Citation Nr: 1237897 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 07-07 126 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boise, Idaho THE ISSUES 1. Entitlement to service connection for type 2 diabetes mellitus, including as due to herbicide exposure. 2. Entitlement to service connection for hypertension, including as due to herbicide exposure and as secondary to type 2 diabetes mellitus. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD M. Young, Counsel INTRODUCTION The appellant is a Veteran who retired from active duty in September 1989 after more than 20 years of service beginning in November 1968. These matters are before the Board of Veterans' Appeals (Board) on appeal from an October 2005 rating decision by the Boise, Idaho Department of Veterans Affairs (VA) Regional Office (RO). In May 2007, a hearing was held before a Decision Review Officer (DRO) at the RO. These matters were previously before the Board in September 2009 and January 2012, when they were remanded for further development. In October 2012 the Board received additional evidence with a waiver of RO review; including a medical opinion that pertains to disabilities not at issue herein; a citation to a United States Court of Appeals for the Federal Circuit decision (Gaston v. Shinseki, 605 F. 3d 979 (Fed Cir. 2010) on an issue of an earlier effective date for a total rating; a redundant partial copy of M21-1 guidelines on processing claims alleging herbicide exposure in Thailand; and copies of STRs that were already in the record. FINDINGS OF FACT 1. The Veteran's duties while serving in Thailand did not place him on the base perimeter, and his allegations to the contrary are not credible; he is not shown to have been exposed to an herbicide agent in service (and specifically while serving at Nakhon Phanom Royal Thai Air Force Base (NPRTAFB) in Thailand). 2. Diabetes mellitus was not manifested in service or in the first year following the Veteran's discharge from active duty, and the preponderance of the evidence is against a finding that his type 2 diabetes mellitus is related to an event, injury, or disease in service. 3. The Veteran had isolated elevated blood pressure readings in service; essential hypertension was not manifested in service or in the first year following the Veteran's discharge from active duty, and the preponderance of the evidence is against a finding that his current hypertension is related to an event, injury, or disease in service; his secondary service connection theory of entitlement lacks legal merit. CONCLUSIONS OF LAW 1. Service connection for type 2 diabetes mellitus, to include as due to exposure to herbicides in service is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1116, 1131, 1137, 5107 (West 2002); 8 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313 (2012). 2. Service connection for hypertension is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1131, 1137, 5107 (West 2002); 8 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The VCAA applies to the instant claims. Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice must: (1) inform the claimant about the information and evidence necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; (3) inform the claimant about the information and evidence the claimant is expected to provide. VCAA notice requirements apply to all five elements of a service connection claim: 1) Veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 484-86 (2006) aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). May 2002, June 2005, and April 2011 and February 2012 (the latter two post-remand) letters advised the Veteran of VA's duties to notify and assist him in the development of his claims. They explained the evidence necessary to substantiate the claims, the evidence VA was responsible for providing, and the evidence he was responsible for providing. He has had ample opportunity to respond/supplement the record, and has not alleged that notice in this case was less than adequate. The April 2011 and February 2012 letters provided notice regarding disability ratings and effective dates of awards. See Dingess/Hartman, 483 F.3d 1311. Notably, the case was readjudicated after corrective notice was issued. Regarding VA's duty to assist, the Veteran's service treatment records (STRs), and postservice VA and private treatment records are associated with the claims file. The Board has reviewed "Virtual VA". [There are no pertinent records therein that are not associated with the claims files.] In May 2007 a hearing was held before a DRO. He was afforded a VA examination for hypertension in August 2011. Regarding the diabetes claim, the Board finds that an examination (to secure a nexus opinion) is not necessary. In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United Stated Court of Appeals for Veterans Claims (Court) explained that 38 C.F.R. § 3.159(c)(4) provides that an examination or opinion is necessary if the evidence of record: (A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of a disability; and (B) establishes that the Veteran suffered an event, injury, or disease in service; (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service, but (D) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. The Court noted that the third prong of 38 C.F.R. § 3.159(c)(4) is a low "threshold" standard. As will be discussed in greater detail below, the Veteran is not entitled to the presumptions afforded under 38 U.S.C.A. § 1116. There is no competent evidence that suggests his type 2 diabetes mellitus may be otherwise related to his service. Consequently, even the "low threshold" standard of McLendon is not met, and an examination is not warranted. The Veteran has not identified any pertinent evidence that remains outstanding. VA's duty to assist is met. Legal Criteria, Factual Background and Analysis Service connection may be established for disability due to disease or injury that was incurred in or aggravated by active service. 