to family history and lifestyle.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260102-619848

Full Decision Text

Citation Nr: A26040707
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260102-619848
DATE: April 30, 2026

ORDER

Service connection for hypertension is denied.

FINDING OF FACT

The Veteran's hypertension did not have its onset in service or within one year of service and is not otherwise etiologically related to service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Navy from December 1990 to December 1994 and in the United States Air Force from March 2002 to July 2002 and from January 2018 to June 2018, with additional periods of active and inactive duty for training in the United States Air Force Reserve.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2025 higher-level review rating decision.

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the February 2024 decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Service connection for hypertension is denied.

The Veteran contends that he is entitled to service connection for hypertension. December 2023 VA 21-526EZ, Fully Developed Claim (Compensation); January 2026 VA Form 10182, Notice of Disagreement.

Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

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 active service; or, if they were noted in service (or within a presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309; see Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service connection may be granted on a presumptive basis for hypertension associated with exposure to certain herbicide agents pursuant to The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. See PACT Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

As stated previously, the Veteran's active service in the United States Air Force occurred incident to his service in the reserve components. Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38?U.S.C. §?101(21), (24); 38?C.F.R. §?3.6(a), (d); Biggins v. Derwinski, 1?Vet. App.?474 (1991). ACDUTRA is, generally, full-time duty in the Armed Forces performed by reserves for training purposes. 38?C.F.R. §?3.6(c)(1).

Generally, the regulations concerning presumptive service connection, the presumption of soundness, and the presumption of aggravation are inapplicable to claims based upon ACDUTRA service. See Smith v. Shinseki, 24?Vet. App.?40 (2010); but see Hill v. McDonald, 28?Vet. App.?243, 250 (2016) ("once a claimant has achieved veteran status for a single disability incurred or aggravated during a period of ACDUTRA, veteran status applies to all disabilities claimed to have been incurred or aggravated during that period of ACDUTRA"). However, if Veteran status is established and a claimant submits documentation that, together with the rest of the record, evidences both the baseline severity of the preexisting condition prior to the period of ACDUTRA and a permanent increase in disability during a period of ACDUTRA, the claimant may take advantage of the presumption of aggravation. See Hill, at 255.

The AOJ has made two favorable findings pertaining to the Veteran's claim. First, the Veteran has a current diagnosis of hypertension. Second, toxic exposure risk activity (TERA) is conceded. April 2025 rating decision. Absent clear and unmistakable error, which is not present here, these favorable findings are binding on the Board. 38 C.F.R. § 3.104.

Given these favorable findings, the first two elements necessary to establish service connection are met. First, the Veteran has a current disability of hypertension. Second, he incurred an in-service injury via his participation in TERA. However, the evidence of record indicates that he is not entitled to a presumption of service connection based on his particular toxic exposures or duty locations, nor is there evidence of a nexus between his hypertension and his military service.

The Veteran received a VA examination pertaining to his claim. The examiner noted that the Veteran was diagnosed with hypertension in 2016 and he was prescribed medication to control it. It was not known whether the Veteran's initial diagnosis was based on blood pressure readings taken two or more times on three different days. January 2024 C&P exam (hypertension DBQ).

Another VA examiner rendered two medical opinions pertaining to the issue of nexus. The examiner addressed the issues of direct service connection and of whether the Veteran's hypertension was caused by the Veteran's participation in TERA. February 2024 C&P exam (medical opinion DBQ).

The examiner was specifically asked to assess whether the Veteran's documented high blood pressure in April 2018 represented the onset of the Veteran's condition. She stated that "There is evidence of hypertension prior to 4/15/2018. There is a STR dated 5/17/14 with mention of hypertension treated with Lisinopril. The claimed hypertension was less likely than not ... incurred in or caused by the onset 4/15/2018 during period of active duty during service." Id.

