Citation Nr: 9905979 Decision Date: 03/03/99 Archive Date: 03/11/99 DOCKET NO. 98-08 356A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Richard Giannecchini, Associate Counsel INTRODUCTION The veteran had active military service in the U.S. Navy from April 1954 to April 1958, and in the U.S. Army from July 1958 to August 1974. The present appeal arises from a January 1998 rating decision in which the RO denied the veteran's claim of service connection for hypertension. In November 1998, the veteran testified before the undersigned during a Video Conference Hearing. FINDING OF FACT The veteran's hypertension had its onset during his military service. CONCLUSION OF LAW Hypertension was incurred during the veteran's military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West1991); 38 C.F.R. § 3.303 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Basis A review of the veteran's service medical records reflects no clinical diagnosis of hypertension. Blood pressure readings of significance during the course of the veteran's 20-year active service career include 140/94 (February 1960), 130/92 (February 1968), 144/90 (May 1970), 144/90 (February 1971), 136/96 (July 1972), and 132/90 (November 1972). In addition, the veteran was noted to have complained of recurrent chest pain during service. However all electrocardiograms (EKGs) undertaken were within normal limits, other than an incidental finding of sinus bradycardia in December 1972. In June 1974, the veteran underwent a medical examination for purposes of separating from active service. On clinical evaluation, there were no abnormalities or deficits reported with respect to the veteran's cardiovascular system. The veteran's blood pressure reading was noted as 128/88. An additional internal medicine consult was ordered, during which an examination revealed the veteran's lungs to be clear and his heart to have no murmurs or lifts. An associated chest X-ray and EKG were reported normal. The examiner's impression was premature benign cardiac beats. In April 1997, the veteran filed claims for service connection for multiple medical conditions, including hypertension. Thereafter, the RO received Seymour Johnson Air Force Base (AFB) Hospital treatment records, dated from January 1984 to June 1996. These records referred to his history of hypertension, for which medication was prescribed. In June 1997, the RO received a statement from Michael King, M.D., dated that same month, in which it was reported that the veteran had a history of hypertension. During the veteran's visit in April, his blood pressure was noted as 120/70, and a cardiovascular examination was essentially negative, with no acute findings, although Dr. King did indicated that the veteran suffered from coronary artery disease. Thereafter, in July 1997, the veteran was medically examined for VA purposes. The veteran reported having had hypertension since "1978," and that he was taking Dyazide and Inderal daily. On further examination, the veteran's heart was noted to have a slight irregularity of rhythm, but otherwise was found normal. His pulse rate was 60, and three separate blood pressure readings, taken while the veteran was seated, were noted as 160/76, 165/80, 160/82. The examiner's diagnosis included "hypertension, under treatment, not controlled." In January 1998, the veteran submitted additional Seymour Johnson AFB Hospital treatment records, dated from January 1975 to May 1979. In particular, in January 1975, the veteran's blood pressure was noted as 148/100. The examiner's assessment was, "? possible HBP [high blood pressure]." From February 3, 1975 to February 7, 1975, the veteran's blood pressure was recorded daily. Reported readings were as follows: 3 Feb Sitting 124/86 and (illegible)/84 - Standing 128/92 and 130/96 4 Feb Sitting 128/90 and 122/84 - Standing 130/90 and 128/88 5 Feb Sitting 130/88 and 128/82 - Standing 138/96 and 132/94 6 Feb Sitting 124/88 and 130/90 - Standing 138/92 and 144/98 7 Feb Sitting 118/90 and 112/84 - Standing 120/90 and 122/92 A treatment note dated February 7, 1975, noted a five-day mean blood pressure average of 128/92, and the examiner's assessment was, "? labile mild HBP." The treatment plan called for a reduced sodium diet. In March 1975, the veteran's blood pressure was recorded as 140/98, and the examiner's impression was mild high blood pressure. Medication was prescribed, which was subsequently identified as Oretic, an antihypertensive agent. An additional reading in March was noted as 138/90, and in April 1975 the veteran's blood pressure was reported as 140/96. In December 1975, treatment notes indicated that the veteran had resumed his medication for high blood pressure after being off it for a period of time. Blood pressure readings during this period were 138/100, 138/88 and 142/88. Assessments noted that the veteran's blood pressure was under control on medication, and that he should continue to take his medication. Thereafter, in June 1998, the RO received an additional statement from Dr. King, dated that same month. In his statement, Dr. King reported that he had first seen the veteran in May 1980, and at that time the veteran's blood pressure was 142/92. He also included examination reports, dated in May 1980 and February 1981, which noted diagnoses for hypertension. In November 1998, the veteran testified before the undersigned during a Video Conference Hearing. Under questioning, the veteran reported that while his records of treatment as an active duty member and as a retired service member reflected the use of the word high blood pressure, it was not until he saw a private physician in 1978 that the word hypertension was used to describe his condition. Furthermore, the veteran indicated that he was given pills while undergoing treatment in 1975, which included Dyazide, a hypertensive diuretic drug (See Physicians' Desk Reference, 46th edition, pg. 2208 (1992)), plus medication to slow down his heart. II. Analysis The Board finds that the veteran has presented a well- grounded claim. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). All relevant evidence has been fully developed. Under applicable criteria, service connection may be granted for a disability resulting from disease or injury which was incurred in, or aggravated by, service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). To establish a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b) (1998). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1998). A veteran shall be granted service connection for hypertension, although not otherwise established as incurred in service, if the disease is manifested to a compensable degree within one year following service. See 38 C.F.R. §§ 3.307, 3.309 (1998). For hypertension to be compensable for rating purposes, there must a showing of diastolic pressure predominately 100 or more, or systolic pressure predominately 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominately 100 or more who requires continuous medication for control. See 38 C.F.R. § 4.104, Diagnostic Code 7101 (1998). Furthermore, the Board notes that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of the rating section, the term hypertension means that the diastolic blood pressure is predominately 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominately 160mm. or greater with a diastolic blood pressure of less than 90mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). A review of the veteran's service medical records reveals that elevated diastolic readings were recorded on numerous times during the veteran's 20-year active service career: 140/94, 130/92, 144/90 (twice), 136/96 , and 132/90. However, the service medical records do not reflect that hypertension or high blood pressure was diagnosed. Similarly, in the first post-service year, the veteran's blood pressure was taken on a number of occasions. The highest systolic pressure recorded during this period was 148, and the highest diastolic pressure measured was 100 (twice), with no reading above 100. However, readings were again predominately in the 90s. Not only was hypertension diagnosed, but the veteran was placed on anti-hypertensive medication, Oretic, and a low sodium diet was recommended. The subsequent medical records continue to show a diagnosis of and treatment for hypertension. A review of the favorable evidence clearly shows that elevated diastolic readings indicative of the later diagnosed hypertension were present in service and continued thereafter. Resolving any doubt in the veteran's favor, the Board finds that the onset of hypertension was during his active military service. ORDER Service connection for hypertension is granted. The appeal is allowed. NANCY R. ROBIN Member, Board of Veterans' Appeals Department of Veterans Affairs