38 U.S.C.A. § 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disability, there must be medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Certain chronic diseases (including diabetes mellitus and hypertension) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period of time postservice (one year for diabetes and hypertension). U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board notes that it has reviewed all of the evidence in the appellant's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. 38 U.S.C.A. § 1116 A threshold matter that must be addressed in this case, given the proposed theories of entitlement, is whether or not the Veteran is entitled to consideration of his claim under the presumptive provisions afforded under 38 U.S.C.A. § 1116. If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases (including type II diabetes mellitus) shall be service connected if the requirements of 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). If a Veteran served in Vietnam, during the Vietnam Era, exposure to herbicides in service is presumed. 38 U.S.C.A. § 1116; 38 C.F.R. § 3.313. VA has extended application of the presumptive provisions of 38 U.S.C.A. § 1116 to include Veterans who were exposed to herbicides during service and did not serve in Vietnam. However, in such cases the exposure to herbicides must be affirmatively shown. Here, it is neither shown, nor alleged, that the Veteran served in Vietnam. He alleges exposure to herbicides (Agent Orange) while stationed at NPRTAFB from June 1969 to June 1970. His accounts have included allegations of exposure to herbicides from aircraft racks/pylons (which held Agent Orange), perimeter duty, washing clothes in the Mekong River water, and being sprayed by low flying aircraft. He further alleges that he rummaged for parts at a scrap heap near the base perimeter (warranting a concession of herbicide exposure under revised M-21guidelines). VA has developed specific evidentiary procedures to verify whether a Veteran was exposed to herbicides in locations other than Vietnam. VA's Adjudication Procedure Manual Rewrite, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C, para. 10(q) was adopted for application when a Veteran alleges exposure to herbicides in Thailand. It directs, in pertinent part, that if a Veteran served in the U.S. Air Force during the Vietnam Era at one of the specified RTAFBs as an Air Force security policeman, a security patrol dog handler, a member of the security police squadron, or in a capacity that otherwise placed him near the air base perimeter as shown by the evidence of record, then herbicide exposure is to be conceded. Id. If herbicide exposure cannot be conceded based upon the above described facts, a copy of the Compensation and Pension (C&P) Service's "Memorandum for the Record" is to be placed in the Veteran's claims file and the Veteran is to be asked for the approximate dates, location, and nature of the alleged herbicide exposure. If the Veteran fails to furnish the requested information, the claim will be referred to the U.S. Army and Joint Services Records Research Center (JSRRC) coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. The claim may then be decided based on the evidence of record. Id. If the Veteran furnishes the requested information within 30 days, the information is to be reviewed along with the other evidence of record (including the "Memorandum for the Record") and a determination is to be made whether herbicide exposure can be established. If such exposure cannot be established and the Veteran has not provided sufficient information to permit a search by the JSRRC, the claim will be referred to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. The claim may then be decided based on the evidence of record. Id. However, if herbicide exposure cannot otherwise be established and the Veteran has provided sufficient information to permit a search by the JSRRC, a request for verification of herbicide exposure is to be sent to the JSRRC. Id. The Veteran's service records show that from June 1969 to June 1970 he was stationed at NPRTAFB, Thailand, where his military occupational specialty was aircraft armament systems technician, and his duties included weapons mechanic. He performed organizational and field level maintenance, phase inspections, modification, and serviced racks and pylons for the A-1E/G/H/J aircraft. He conducted shop maintenance on all weapons release components for said aircraft. As is noted above, the Veteran served at NPRTAFB during the Vietnam Era. However, there is no evidence he was a security policeman, security patrol dog handler, member of the security police squadron, or was assigned duties at the base perimeter. His military occupational specialty was aircraft armament systems technician; his duties were those of a weapons mechanic. The Board notes his allegations of being near the base perimeter while rummaging for parts at a scrap heap. However, such account is uncorroborated and self-serving (See Pond v. West 12 vet. App. 341 (1999). It does not fall within the manual guidelines as to when exposure to tactical herbicides should be conceded. Therefore, following the Board's remands, the RO arranged for exhaustive development to confirm his allegations of such exposure at NPRTAFB. An April 6, 2012 Memorandum for the record outlines such