Additionally, the examiner concluded that the Veteran's hypertension was less likely than not caused by his participation in TERA. She stated that "Veteran has a history of hypertension. Although hypertension is recognized as presumptive due to certain toxic exposures it was not due to exposure while deployed in Qatar or from exposures from the veteran's MOS. Hypertension is due to family history and unhealthy
evidence of hypertension prior to 4/15/2018. There is a STR dated 5/17/14 with mention of hypertension treated with Lisinopril. The claimed hypertension was less likely than not ... incurred in or caused by the onset 4/15/2018 during period of active duty during service." Id.

The Veteran responded to the examiner's conclusions in his request for higher-level review and incorporated the same arguments into his notice of disagreement. December 2024 VA Form 20-0996, Request for Higher-Level Review; January 2026 VA Form 10182, Notice of Disagreement.

The Veteran argued as follows: "VA limited the requested opinion to the time Veteran was on active duty in 2018; however, there are high blood pressure readings and treatment in 2013 in addition to the fact that the 2/8/24 VA opinion noting ... 'There is a STR dated 5/17/14 with mention of hypertension treated with Lisinopril.' [bold underlined print in original]. ... STRs are not created if a service member is not on duty. ... The opinion request was too narrow, limiting the examiner to linking Veteran's hypertension to a 2018 onset when the evidence of record clearly indicates the onset and treatment earlier (2013) and while on duty. The date of onset alone is not the issue; service connection is the issue." Id.

The Veteran performed military service on six occasions in 2013. He performed one or two day periods of apparent IDT on the following dates: 3/16/2013, 4/20-4/21/2013, 5/18-5/19/2013, 6/22-6/23/2013, and 12/28/-12/29/2013. He performed two weeks of apparent ADT from 7/27/2013-8/10/2013. January 2023 Service Record (SR).

Initially, the Board notes that there is no evidence that the Veteran was exposed to herbicides while in service, whether in fact or presumptively due to duty location. See September 2023 other (TERA memorandum). Therefore, he does not qualify for presumptive service connection for hypertension pursuant to the PACT Act.

Turning to the date of onset, the Board notes that the earliest indication in the record of the Veteran's hypertension diagnosis is an STR note from March 2012. The Veteran received a flight physical related to his civilian employment as an aircraft structural repair supervisor. At the time, the Veteran "stated that he is currently taking blood pressure meds." The Veteran denied "any medical disorders except hypertension" and was "being treated for hypertension with Lisinopril." August 2022 STR (notes for 3/13/2012, 3/14/2012, and 3/17/2012).

As stated, this physical evaluation was for his civilian employment, not his military service. Further, the Veteran's only documented military service in March 2012 was approximately one week after the physical exam. See January 2023 Service Record (SR) (showing duty on 3/24/2012 and 3/25/2012). Consequently, the earliest documentation of the Veteran's hypertension diagnosis is correlated with a date on which he was not in a military duty status or otherwise performing military duties.

While the exact date of the Veteran's initial hypertension diagnosis is unclear, no diagnosis or prescribed medications were noted during the Veteran's occupational health exam in March 2011. August 2022 STR (3/2/2011 occupational exam). The Veteran reported a diagnosis and prescribed medication one year later at his next health exam. Thus, the evidence is persuasively in favor of a determination that the diagnosis occurred between March 2011 and March 2012.

The Board acknowledges the VA examiner's note that the Veteran's diagnosis occurred in 2016, but it is not clear what evidence that was based on. For the reasons stated, the Board finds that the diagnosis occurred in 2011 or early 2012.

The persuasive weight of the evidence indicates that the Veteran's hypertension was not incurred in service. There is no evidence tending to indicate aggravation of the condition while in service, either, so
3/2/2011 occupational exam). The Veteran reported a diagnosis and prescribed medication one year later at his next health exam. Thus, the evidence is persuasively in favor of a determination that the diagnosis occurred between March 2011 and March 2012.

The persuasive weight of the evidence indicates that the Veteran's hypertension was not incurred in service. There is no evidence tending to indicate aggravation of the condition while in service, either, so that issue is not raised. To address the Veteran's specific contention, the evidence indicates that he incurred hypertension before any of his duty periods in 2013.

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As the evidence is persuasively against the claim, service connection for hypertension must be denied.

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Dunn

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.

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