92 Decision Citation: BVA 92-17298 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-50 956 ) DATE ) ) ) THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. T. Hutcheson, Associate Counsel INTRODUCTION This matter came before the Board of Veterans' Appeals (hereinafter "the Board") on appeal from a February 1990 rating decision of the Los Angeles, California Regional Office (hereinafter "the RO"). The veteran had active military service from December 1953 to June 1973. The notice of disagreement was received in January 1990. The statement of the case was issued in September 1990. The substantive appeal was received in October 1990. The veteran has been represented throughout this appeal by the American Legion. That organization submitted written argument in November 1990. This appeal was received at the Board in November 1990 and docketed in December 1990. A written presentation from the accredited representative was submitted in January 1991. In March 1991, the Board remanded this case to the RO so that additional development of the record could be conducted. Additional private clinical documentation and negative responses from both the Air Force and the National Personnel Records Center were subsequently received. A supplemental statement of the case was issued in February 1992. Written argument was received in April 1992. This appeal was again received at the Board in April 1992 and docketed in May 1992. A second written presentation was submitted in May 1992. CONTENTIONS OF APPELLANT ON APPEAL The appellant asserts on appeal that the RO committed error in denying service connection for the cause of the veteran's death. She contends that the veteran's fatal cardiovascular disorder was first manifested as inservice hypertensive blood pressure readings. The appellant and her accredited representative request that this case be remanded again to the RO so that an additional attempt may be made to obtain post-service treatment records from George Air Force Base and that an independent medical expert's opinion be obtained. DECISION OF THE BOARD For the reasons and bases hereinafter set forth, it is the decision of the Board that a preponderance of the evidence is adverse to the appellant's claim for service connection for the cause of the veteran's death. FINDINGS OF FACT 1. The veteran died in April 1989. The cause of death was certified as cardiopulmonary arrest secondary to a myocardial infarction and hypertensive heart disease. 2. At the time of the veteran's death, service connection was not in effect for any disability. 3. The veteran experienced elevated blood pressure readings during service which were indicative of a labile hypertension. 4. Essential hypertension and hypertensive heart disease were not shown in service or for many years following service separation. 5. The veteran's death was not proximately related to a service-connected disability. 6. This appeal does not hinge upon a medical question of a complex or controversial nature which would render it appropriate to obtain the opinion of an independent medical expert. 7. A preponderance of the evidence is adverse to the appellant's claim for service connection for the cause of the veteran's death. CONCLUSIONS OF LAW 1. A service-connected disability did not cause or contribute substantially or materially to the cause of the veteran's death. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1310, 5107; 38 C.F.R. §§ 3.307, 3.309, 3.312. 2. The opinion of an independent medical examiner is not warranted. 38 U.S.C. § 7109. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, it is necessary to determine if the appellant has submitted a well-grounded claim within the meaning of 38 U.S.C. § 5107(a) and if so, whether the Department of Veterans Affairs (hereinafter "VA") has properly assisted her in the development of her claim. A "well-grounded" claim is one which is not implausible. Our review of the record indicates that the appellant's claim is reasonable. In regards to the appellant's request that an additional attempt be made to obtain post-service clinical documentation from the George Air Force Base, we note that repeated efforts by the RO to obtain such treatment records from both the Air Force and the National Personnel Records Center have proven to be fruitless. As to the accredited representative's request for an independent medical expert's opinion, we believe that the clinical documentation of record and the nature of the veteran's final illness belie the need for such an opinion. Therefore, we find that further development of the record is not necessary in order to allow for an adequate resolution of the issues raised by the instant appeal. In order to establish service connection for the cause of the veteran's death, the evidence must show that a disability incurred in or aggravated by active military service either caused or contributed substantially or materially to the veteran's demise. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. The veteran's April 1989 death certificate reports that he succumbed to cardiopulmonary arrest due to a myocardial infarction and hypertensive heart disease. At the time of the veteran's death, service connection was not in effect for any disability. The appellant argues that the onset of veteran's fatal cardiovascular disease was first manifested in service by several elevated blood pressure readings first manifested in service. Given that service connection was not in effect for essential hypertension or other cardiovascular disease at the time of the veteran's death, it is necessary to determine if such a condition was incurred in service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131. Further, where a veteran has served continuously for 90 days or more during a period of war or peacetime and cardiovascular disease (including esssential hypertension) becomes manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Board observes that the range of normal blood pressure is from approximately 100 to 140 mmHg systolic and from approximately 60 to 90 mmHg diastolic. The term borderline hypertension is used for those readings consistently between 140/90 and 160/95 mmHg. Readings above 160/95 are termed definite hypertension... People with occasionally elevated pressures are said to have labile hypertension... Intermittent elevation of the blood pressure can be associated with emotional stress. J. Willis Hurst, The Heart, at 185, 1175, 1182 (1982). A review of the veteran's service medical records indicates that he exhibited some elevated blood pressure readings during service. A November 1970 entry relates that the veteran had a blood pressure reading of 140/90 when he was treated for migraine headaches. A subsequent physical examination conducted in February 1972 noted a blood pressure reading of 130/90 and no cardiovascular abnormalities. His blood pressure was 128/90 when he was admitted to a hospital for minor surgery in April 1972. A November 1972 hospital discharge summary reports that the veteran was brought to the emergency room following the sudden onset of pain in the left orbital region and paresthesia in the left face, left arm and left thorax. The veteran related a history of non-specific headaches. A physical examination revealed a blood pressure reading of 210/100 at admission. Treating medical personnel observed that the veteran's blood pressure quickly dropped to 140/95. At discharge, the veteran was found to be asymptomatic and the veteran was diagnosed as suffering form Horton's Cephalalgia (cluster migraine headaches). The remainder of the veteran's service medical records show normal blood pressure readings and no indicia of hypertension or other cardiovascular disease. An October 1988 discharge summary from the Victor Valley Community Hospital notes that the veteran related having been diagnosed with essential hypertension in approximately 1985. The veteran was found to be suffering from probable hypertensive cardiovascular disease, probable peripheral vascular disease, probable coronary artery disease and uncontrolled essential hypertension. Our longitudinal review of the record illuminates that the veteran's inservice elevated blood pressure readings were intermittent, and with one exception, fell within the borderline range. Consistently elevated blood pressure demonstrative of definite hypertension were not shown. The course of his blood pressure during service was indicative of labile hypertension, rather than essential or definite hypertension. Given that the veteran did not manifest essential hypertension in service or until approximately 1985, we are unable to conclude that either essential hypertension or other cardiovascular disease was incurred in service directly or presumptively. Absent such a showing, we find that service connection for the cause of the veteran's death is unwarranted. Accordingly, the benefit sought on appeal is denied. In making the above determinations, the Board has carefully weighed the appellant's contentions and finds that a preponderance of the evidence is adverse to her claim for service connection for the cause of the veteran's death. ORDER Service connection for the cause of the veteran's death is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 JEFF MARTIN IRVIN H. PEISER, M.D. E. W. SEERY NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1992), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.