development (in accordance with M-21MR), and includes a notation of a JSRRC certification that there is no record of Agent Orange spraying, testing, storage at NPRTAFB during the time the Veteran was stationed there. The Veteran has submitted a photocopy of a February 1967 memorandum by an Air Force colonel regarding "Spray Aircraft for Mosquito Control[,]" which proposed the reallocation (from herbicide spraying) of certain aircraft for spraying for mosquitoes in South Vietnam. The Memorandum mentions NPRTAFB. However, February 1967 is more than a year and a half prior to the Veteran's entrance on active duty, and the Memorandum has no bearing as to whether herbicides (Agent Orange) were used or stored at NPRTAFB while the Veteran was stationed there. At the May 2007 DRO hearing, the Veteran described his duties in service and expressed a belief ("I think . . ") that the pylons he worked on had had Agent Orange on them, and that he was thus exposed to herbicides. His speculation, without citation to supporting factual data, has no probative value regarding his allegation of exposure to herbicides in Thailand. In a June 2011 medical statement Dr. D.D.C. (Veteran's private physician) notes that the Veteran was stationed at an Air Force base in Thailand where he periodically had duty near the base perimeter and was sprayed with defoliant, at least once, and probably more, and on one occasion he could see and feel [Agent Orange] on his skin and uniform and had to shower and change his uniform. An unsupported allegation regarding an unverified environmental exposure does not gain in evidentiary value by virtue of repetition by an healthcare provider. Dr. D.D.C. does not cite to any factual data (other than the Veteran's accounts) supporting his report that veteran was exposed to Agent Orange in service. In April 2012, the JSRRC reported that it could not document or verify that the Veteran or other personnel assigned to his unit (456th MMS) were exposed to Agent Orange or tactical herbicides or were sprayed by a low flying aircraft while serving at NPRTAFB, or that his duties required him to be on or near the perimeter of the base. It was further certified that the available historical data do not document Agent Orange or herbicide spraying, testing or storage at Nakhon Phanom RTAFB during the June 1969 to June 1970 time frame. The Veteran's accounts that he was sprayed by a low flying aircraft while walking near the base perimeter, and that he worked in a scrap plane yard near the fence line and was thus exposed to Agent Orange are contradicted by the JSRRC finding that exposure to tactical herbicides was not shown. They could not document or verify that he was exposed to Agent Orange or tactical herbicides or was sprayed by a low flying aircraft while serving at NPRTAFB. Furthermore, the accounts are self-serving. See Pond v. West, 12 Vet. App. 341 (1999) (although Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements). Therefore, the Board finds those accounts not credible, and not probative evidence in this matter. In support of his claim, the Veteran has submitted printouts of Internet articles and reports concerning Agent Orange, and chemical use and chemical weapons testing in Thailand, and alleging cover-ups of such use. None of these identifies NPRTAFB as an installation where herbicides were used (other than on the perimeter)/or stored while the Veteran was stationed there. Additionally, in support of his claim, the Veteran submitted a copy of a prior Board decision in a different Veteran's case. The Veteran in that case was likewise stationed at NPRTAFB in 1969/1970. In the cited prior decision the Board found that there was credible evidence establishing a reasonable probability that the Veteran was exposed to Agent Orange while so stationed. Notably, prior Board decisions are only binding in the specific case decided, and the cited decision has no precedential value in the instant case. 38 C.F.R. § 20.1303. [The Board notes incidentally that the instant case is also distinguishable from the prior cited Board decision. In the prior case there was no development (per manual guidelines) for verification of herbicide exposure (and no JSRRC certification that herbicides were not sprayed, tested, or stored at NPRTAFB). Significantly, that decision also found (on p. 8) that NPRTAFB is on the "Thailand Vietnam territorial border", and the reasoning for the Board's decision included in part reliance on the proximity of that base to Vietnam. The undersigned takes judicial notice that Thailand and Vietnam do not share a border, in fact, NPRTAFB is, as the Veteran in the instant case observes, near the Thai-Laos border.] The Board also notes that at the May 2007 DRO hearing the Veteran testified that the aircraft he serviced flew in the "mist of whatever was over there", and that he "thinks" the pylons had Agent Orange on them. The Board finds such speculation to be without any probative value. The Veteran does not cite to any supporting factual evidence pertinent to the specifics of his case. The JSRRC considered his testimony and concluded that it could not document or verify that he was exposed to Agent Orange, or tactical herbicide. As it has been officially certified that the Veteran was not exposed to herbicides by virtue of being stationed at NPRTAFB and his assigned duties there, and there being no probative evidence to the contrary, the Board finds that he is not entitled to consideration of his claims under the presumptions afforded in 38 U.S.C.A. § 1116. Type 2 Diabetes Mellitus The Veteran's STRs are silent for complaints, findings, treatment, or diagnosis of diabetes. On examination for retirement