A0 Hypertension More info

[Berta]

I was trying to find any other AO HBP awards at the BVA, other than the one I posted here, and it takes quite a bit of time to go through their decisions, regarding AO and HBP but I found many remands on this , and certainly feel that many veterans have a chance to get their HBP service connected to Agent Orange-particularly if the VA has deemed their HBP as "essential:

There are quite a few claims at the BVA on remand for Hypertension due to AO exposure:

“The February 2018 opinion is inadequate because subsequent to the opinion, the NAS moved hypertension from the “limited or suggestive” category and indicated that there is now “sufficient evidence” of an association between hypertension and Agent Orange exposure. See Veterans and Agent Orange: Update 11 (2018). In addition, the Board points out that it does not need to be shown that Agent Orange “definitively” caused the Veteran’s hypertension. Rather, it need only be “at least as likely as not” (i.e. at least a 50 percent probability) that a relationship exists between his hypertension and Agent Orange exposure."

 

"The Board cannot make a fully-informed decision on the issue of entitlement to service connection for hypertension because no VA examiner has adequately opined whether the Veteran’s hypertension is related to his Agent Orange exposure in service. Therefore, an appropriate medical opinion should be obtained upon remand.”

https://www.va.gov/vetapp19/files6/19149054.txt

 

“While the March 2011 examiner opined that the Veteran’s hypertension was not caused by or a result of his service connected DMII, the examiner did not address the Veteran’s presumed exposure to Agent Orange.  Recently, hypertension was moved from the “limited or suggestive” category to the category of “sufficient” evidence of an association.  Veterans and Agent Orange: Update 11 (2018).  However, hypertension has not yet been added to the list of diseases for which veterans exposed to Agent Orange are entitled to service connection on a presumptive basis.  A remand is therefore warranted for an opinion as to whether the Veteran’s hypertension is related to his presumed Agent Orange exposure or, if hypertension is added to the list of diseases for which veterans exposed to Agent Orange are entitled to service connection on a presumptive basis, for the grant of service connection.”

https://www.va.gov/vetapp19/files8/19165514.txt

"Post-service, the National Academy of Science’s (NAS) Institute of Medicine’s Veterans and Agent Orange: Update 2010, concluded that there was “limited or suggestive” evidence of an association between herbicide exposure and hypertension.  See Nat’l Acad. of Sci., Inst. of Med., Veterans & Agent Orange: Update 2010 (2011) at 694; see also Notice, 77 Fed. Reg. 47924-47928 (2012).  Moreover, more recently, publication of Veterans and Agent Orange: Update 11 (2018) by the NAS found “sufficient evidence” of an association between hypertension and exposure to herbicide agents such as Agent Orange.  This 2018 publication upgraded hypertension’s previous classification in 2010 from the category of “limited or suggestive” evidence of an association to the category of “sufficient” evidence of an association.  According to the NAS in 2018, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. 

https://www.va.gov/vetapp19/files8/19164166.txt

Additionally, in November 2018, the National Academy of Sciences upgraded hypertension to the “sufficient” category from “limited or suggestive,” indicating that “there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure.”

 

In light of the foregoing, the Board finds that this issue must be remanded for another medical opinion.

https://www.va.gov/vetapp19/files6/19149350.txt

What these remands show is that the BVA has given serious consideration of the 2018 NAP report, and I would think any additional C & P exams for HBP would be hard pressed to find an examiner willing to go against the NAS findings.

To me, (AO has been the most important issue of my life) the NAS report is Golden and there might be Vietnam and BWN AO vets out there,who filed for HBP as secondary to what might even have been an obvious medical link to a SC disability and were denied- in the past, yet now they do have a better chance of getting their HBP service connected.

I have filed my accrued claim on this-I even sent them the breakdown of what they need to pay me.

The HBP was awarded under 1151 so that shows they didn't have any idea what caused it and obviously didn't treat it properly. 

