Citation Nr: 18140071 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 11-17 751 DATE: October 2, 2018 ORDER Service connection for hypertension is denied. FINDING OF FACT The Veteran does not have currently diagnosed hypertension. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. 1110, 1112, 5103, 5103A, 5107; 38 C.F.R. 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from January 2004 to December 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision by the Regional Office (RO) in Denver, Colorado, which, in pertinent part, denied service connection for hypertension. In January 2015, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The issue of service connection for hypertension was previously before the Board in March 2015, where the Board, in pertinent part, remanded the issue for a VA examination. The Veteran did not report to a scheduled VA examination in April 2015. Because the Veteran did not report for the VA examination scheduled to help provide the requested medical opinion, a supplemental VA medical opinion was obtained. The Veteran has also not provided any reason or good cause as to why he was unable to attend the VA examination. In consideration thereof, the Board finds that there has been substantial compliance with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008). The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). Review of the record reflects that the Veteran received adequate notice concerning the issue on appeal. As to the duty to assist, the record reflects that VA obtained VA treatment (medical) records. The Veteran did not report to a scheduled VA examination in April 2015. Because the Veteran did not report for the VA examination scheduled to help provide the requested medical opinion, a March 2018 VA medical opinion was obtained. The March 2018 VA reviewing physician had adequate facts and data regarding the history and condition of the claimed hypertension when rendering the medical opinion. For these reasons, the Board finds that the March 2018 VA medical opinion is adequate, and there is no need for further examination or medical opinion. There remains no question as to the substantial completeness of the record as to the issue on appeal. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.159, 3.326(a). Any duties imposed on VA, including the duties to assist and to provide notification, have been met. Service Connection for Hypertension Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Cardiovascular-renal disease, to include hypertension, is recognized by VA as a “chronic disease” under 38 C.F.R. § 3.309(a); however, and as discussed below, the Board finds that the weight of the evidence is against a finding that the Veteran has currently diagnosed hypertension. The term hypertension means that the diastolic blood pressure is predominantly 90 millimeters (mm.) or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104. The Veteran contends that a current hypertension disability is related to service. Specifically, the Veteran asserts that the claimed hypertension began in service as evidenced by a series of high blood pressure readings. See January 2015 Board hearing transcript at 9–11. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a current hypertension disability. A March 2018 VA medical opinion reflects that, after reviewing the record, the VA physician opined that it is less likely than not that the Veteran has hypertension. The March 2018 VA physician reasoned that, while in-service treatment records reflects elevated blood pressure readings, the readings were taken during times of an acute illness or significant pain, factors known to transiently elevate blood pressure. The March 2018 VA physician also reasoned that, while an April 2006 VA treatment record reflects a visit for “high blood pressure,” smoking likely transiently elevated the blood pressure on that occasion. See April 2006 VA treatment record reflecting the Veteran reported smoking eight cigarettes per day. The March 2018 VA physician also assessed that blood pressure readings recorded at a VA examination six months after service were “well within normal limits.” See June 2007 VA examination report reflecting blood pressure readings of 118/80, 120/80, and 120/80. The March 2018 VA medical opinion reflects that the VA physician opined that a purported July 2009 hypertension diagnosis was premised on the Veteran experiencing “significant stressors,” and that subsequent blood pressure readings were well within normal limits, indicating that the Veteran did not have hypertension. See July 2014 VA treatment record reflecting a blood pressure reading of 115/68. The March 2018 VA physician also assessed that a March 2017 VA treatment record reflecting an elevated blood pressure reading barely met the criteria for hypertension, and that the March 2017 VA examiner specifically assessed an element of white coat hypertension. The March 2018 VA physician noted that the Veteran was instructed to check his blood pressure at home, to call if readings were elevated, and that subsequent VA treatment records did not reflect any self-reports of elevated blood pressure readings. See March 2017 VA treatment record. For these reasons, the March 2018 VA physician concluded that the Veteran did not have hypertension. The Board finds that the March 2018 VA medical opinion is highly probative, and is adequately based on objective findings as shown by the record. The March 2018 VA medical opinion includes all relevant findings and medical opinions needed to evaluate fairly the appeal. The VA physician considered a complete and accurate history of the claimed disability as provided through review of the record, which included prior interview of the Veteran and the Veteran’s subjective complaints as it related to the current symptomatology. The March 2018 VA reviewing physician had adequate facts and data regarding the history and condition of the claimed hypertension when rendering the medical opinion, specifically considered elevated blood pressure readings during and since service, and considered the Veteran’s reports that hypertension began during service. For these reasons, the Board finds that the March 2018 VA medical opinion provides competent, credible, and probative evidence that shows that the Veteran does not have a current diagnosis of hypertension. In addition, and as discussed above, the Board previously remanded this appeal to obtain a VA examination to assist in determining the etiology of the claimed hypertension; however, the Veteran failed to report to the VA examination. The Veteran has not provided explanation or good cause regarding the failure to report to the examination. Individuals for whom examinations have been authorized and scheduled in conjunction with VA compensation claims are required to report for such examinations. 38 C.F.R. § 3.326(a). The failure to report to the scheduled examination has also precluded the creating of potentially favorable of a current disability. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that the duty to assist is not a one-way street). While, as a lay person, the Veteran is competent to relate injury, treatment, and some symptoms that may be associated with hypertension, under the facts of this case that include no symptoms for years after service and a VA medical opinion, he does not have the requisite medical knowledge, training, or experience to be able to diagnose medically complex cardiovascular disorders. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that requires a medical opinion to diagnose and to relate to service or differentiate from in-service symptoms and diagnosis). Cardiovascular disorders are medically complex because of the multiple potential etiologies, can require specialized testing to diagnose, and observable symptomatology can overlap with other disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever). Diagnosing a cardiovascular disorder involves internal and unseen system processes unobservable by the Veteran, and the Veteran has not been shown to have such knowledge, training, or experience. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of evidence of a present disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223 (1992).; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). The Board recognizes that the U.S. Court of Appeals for Veterans Claims has held that the presence of a chronic disability at any time during the claim process, including immediately prior to filing a claim (see Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), can justify a grant of service connection, even where the most recent diagnosis is negative; however, where, as here, the overall evidence of record does not support a diagnosis of the claimed hypertension, that holding is of no advantage. As noted above, VA attempted to arrange for a VA examination to obtain medical evidence regarding this issue, but the Veteran did not report to the scheduled examination. Thus, the claim must be decided on the current evidence of record. As the weight of the evidence demonstrates that the Veteran does not have hypertension, the preponderance of the evidence is against the claim for service connection for hypertension, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Tenney, Associate Counsel