Citation Nr: 9822185 Decision Date: 07/22/98 Archive Date: 08/03/98 DOCKET NO. 97-21 876 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for hypertension claimed to be associated with a service-connected anxiety disorder. REPRESENTATION Appellant represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD L.A. Howell, Associate Counsel INTRODUCTION The veteran served on active duty from May 1966 to May 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which found that the veteran had not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim for hypertension on a secondary basis was well grounded. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that he is entitled to service connection for hypertension. Specifically, he maintains that his hypertension is due to his service- connected psychiatric disability. His representative joins in these contentions and attention is directed to the private medical opinion on file. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that, giving the benefit of the doubt to the veteran, the evidence favors the grant of entitlement to service connection for hypertension secondary to a service-connected anxiety disorder to the extent that the psychiatric disorder aggravates the hypertension. FINDINGS OF FACT 1. The RO has developed all evidence necessary for an equitable disposition of the veteran’s claim. 2. The medical evidence of record indicates that the veteran’s service-connected anxiety disorder aggravates his currently diagnosed hypertension. 3. It is more probable than not that the veteran’s hypertension is aggravated by his service-connected anxiety disorder. CONCLUSION OF LAW Resolving reasonable doubt in favor of the veteran, hypertension is aggravated by the service-connected anxiety disorder. 38 U.S.C.A. § 5107 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.303, 3.310(a) (1997); Allen v. Brown, 7 Vet. App. 439 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998); that is, he has presented a claim that is plausible. Further, he has not alleged nor does the evidence show that any records of probative value, which could be associated with the claims folder and that have not already been sought, are available. The Board accordingly finds that the duty to assist the veteran, as mandated by § 5107(a), has been satisfied. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998). If a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b) (1997). However, continuity of symptoms is required where the condition in service is not, in fact, chronic or where diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b) (1997). In addition, 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 U.S.C.A. § 1113(b) (West 1991 & Supp. 1998); 38 C.F.R. § 3.303(d) (1997). Finally, the Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Importantly, service connection is warranted for a disability which is aggravated by, proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (1997); Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. In this case, the Board notes that the veteran is service connected for anxiety reaction with depressive features, currently rated at 50 percent disabling. The Board also observes that the veteran has not alleged direct service connection for hypertension; rather, he maintains that his hypertension is caused by or is related to his service- connected anxiety disorder. Medical records associated with the claims file indicate that the veteran has been treated for hypertension since at least 1991, and suggest treatment prior to that time. In a November 1996 letter, Jonathan Perwien, M.D. indicated that the veteran suffered from labile hypertension which was exacerbated by this anxiety disorder and post traumatic stress. Dr. Perwien stated that these disorders were both chronic. In a VA general medical examination report dated in March 1997, the veteran reported that he had been treated for emotional problems since 1968 and had received shock treatments several years previously. A history of moderately severe, somewhat labile hypertension for twenty years was also noted. The examiner related that the veteran had taken virtually every antihypertensive drug in the book and was currently taking Catapres, Toprol, and Hydrochlorothiazide. The examiner remarked that the veteran’s blood pressure problems were being managed by his private physician and that the association of his blood pressure problems with his anxiety neurosis was somewhat difficult to establish. In a letter dated in July 1997, Dr. Perwien indicated that the veteran had been a patient of his for the past two years and was diagnosed with severe anxiety disorder and post traumatic stress. In addition to his anxiety disorder, he had significant hypertension requiring three medications. Dr. Perwien reflected that the veteran’s anxiety disorder resulted in very labile hypertension and numerous side effects to the medications. He noted that when the veteran was doing well emotionally his blood pressure was well controlled. Dr. Perwien opined that the veteran’s anxiety disorder had a direct effect on his hypertension, as well as his daily well-being. Based on the evidence outlined above with particular consideration placed on the opinion of the private treating physician, and giving the benefit of the doubt to the veteran, the Board finds that the record supports a finding that the veteran’s hypertension is aggravated by his service- connected anxiety disorder. Significantly, two letters from his treating physician very clearly indicate that there is a relationship between the veteran’s anxiety disorder and his hypertension. It does not appear that the medical evidence supports the conclusion that the hypertension is caused by the anxiety. It does appear, however, that the hypertension is aggravated by the service connected disorder. Thus, under the guidance of the United States Court of Veterans Appeals in Allen, supra, a basis for allowance of that portion of the hypertension aggravated by the anxiety is in order. Moreover, it cannot be said that the most recent VA examiner arrived at an opposite conclusion. Specifically, the VA examiner suggested that the connection between the two was “somewhat difficult to establish” but did not concede that it was impossible. Thus, giving every benefit of the doubt to the veteran, the Board concludes that entitlement to secondary service connection for hypertension on the basis of aggravation is indicated. ORDER Entitlement to secondary service connection for hypertension as a result of aggravation by a service-connected anxiety disorder is granted. The appeal is allowed to the extent indicated. MICHAEL D. LYON Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), 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, 102 Stat. 4105, 4122 (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. - 2 -