I hope more veterans consider that their HBP potentially be service connected ( and many probably have many HBP SC denials on many different theories with this recent finding by NAS. I made a strong medical argument for it, and  sent it to Sec. Wilkie.But he might put NO further presumptives on the AO list at all....

 

 

 

 

 

[Berta]

This are the two pages of the recent NAS study that I used in my claim and can be used for any AO HBP claim.

The full report is here:

https://www.nap.edu/catalog/25137/veterans-and-agent-orange-update-11-2018

 

AO HBP NAS.pdf

[Berta]

“Resolving reasonable doubt in the Veteran’s favor, his hypertension was due to in-service exposure to herbicides while patrolling along the perimeter of the Royal Thai Air Force Base in U-Tapao, Thailan

 

Service connection for bladder cancer is granted.(due to AO)

 

Service connection for chronic myeloid leukemia is granted. (due to AO)

https://www.va.gov/vetapp19/files7/19153386.txt

 

This veteran, unlike many who used older NAS studies, was the second AO HBP award I have found at the BVA.

 

I posted here the NAS study that finds there is “Sufficient” association between hypertension and AO exposure.

The BVA put that info into their decision on both AO HBP awards I have found:

“In this regard, the Board notes that while hypertension is not recognized as a presumptive condition due to herbicide exposure, the National Academy of Sciences (NAS) has recently indicated that there is sufficient evidence of an association between hypertension and herbicide exposure.  The NAS moved hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category.  According to NAS, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure.  See Veterans and Agent Orange: Update 11 (2018) (available at http://nationalacademies.org/hmd/ reports/2018/veterans-and-agent-orange-update-2018.aspx); see also 38 C.F.R. § 3.309 (2018).  “

In the next case here the BVA states:

In an April 2019 brief, the Veteran’s representative argued that the advisory opinions are devoid of any analysis and review of the NAS findings.  Further, the representative argued that relevant medical literature has since shown a sufficient evidentiary link between herbicide agent exposure and hypertension.  The representative referred to the most recent NAS findings in 2018 (NAS Veterans and Agent Orange: Update 11 (2018)). In Update 11 NAS indicates there is sufficient evidence of an association between hypertension and herbicide exposure. 

 

In November 2018, almost simultaneous to the VHA addendum, the NAS moved hypertension to the category of “sufficient” evidence of an association, which indicates that there is enough epidemiologic evidence to conclude that there is a positive association.  See Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War: Update November 15, 2018.  While this evidence alone is insufficient to grant the claim, it implicates the need for a new VA opinion addressing all the relevant medical evidence, to include the latest NAS findings.

 

“The matter is REMANDED for the following action:

 

Obtain an addendum opinion on the etiology of the Veteran’s hypertension.  The examiner should opine as to whether it is at least as likely as not that the Veteran’s hypertension is related to his presumed exposure to herbicide agents.

 

In doing so, the examiner should review the file and a copy of this remand.  The examiner must consider the November 2018 Update 11 NAS study finding “sufficient” evidence of a positive association between hypertension and exposure to tactical herbicides. See http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137.”

https://www.va.gov/vetapp19/files4/19130985.txt

This vet as well got remanded for an opinion on the HBP and how the study would relate to that.

https://www.va.gov/vetapp19/files5/19140647.txt

So there seems to be conflicting BVA decisions, as\\BUT  here is another winner:

“The Veteran contends that his hypertension is related to active service.  Granting the benefit of the doubt to the Veteran, the Board concludes that hypertension is at least as likely as not due to the Veteran’s presumed herbicide agent exposure in Vietnam and that service connection is therefore warranted. 

 

The Veteran had service in the Republic of Vietnam; herbicide exposure is therefore presumed.  38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307(a)(6)(iii). 

 

The Veteran has been diagnosed with hypertension.  Hypertension is not included on the list of diseases presumed to have been incurred in service in Vietnam. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307(a)(6), 3.309(e).  However, the Veteran may still be entitled to service connection on a direct basis if the evidence establishes that hypertension is related to herbicide agent exposure.