from active service, the Veteran's endocrine system was normal on clinical evaluation. Reports of blood glucose testing show normal glucose levels in September, October and December 1990, August 1991, August and November 1992, March and December 1993, July 1994, January and March 1995. Elevated glucose levels were shown in September 1991, January 1992, January 1994 and November 1996. On February 1994 Air Force medical center outpatient treatment hyperglycemia was diagnosed. An August 2001 private treatment record shows the Veteran had been taking medication for diabetes for about six weeks. Private outpatient treatment records from October 2001 to March 2007 show ongoing treatment for type 2 diabetes mellitus. It is not in dispute that the Veteran has diabetes mellitus. However, there is no evidence that such disease was manifested in service, nor is it alleged otherwise. Likewise, there is no evidence that diabetes was manifested in the first year following the Veteran's retirement from service in September 1989 (nor is it so alleged). Glucose studies in the first postservice year were all normal, and remained so through August 1991. Hyperglycemia was diagnosed in February 1994; and diabetes mellitus was not diagnosed until 2001 (about 12 years following the Veteran's retirement from service). Consequently, service connection for diabetes on the basis that such disease became manifest in service, and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C.A. § 1112) is not warranted. In light of the foregoing, to establish service connection for diabetes the Veteran must affirmatively show, by competent medical (as nexus between diabetes and service in the absence of manifestation in service and/or continuity is a medical question, beyond lay observation) evidence, that the diabetes is related to disease, injury, or event in service. The Veteran has submitted a statement from Dr. D.D.C. in support of his claim. However, that opinion is without probative value, as it is based on an inaccurate factual premise (that the Veteran was exposed to herbicides in service, when in fact the evidence shows otherwise). See Swann v. Brown, 5 Vet. App. 229, 233 (1993). The record reveals no other basis (alleged or suggested by factual data) for relating the Veteran's diabetes to his service. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran's diabetes is/may be related to his service, and therefore, against his claim. Hence, the benefit of the doubt rule does not apply; the appeal in this matter must be denied. Hypertension The Veteran alleges that his hypertension had its onset in service, is related to exposure to herbicides in service, and alternatively that it is secondary to his type 2 diabetes mellitus. He points to a dental appointment in service when he could not be treated because his blood pressure was elevated (and has stated he has been on medication for hypertension since). At the outset, it is noteworthy that the Board has determined (see discussion above) that the Veteran is not entitled to the presumptions afforded under 38 U.S.C.A. § 1116. [Significantly also hypertension is not a listed disease in 38 C.F.R. § 3.309(e).] Furthermore, because his type 2 diabetes is not service-connected, his secondary service connection theory of entitlement lacks legal merit. See 38 C.F.R. § 3.310; see also Sabonis v. Brown, 6 Vet. App. 426 (1994). On May 1968 service enlistment examination, the Veteran's blood pressure was 130/70. On November 1976 periodic physical examination report, his blood pressure was 124/80. An August 1980 dental record shows his blood pressure was 132/90, and subsequently a series of blood pressure checks were ordered to rule out hypertension. On August 12, 1980 his blood pressure was 120/78, on August 14 it was 140/94 on the right and 130/100 on the left, on August 15 it was 138/86, on August 16 it was 122/86, and on August 18 it was 140/88; the assessment was rule out high blood pressure. An August 28, 1980 health record notes that the Veteran was referred from dental after five blood pressure readings. Five of the last six blood pressure readings were normal. It was noted that he was under much stress as an inspector, and was taking "CTM" and Sudafed for allergies. The assessment was normotensive; no blood pressure treatment was deemed required. On December 11, 1980 periodic physical examination the Veteran's blood pressure was 120/78. On December 19, 1980 he was seen at a hospital with complaints of sore throat and headache, his blood pressure was 138/90. In July 1983 he was seen in emergency care with a viral illness; his blood pressure was 140/100. In January 1985 he was seen in emergency care with viral syndrome; his blood pressure was 140/100. The June 1989 retirement examination noted "yes" to the question as to whether the Veteran had ever had high or low blood pressure. The medical officer noted, "High blood pressure occasionally since 1980, no treatment given, NCNS." On clinical evaluation the heart and vascular system were normal; his blood pressure was 102/88. Postservice, in October 1989, the Veteran was seen in emergency care for an upper respiratory infection; his blood pressure was 120/80. On November 1989 emergency care (for acute bronchitis) his blood pressure was 104/70. On follow-up (a week later), his blood pressure was 100/68. Treatment reports from an Air Force medical facility (for various complaints) show that in September 1990 his blood pressure was 120/80, in April 1991 it was 130/100, in July 1991 it was 140/80 (he had been treated for pneumonia), in December 1991 it was 145/93 (he had a probable postoperative infection), in August 1992 it was 122/80, and in May 