Citation Nr: 18140841 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 13-30 602 DATE: ORDER Entitlement to service connection for hypertension is denied. REMANDED Entitlement to a rating in excess of 40 percent disabling for prostate cancer, after September 1, 2012 is remanded. FINDING OF FACT The Veteran’s hypertension did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, or disease. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1965 to August 1968 with service in the Republic of Vietnam. In June 2016, the Board remanded the Veteran’s claim for further development. The agency of original jurisdiction (AOJ) substantially complied with the June 2016 remand directives, and no further development is necessary with regard to those specific directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131 (West 2014); 38 C.F.R. § 3.303 (a) (2016). In general, service connection requires competent and credible evidence of (1) a current disability; (2) 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 Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. With respect to continuity of symptomatology, the Court has held that, under 38 C.F.R. §3.303(b), the theory of continuity of symptomatology is an alternative route to establish service connection for specific chronic diseases, including hypertension, and can only be used in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Entitlement to service connection for hypertension The Veteran contends that his hypertension is the result of his active service. His service treatment records are silent for complaints, treatment, or diagnosis of essential hypertension. Compensably disabling hypertension is also not shown within a year of separation from active duty. The earliest recorded instance of treatment or diagnosis of hypertension is a February 1998 private treatment record from Rome Medical Group indicating an assessment of hypertension for the Veteran. Numerous private medical treatment records from St. Elizabeth Medical Center indicate the Veteran presents with a history and assessment of hypertension. Multiple VA treatment records indicate an assessment of hypertension without any discussion as to its etiology. In May 2015, the Veteran attended a Board hearing. He testified that he started suffering from hypertension after service in his “late 30’s, early 40’s.” In February 2017, the Veteran attended a VA Hypertension Disability Benefits Questionnaire (DBQ) examination. The examiner diagnosed hypertension and opined that it was less likely than not that it incurred in or was caused by active service. The rationale that was provided stated that there was insufficient supportive evidence-based medical literature to support the Veteran’s claim. For this individual Veteran, it is more likely than not that the development of hypertension is secondary to the most common risk factors for hypertension, e.g., male gender, age, and obesity; Thus, these risk factors significantly outweigh the suggestive contribution of Agent Orange exposure. Based on the foregoing evidence of record, the Board finds that service connection on a direct or presumptive basis is not warranted for hypertension. As noted above, the first instance of any treatment or diagnosis of hypertension occurs in 1998, more than 30 years after the Veteran’s active service. The multi-year gap between discharge from active duty service and evidence of the disorder years later is viewed as a factor weighing against this claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Further, the February 2017 medical opinion, considered the most probative medical evidence of record, indicates that more likely than not the development of hypertension is secondary to the most common risk factors for hypertension, e.g., male gender, age, and obesity. In addition, while the Veteran is competent to report his belief of when hypertension started, he has not presented any evidence of blood pressure readings suggestive of hypertension - as defined by VA - in service or blood pressure readings to a compensable degree within one year of discharge. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), in this case the etiology of his high blood pressure falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) Hence, the Veteran is not competent to address the etiology of any current high blood pressure. Additionally, the Veteran has not provided competent evidence of persistent or recurrent symptoms of hypertension since service to warrant service connection on the basis of continuity of symptomatology under 38 C.F.R. § 3.303 (b). Further, while the Board notes the private medical assessments of hypertension, it brings attention to the lack of opinion and rationale provided with regard to these diagnoses. For the reasons stated above, service connection for high blood pressure is denied. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107 (b). REASONS FOR REMAND Entitlement to a rating in excess of 40 percent for prostate cancer, after September 1, 2012 is remanded. With regard to the Veteran’s prostate cancer claim, the Board notes that the Veteran’s last examination for his prostate cancer occurred in June 2011, over seven years ago. In addition, medical evidence of record appears to indicate the possibility of worsening symptomatology, therefore Board finds that he should be afforded another VA examination to determine the current severity of his service-connected prostate cancer. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matter is REMANDED for the following action: 1. Ask the Veteran to identify any additional records of treatment he would like considered in connection with this appeal, which should then be associated with the claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected prostate cancer residuals. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.A. Elliott II, Associate Counsel