 

In this regard, the Board notes that in its 2018 Update the National Academy of Sciences (NAS) indicated that there is “sufficient” evidence of an association between hypertension and herbicide agent exposure.  The NAS therefore upgraded hypertension from its prior classification in the “limited or suggestive” evidence category to the category of “sufficient” evidence of an association.  According to NAS, “[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure.  See National Academy of Science, Veterans and Agent Orange: Update 11 (2018), http://nationalacademies.org/hmd/ reports/2018/veterans-and-agent-orange-update-2018.aspx.

 

An April 2018 VA examination diagnosed hypertension but found that it was not due to service as the Veteran’s blood pressure was normal at separation and there was no evidence of hypertension on active duty.  However, the opinion did not address the question of exposure to herbicide agents and the Board therefore accords it no probative weight.

 

There is no other competent evidence of record addressing the relationship between the Veteran’s hypertension and herbicide agent exposure.  Therefore, resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for hypertension is warranted.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 3.303.  “

https://www.va.gov/vetapp19/files6/19144930.txt

 

These claims, if a C & P exam is done, might find the examiner to be hard pressed for coming up with any other etiology than AO exposure, per the NAS 2018 report.

In my accrued claim for my husband’s Hypertension ( with no known cause ever sought by VA)I copied and pasted this:

“I also cite this statement from the VA’s Web site:

“If you have an illness that’s not on the list of Agent Orange‒related diseases, but you believe was caused by Agent Orange

You’ll need to:

Provide scientific and medical evidence that the condition is related to exposure to Agent Orange, or

Show that the problem started during—or got worse because of—your military service

Scientific proof may include an article from a medical journal or a published research study.”

Source:https://www.va.gov/disability/eligibility/hazardous-materials-exposure/agent-orange/”

That seems clear to me that many AO exposed veterans whose HBP has not been attributed to any other cause, can  use the 2018 NAS study  and would have the proof they need,per the VA quote from above.

[Buck52]

Ms Berta

I took a Nuclear Stress Test At the VA Hospital and the results came back with an Abnormality.??.they could not say why?...only mention to me to lose weight and come back in a year..and take a Bicycle Stress test. 

I know I need to lose weight I need to lose over 100lbs and I do run out of breath just walking fast pace  my PCP sent me to cardiology to be tested and this is what they said.

[Berta]

Another Hypertension due to AO award:

 

"Regarding whether there is a nexus between the Veteran’s hypertension and his Agent Orange exposure while in Vietnam, the Board takes judicial notice of the existence of the finding by the National Academies of Sciences, Engineering and Medicine (NAS) that there is sufficient evidence of an association between hypertension and exposure to Agent Orange and other herbicides used during the Vietnam War. See Veterans and Agent Orange: Update 11 (2018); Smith v. Derwinski, 1 Vet. App. 235, 238 (1991) (regarding judicial notice); see generally Polovick v, Shinseki, 23 Vet. App. 48, 54 (2009) (NAS’s statistical analysis of the scientific and medical data pertaining to the health effects of Agent Orange exposure remains a source of relevant, competent evidence that VA may “consider when assessing whether the totality of the evidence is sufficient to establish service connection on a direct basis”). In this matter, on the February 2014 Disability Benefits Questionnaire, the examiner opined it is as likely as not that the Veteran’s hypertension could be a result of his exposure to Agent Orange during his one-year deployment. Based on this statement, with support from the NAS scientific and medical data pertaining to the health effects of Agent Orange exposure, resolving all reasonable doubt in favor of the Veteran, the Board finds that the medical evidence establishes a nexus between the Veteran’s hypertension and his exposure to herbicide agents, including Agent Orange. The Board finds that the criteria for service connection for the Veteran’s hypertension, as a result of herbicide agent exposure, including Agent Orange, have been met, and entitlement to service connection is warranted. The appeal is granted."

https://www.va.gov/vetapp19/files6/19144647.txt