1993 it was 130/90 (the assessment was possible hypertension). A May 1997 private treatment report of Dr. R.S., the Veteran's private physician, shows the Veteran's blood pressure was 170/90. In July 1997 it was 142/102. It was noted that his blood pressure was consistently elevated, and he was started on Prinivil. A February 2002 private insurance physical report shows the Veteran's blood pressure was 130/80. The impression was normal examination. It was noted that his blood pressure was in good control and Prinivil would be continued. A November 2003 private progress report notes essential hypertension, on Prinivil. On examination, his blood pressure was 134/80. A December 2004 private progress note shows a diagnosis of essential hypertension, on Prinivil. On examination, his blood pressure was 140/80. A February 2006 letter from Dr. R.S., reveals the Veteran was started on anti-hypertensive medication in July 1997 following monitoring, which showed a consistently elevated blood pressure. Subsequently, in February 2006, essential hypertension was diagnosed by Dr. N.Z., a private physician. Private treatment records show that the Veteran received ongoing care for hypertension from March 2007 to July 2011. On August 2011 VA examination, the examiner opined that the Veteran's hypertension is less likely as not (less than 50/50 probability) caused by or a result of military service. The examiner explained that the Veteran's medical records clearly establish that he had essential hypertension in 1997 and had been treated for it since that time. However, earlier, when he had a five-day check in August 1980, he was on Sudafed for allergies, and under a lot of stress due to an upcoming inspection; nonetheless, he was found to be normotensive, and that ended the discussion for that time period. In April 1980 the Veteran's blood pressure was 110/68, off medications. In January 1985 his blood pressure was 140/100, but he was sick and on medication (Sudafed). In July 1983, his blood pressure was 104/56; he was on no apparent hypertension medications. In August 1988 his blood pressure was 124/84. He had a seven-day blood pressure check in February 1985 - March 1985 and all values were normal. On his retirement physical his blood pressure was 102/88 with no mention of any concern for sustained hypertension values. In summary, the examiner noted that while the Veteran had some isolated elevated blood pressure readings in service those were related to acute illness, pain or medications known to raise blood pressure. When he was formally measured for hypertension over several-day periods in service, hypertension was never diagnosed, in service or within one year thereafter. He was clearly being treated for hypertension by 1997, but that was eight years after separation from service, well beyond the one-year presumptive period. It is not in dispute that the Veteran now has hypertension. His STRs show he had some isolated elevated blood pressure readings in service. However, when he was evaluated for hypertension, such disease was not diagnosed, and treatment was not instituted (despite the Veteran's initial allegation to that effect). Furthermore, on service retirement examination, his blood pressure was normal, and there is no evidence that hypertension was manifested in the first postservice year. The earliest clinical record showing that the Veteran had hypertension is dated in 1997, eight years after his retirement from service, when it was noted that his blood pressure was consistently elevated and he was started on hypertension medication, Prinivil. Consequently, service connection for hypertension on the basis that it was found in service or became manifest therein and persisted, or on a chronic disease presumptive basis (under 38 U.S.C.A. § 1112) is not warranted. What remains for consideration is whether or not in the absence of a diagnosis in service and/or continuity of symptoms, the Veteran's hypertension may nonetheless somehow otherwise be related to his service. He has not submitted any medical opinion that relates his hypertension to his service/events therein. The only competent (medical) evidence that directly addresses the matter of a nexus between the Veteran's hypertension and his service is the opinion of the August 2011 VA examiner who indicated there was no nexus. The examiner explained the rationale for the opinion in detail, as stated above (indicating, in essence, that isolated elevated blood pressure readings in service were due to acute intervening factors, and did not signify that the Veteran had hypertension, and that the initial diagnosis of hypertension was too remote from service for the disease to be related to service. Given the explanation of rationale, with citation to factual data, that opinion is probative evidence in the matter. Because there is no competent evidence to the contrary, it is persuasive. The Board acknowledges the Veteran's sincere belief that his hypertension is related to service/events therein. However, his opinion in the matter is not competent evidence. The matter of a nexus between current hypertension and remote service (and isolated elevated blood pressure readings therein) is a complex medical question. The Veteran is a layperson, and lacks the requisite expertise to provide probative evidence in this matter by his own opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran's claim. Accordingly, the appeal in this matter must be denied. ORDER Service connection for type 2 diabetes mellitus is denied. Service connection for hypertension is denied. ____________________________________________ GEORGE R. SENYK Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs