Citation Nr: 1320946 Decision Date: 06/28/13 Archive Date: 07/05/13 DOCKET NO. 07-20 938A ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Veteran represented by: The American Legion WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD M. M. Celli, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1994 to March 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a June 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. Jurisdiction rests with the RO in Denver, Colorado, from which the appeal was certified. In August 2010, the Veteran testified at a hearing before a Decision Review Officer (DRO) at the RO, and in July 2011, the Veteran testified during a video conference hearing before the undersigned Veterans Law Judge (VLJ). Transcripts of the two hearings are of record. FINDINGS OF FACT 1. The earliest clinical evidence of a diagnosis of hypertension is in April 2008, more than 10 years after separation from active duty. 2. The most probative competent evidence of record does not demonstrate that it is at least as likely as not that the Veteran has hypertension causally related to active duty. CONCLUSION OF LAW Hypertension was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred or aggravated. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Duty to Notify Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information and any medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and 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. In VA correspondence dated in February 2005, the Veteran was informed of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. In March 2006, the U.S. Court of Appeals for Veterans Claims (Court) issued its decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Court in Dingess/Hartman held that the VCAA notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim. As previously defined by the courts, those five elements include: (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. Upon receipt of an application for "service connection," therefore, VA is required to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. This includes notice that a disability rating and/or an effective date will be assigned if service connection is awarded. In a letter issued in February 2005, VA apprised the Veteran of the information and evidence necessary to substantiate his claim for service connection for hypertension. He was informed of the division of responsibility between VA and the Veteran in obtaining such information and evidence. In VA correspondence dated in March 2006, the Veteran was notified of the criteria for consideration in the assignment of a disability rating and/or effective date in the event of award of the benefit sought. VCAA notice should be provided to a claimant before the initial unfavorable decision of the Agency of Original Jurisdiction on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule). In any event, where complete notice is not timely accomplished, such error may be cured by issuance of a fully compliant notice, followed by re-adjudication of the claim. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). As outlined above, VCAA notice was not completed prior to the June 2005 initial adjudication of the issue on appeal. However, the Board finds that the Veteran was not prejudiced in this regard as, following the issuance of the March 2006 letter, the Veteran's claim was re-adjudicated in Supplemental Statements of the Case dated in February 2007 and March 2010. All the VCAA requires is that the duty to notify is satisfied and that claimants are given the opportunity to submit information and evidence in support of their claims. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996). The Board finds the VCAA notice requirements have been met in this case. Duty to Assist With regard to the duty to assist, the Veteran's claims file contains service treatment records, VA examination reports, private treatment records, and lay testimony. In September 2011, the Board remanded the Veteran's claim on appeal for additional development. Specifically, the Board directed that the Appeals Management Center (AMC) schedule the Veteran for an examination to determine the etiology of the Veteran's current hypertension. To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The evidence demonstrates the Veteran underwent VA examination in November 2011. In this case, the Board finds the November 2011 VA examination adequate for the purpose of determining service connection. The record shows the VA examiner reviewed the Veteran's claims file, to include the relevant medical history and lay testimony, completed a physical examination and other appropriate testing, and provided an opinion based on the clinical findings. In addition, the VA examiner provided an adequate rationale for the opinions stated, relying on and citing to the records reviewed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from when it is the factually accurate, fully articulated, and sound reasoning for the conclusion, not the mere fact that the claims file was reviewed). Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4). As such, the Board finds the AMC substantially complied with the remand directives with respect to the issue on appeal. See 38 U.S.C.A. § 5103A(b); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) (2012) requires that the DRO and/or VLJ who conducts a hearing to fulfill two duties to comply with the above regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, the DRO and VLJ asked the Veteran specific questions regarding his symptoms of and treatment for his hypertension during active duty and following separation from service. No pertinent evidence that might have been overlooked and that might substantiate the claim was identified by the Veteran. The hearing focused on the elements necessary to substantiate the claim. The Veteran has not suggested any deficiency in the conduct of the hearing. Therefore, the Board finds that, consistent with Bryant, the DRO and VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). As all relevant facts have been properly and sufficiently developed in this appeal, no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to his claim. Essentially, all available evidence that could substantiate the claim has been obtained. Legal Criteria Generally, 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.A. § 1110; 38 C.F.R. § 3.303(a). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013) (holding that the provisions of § 3.303(b), however, only apply to the list of disabilities identified under § 3.309(a)). In addition, service connection may 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); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and hypertension becomes manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in or aggravated by 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.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In relevant part, 38 U.S.C. § 1154(a) (West 2002) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits. In order to establish direct service connection for a disorder, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of a disease contracted, an injury suffered, or an event witnessed or experienced in active service; and (3) competent evidence of a nexus or connection between the disease, injury, or event in service and the current disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. at 309. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Analysis The Board has reviewed all the evidence in the Veteran's claims file. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The medical criteria relevant to rendering a diagnosis of hypertension for VA purposes is governed by VA Training Letter 00-07 (July 17, 2000), which states that hypertension is present if the diastolic blood pressure is 90 mm Hg or more or the systolic pressure is 140 mm Hg or more, or if both are present. In isolated systolic hypertension, the systolic pressure is 140 mm Hg or more, but the diastolic pressure is less than 90 mm Hg. See also 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1) (2012). The Veteran asserts that his hypertension had its onset during active duty. He contends that his service treatment records show pre-hypertension readings and that his history of nose bleeds is related to his hypertension. The Veteran asserts that although his service treatment records do not document any treatment for hypertension, at one time his blood pressure was considered a serious issue and as a result, he underwent testing for his blood pressure. The Veteran's June 1993 entrance examination reflects a blood pressure reading of 134/80, and the Veteran denied a history of high blood pressure on the June 1993 report of medical history. A January 1994 emergency medical services report reflects that the Veteran complained of epistaxis of the right nare. His blood pressure was 150/88. The Veteran reported a history of nose bleeds, to include six nose bleeds in the last three days. A subsequent January 1994 service treatment record demonstrates a blood pressure reading of 134/76. A February 1994 service treatment record indicates the Veteran's blood pressure was 130/72. The assessment was viral URI. An undated service treatment record reflects the Veteran's blood pressure was 128/86. An April 1995 service treatment record shows the Veteran's blood pressure was 142/86. A May 1995 service treatment record reflects that the Veteran's blood pressure was 140/86. Service treatment records dated in November 1995 demonstrate blood pressure readings of 114/78 and 137/69. A March 1996 service treatment record indicates the Veteran presented with a history of a cough, and the assessment was viral URI. His blood pressure was measured as 138/90 and 130/80. The plan indicated a follow-up with a PRN for blood pressure. The Veteran denied a history of high blood pressure on a March 1996 report of medical history. The March 1997 separation examination shows a blood pressure reading of 144/82. The examiner noted the Veteran was currently under a stressful transition. The Veteran denied a history of high blood pressure on the March 1997 report of medical history. An April 2003 private treatment record reflects a blood pressure reading of 126/80. A complete review of the systems was performed and found to be negative. It was noted that the Veteran's father had elevated blood pressure. In the December 2005 notice of disagreement, the Veteran's representative asserted that a review of the Veteran's service medical records showed multiple elevated blood pressure readings. The representative stated that current medical standards hold that blood pressure readings of 130/80 are indicative of pre-hypertension and that blood pressure ratings of 140/90 are indicative of stage 1 hypertension. The representative reported that the Veteran was currently required to take medication to control his hypertension. The representative argued that the blood pressure readings while on active duty provide a reasonable basis to assume that the Veteran's chronic hypertension had its onset during his period of active service. A November 2005 private clinic progress note shows the Veteran was concerned about borderline hypertension. The Veteran reported that for the last several years his blood pressure sometimes had been elevated when it was checked. He did not report a formal diagnosis of hypertension. Blood pressure readings were 150/96 and 138/96. The assessment was some early hypertension. An April 2008 VA treatment record indicates the Veteran had a history of hypertension. The Veteran reported having had high blood pressure for 15 years that was never treated. The Veteran's blood pressure was 155/108. The assessment was hypertension; blood pressure not controlled. The record shows the Veteran was prescribed daily medication. Follow-up April 2008 VA treatment records show blood pressure readings of 161/101, 150/105, and 145/96. In his April 2009 informal appeal, the Veteran asserted that he had submitted service treatment records showing several hypertensive readings and private medical evidence to establish a link to his current diagnosis of hypertension. The Veteran also submitted internet articles in support of his claim. An internet article from the Mayo Clinic indicates that pre-hypertension is from 120/80 to 139/89; stage 1 hypertension is from 140/90; and stage 2 hypertension is from 160/100 or higher. Because blood pressure tends to fluctuate, a diagnosis of pre-hypertension was based on the average of two or more blood pressure readings taken on separate occasions in a consistent manner. An additional internet article indicates that most people are not aware that they may have hypertension because of a general lack of symptoms. In rare cases, some people with hypertension may have headaches or nosebleeds. The Veteran highlighted a section indicating nose bleeds are one of the many symptoms of hypertension. The Veteran also included a list of his blood pressure readings from his service treatment records: 134/76; 150/80; 128/86; 142/86; 140/86; 130/72; 114/78; 114/78; 126/86; 137/69; 138/90; 134/80; and 150/88. In August 2010, the Veteran's representative asserted that the Veteran's service treatment records showed pre-hypertension readings. The representative stated that the Veteran's history of nose bleeds was related to his hypertension. The Veteran testified that during active duty, he had people tell him that he needed to watch his blood pressure. He also stated that toward the end of his service, he was told his blood pressure was a serious issue and that flight surgeons wanted to keep him there for observation. He reported that for almost two days his blood pressure was taken very seriously and that he was put through a series of tests called "tilts." Because the Veteran wanted to focus on his family and get out of service, however, he turned down the offer to monitor his blood pressure and instead was discharged. The Veteran acknowledged that the records documenting this treatment were not available for review. At the July 2011 hearing, the Veteran asserted that several in-service readings would have been considered pre-hypertensive or stage 1 hypertension. The Veteran stated that the readings reflected that his hypertension began during active duty. The Veteran reported that hypertension had been formally diagnosed in June 2008 at the VA Medical Center in Minneapolis, Minnesota. In November 2011, the Veteran underwent VA examination in connection with his claim. The Veteran reported that he was officially diagnosed with hypertension in early 2002 or 2003, although he had been dealing with elevated blood pressure since active duty. He reported that while in the military he monitored his blood pressure and that he was informed that during field exercises he had significant elevations of blood pressure. The Veteran asserted that he had "tilt" testing performed during active duty to evaluate his episodes of elevated blood pressure but stated that those records were not in the claims file. The Veteran indicated he had begun taking blood pressure medication approximately three years ago. The Veteran denied any symptoms attributable to hypertension, to include headaches; however, he reportedly had a history of epistaxis when he became upset. The VA examiner reviewed the Veteran's claims file and noted the blood pressure readings demonstrated in the service treatment records and post-service treatment records. The VA examiner also reported that the Veteran had a history of diastolic blood pressure elevation as demonstrated in diastolic blood pressure readings in April 2008. On examination, the Veteran's blood pressure readings were 170/102, 170/205, and 170/105. The VA examiner diagnosed essential hypertension and opined that based on the available information, to a reasonable degree of medical certainty, the Veteran's current condition of essential hypertension was not the result of or aggravated by events that occurred during active duty. The VA examiner based the opinion on the evidence showing that each time the Veteran had documented elevated blood pressure, it was during a time of illness or stressful situation. The VA examiner opined that elevated blood pressure during these times is not diagnostic for hypertension since blood pressure normally increases during times of stress or illness. In addition, there was no documentation suggesting that the Veteran had hypertension which was consistent within one year following active duty. The VA examiner explained that proper measurement and interpretation of blood pressure was essential in the diagnosis and management of hypertension. In the absence of end-organ damage, the diagnosis of mild hypertension should not be made until the blood pressure has been measured on at least three to six visits, spaced over a period of weeks to months. For the diagnosis of hypertension, three readings should be taken at least one week apart, and the measurements should be performed in a quiet, warm setting. Although the Veteran had episodes of elevated blood pressure during active duty, these were in the setting of illness or stressful situations, and even in normal situations, studies have shown that blood pressure can change by 10 to 15 mm Hg between visits. The VA examiner determined that the episodes of elevated blood pressure did not confirm a diagnosis of hypertension while the Veteran was in the military because the blood pressure was not measured during a time without illness or heightened stress, and there was no documentation of consistent monitoring of blood pressure or three readings taken at least one week apart. Further, even if the Veteran had a firm diagnosis of hypertension during active duty, the VA examiner would have expected that the Veteran's blood pressure would have been elevated in 2003. The VA examiner also would have expected a history of hypertension when seen by physicians during this time; however, the Veteran denied a history of hypertension and only reported that his father had hypertension. Initially, the Board notes that the first clinical diagnosis of hypertension shown in the record is in April 2008, more than 10 years following the Veteran's separation from service. In addition, the Veteran testified that he was not formally diagnosed with hypertension until 2002 or 2003. Although the Veteran's blood pressure was elevated at the time of his separation from service, the medical evidence of record does not include documentation demonstrating hypertension within the year following. Regardless of whether the Veteran's current hypertension was diagnosed in 2002 or 2008, the clinical evidence of record does not demonstrate that hypertension manifested to a compensable degree within the year following active duty. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. As such, the Board finds the Veteran is not entitled to service connection for hypertension on a presumptive basis. However, the Veteran may still establish service connection under other service connection principles. See Combee v. Principi, 34 F.3d 1039, 1043 (Fed. Cir. 1994). With respect to service connection on a direct basis, the record reflects a current diagnosis of hypertension, and therefore, the Board finds the Veteran has established a current disability for the purpose of service connection. Concerning the second element of a claim for service connection, the Veteran's service treatment records are negative for any complaints of, treatment for, or diagnosis of hypertension. The service treatment records do include some medical records that demonstrate the presence of elevated blood pressure readings. In this respect, the Veteran and his representative assert that these in-service readings are evidence of the onset of hypertension during active duty. However, the November 2011 VA examiner determined that these periods of elevated blood pressure did not render a diagnosis of hypertension and opined that the Veteran's current condition of essential hypertension was not the result of or aggravated by events that occurred during active duty. Here, the Board finds the opinion provided by the November 2011 VA examiner more probative than the Veteran and his representative's assertions. The VA examiner reviewed the Veteran's relevant medical history and his lay testimony concerning his in-service and post-service symptoms. The VA examiner also provided opinions as to the clinical findings and an adequate rationale for the opinions stated, relying on and citing to the records reviewed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA examiner found it significant that each time the Veteran had documented elevated blood pressure during active duty, it was at a time of illness or stressful situation. As such, the VA examiner opined that the episodes of elevated blood pressure did not confirm a diagnosis of hypertension while the Veteran was in the military because the blood pressure was not measured during a time without illness or stressful situations. Furthermore, even if the Veteran had a confirmed diagnosis of hypertension during active duty, the VA examiner noted that the Veteran's blood pressure was normal in 2003. The VA examiner would have expected that if the Veteran had hypertension during active duty, his blood pressure would have been elevated at the time of the next medical evaluation in 2003. The Board acknowledges that in some circumstances, if there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). However, the Court has recently held that the provisions of 38 C.F.R. § 3.303(b) only apply to the list of disabilities identified under § 3.309(a). See Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). As hypertension is not one of the identified disabilities, 38 C.F.R. § 3.303(b) is inapplicable in this case, and a showing of continuity of symptomatology following service is not sufficient to support a finding of chronicity. Here, the only competent medical opinion of record does not support a relationship between the Veteran's current hypertension and active duty, to include the episodes of elevated blood pressure. The Board acknowledges that the Veteran is competent to testify to matters within the realm of his personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that a lay witness is competent to testify to that which the witness has actually observed and is within the realm of his personal knowledge). Although the Veteran and his representative assert that his current hypertension had its onset during active duty, it is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of complex disorders and disabilities which require medical training. See 38 C.F.R. § 3.159(a)(1). In certain unique instances, lay testimony may be competent to establish medical etiology or nexus. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). However, the evidence does not show that the Veteran or his representative possesses the requisite training or credentials needed to render a competent opinion as to medical causation of hypertension, a complex medical matter. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Here, the Board finds that the relationship between the Veteran's current hypertension and any in-service evidence of elevated blood pressure is not something for which a layman is competent to provide an opinion. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (noting that lay testimony is competent to establish observable symptomatology but not competent to establish medical etiology or render medical opinions). As such, the lay opinions provided by the Veteran and his representative do not constitute competent medical evidence and lack probative value. The Board also notes that the claims file includes written articles on hypertension submitted by the Veteran in support of his claim. Assuming, arguendo, that the articles rise to the level of a medical article or medical treatise, the Board notes that the Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222, 228 (1999); see also Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). In short, articles and treatises tend to be general in nature and tend not to relate to the specific facts in a given veteran's claim. In the present case, the articles submitted by the Veteran fall into this general category. Although the articles discuss hypertension, none of the articles pertains specifically to this Veteran, and the articles are not combined with any opinion of a medical professional. Therefore, this evidence is not probative with regard to the issue on appeal. In sum, presumptive service connection, as due to disabling hypertension within one year of separation, is not warranted, and the competent, credible evidence of record is against a finding that the Veteran has hypertension causally related to, or aggravated by, active duty. Based on the foregoing, the Board finds that the preponderance of the evidence is against a grant of service connection for hypertension. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER Entitlement to service connection for hypertension is denied. ____________________________________________ U. R. POWELL Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs