Citation Nr: 0813048 Decision Date: 04/21/08 Archive Date: 05/01/08 DOCKET NO. 04-35 001A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD S. Coyle, Associate Counsel INTRODUCTION The veteran served on active duty from October 1966 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2003 rating decision by the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA), which denied entitlement to the benefit currently sought on appeal. The case was referred for a VHA opinion in September 2007, and now again returns to the Board. FINDING OF FACT Hypertension first manifested years after the veteran's service and is not related to his service. CONCLUSION OF LAW Hypertension was not incurred in or aggravated by active service, nor may it be so presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 4.104 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist In correspondence dated December 2004, the RO satisfied its duty to notify the veteran under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b). Specifically, the RO notified the veteran of: information and evidence necessary to substantiate the claim for service connection; information and evidence that VA would seek to provide; and information and evidence that the veteran was expected to provide. The veteran was instructed to submit any evidence in his possession that pertained to his claim. Because service connection is denied, any question as to the appropriate disability rating or effective date is moot, and there can be no failure to notify prejudice to the veteran. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Board notes that fully satisfactory notice was not delivered until after the claim was originally adjudicated. However, the RO subsequently readjudicated the claim based on all the evidence in March 2005. The veteran was able to participate effectively in the processing of his claim. There is no indication in the record or reason to believe that the ultimate decision of the originating agency on the merits of the claim would have been different had complete VCAA notice been provided at an earlier time. VA has done everything reasonably possible to assist the veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A and 38 C.F.R. § 3.159(c). Service medical records have been associated with the claims file. All identified and available treatment records have been secured. A medical opinion has been rendered in conjunction with the claim. The duties to notify and assist have been met. Legal Criteria In general, service connection will be granted for disability resulting from injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not determined to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). 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 C.F.R. § 3.303(d). There must be medical evidence of a current disability, medical or lay evidence of in-service incurrence or aggravation of a disease or injury, and medical evidence linking the current disability to that in-service disease or injury. Pond v. West, 12 Vet. App. 341, 346 (1999); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection will also be presumed for certain chronic diseases, including hypertension, if manifest to a compensable degree within one year after discharge from service. See 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309. However, there is no evidence indicating that the veteran's hypertension manifested to a compensable degree within the relevant time period. Thus, the presumption is not for application. Analysis Medical evidence shows that the veteran has a current diagnosis of hypertension. However, a review of the post- service evidence does not lead to the conclusion that the veteran's hypertension was incurred in service. The veteran received an examination at service entry on February 1, 1966. His blood pressure reading was 150/90. A repeat reading was taken on February 2, 1966, which showed blood pressure of 134/80. On February 3, 1966, the veteran's blood pressure was 136/84. The veteran was deemed fit for active military service. The veteran's service medical records are negative for any hypertension-related complaints. On service discharge in October 1968, the veteran's blood pressure was 130/90. No repeat blood pressure reading was ordered, and the veteran was found qualified for discharge. The first post-service blood pressure reading was recorded in February 1977, at which point it was 160/102. The veteran was prescribed anti-hypertensive medications, which he continues to take. A review of the post-service evidence shows that the veteran's blood pressure has remained slightly elevated despite medication. In September 2007, the opinion of a Veterans Health Administration (VHA) medical expert was sought on the question of whether the veteran was hypertensive at service entry or discharge. After reviewing the claims folder, the examiner found that the veteran's elevated blood pressure reading at entry was most likely due to anxiety, as the blood pressure readings taken on following two days were "acceptable." Although the veteran's blood pressure was 130/90 at separation, the expert did not feel that the veteran was hypertensive at discharge. There was no diagnosis of hypertension, the veteran had not demonstrated any new medical problems during his active service, a physical examination was normal and a urinalysis showed no end organ damage indicative of hypertension. The specialist pointed out that the veteran had gained more than 50 pounds since his separation, and that the veteran's weight gain appeared to be coincident with his development of hypertension. In the specialist's view, a preponderance of the clinical evidence suggested that the veteran was not hypertensive at entry or upon discharge from the military. On review, the Board finds that a preponderance of the evidence is against a finding that the veteran's hypertension had its onset in service. The veteran had one elevated blood pressure reading at entry; however, readings taken on consecutive days thereafter were acceptable. There was no evidence of hypertension in service. Although the veteran's blood pressure was slightly elevated at discharge, the VHA specialist pointed out that the veteran had exhibited no other signs of chronic hypertension such as a urinalysis positive for proteinuria, abnormal physical examination, or new medical symptoms. No evidence has been submitted that rebuts the specialist's opinion. For VA compensation purposes, hypertension must be confirmed by readings taken two or more times on at least three different days. The term hypertension means that the diastolic blood pressure is predominantly 90 mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm.. See 38 C.F.R. § 4.104 Note(1) to Diagnostic Code 7101 (2007). The veteran was first treated for hypertension in 1977, over 7 years after his discharge. There is no medical evidence linking the veteran's hypertension to his service. The Board has considered the veteran's statements that his hypertension is causally related to active service. However, he has not been shown to possess the requisite training or credentials needed to render a competent opinion as to medical causation. As such, his lay opinion does not constitute competent medical evidence and lacks probative value. See Routen v. Brown, 10 Vet. App. 183, 186 (1997); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In conclusion, a preponderance of the evidence is against a finding that the veteran's hypertension is causally related to active service. Thus, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Service connection for hypertension is denied. ____________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs