Citation Nr: 18140850 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 14-34 568 DATE: ORDER Entitlement to service connection for hypertension is denied. FINDINGS OF FACT The preponderance of the evidence shows that the Veteran’s hypertension is not related to his active duty service. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1966 to April 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boise, Idaho. Additionally, the Veteran originally requested a hearing regarding his claim for service connection for hypertension. However, in July 2015 correspondence, his representative indicated that the Veteran was withdrawing his hearing request. Thus, the request is deemed withdrawn and the Board will proceed with adjudication of the claim. 1. Entitlement to service connection for hypertension is denied. Under the relevant laws and regulations, 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 (2012); 38 C.F.R. § 3.303 (a) (2017). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370, 374 (2002). When considering whether lay evidence is competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, although the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of psychiatric, respiratory, or orthopedic disorders. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Additionally, hypertension is classified as a “chronic disease” eligible for presumptive service connection under 38 C.F.R. § 3.309 (a). The Board may consider presumptive service connection for “chronic diseases” on three bases: (1) chronicity during service, (2) continuity of symptomatology since service, and (3) manifestations to a degree of 10 percent disabling or more within one year of the Veteran’s separation from service. 38 C.F.R. §§ 3.303 (b), 3.307(a)(3) (2017); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The rating criteria for hypertension define hypertension as diastolic blood pressure predominantly at 90 millimeters or greater. See 38 C.F.R. § 4.104, Diagnostic Code 7101. A 10 percent rating under Diagnostic Code 7101 is: (1) diastolic pressure predominantly 100 or more; or (2) systolic pressure predominantly 160 or more; or (3) a history of diastolic pressure predominantly 100 or more with continuous medication for required control. Furthermore, in determining whether service connection is warranted for a disability, 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 preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As an initial matter, the Board notes that the Veteran has a current diagnosis of hypertension. See November 2012 VA Examination Report. A review of the Veteran’s service treatment records (STRs) indicates that he was diagnosed with an episode of hypertension during service. Indeed, a treatment record dated September 29, 1966, reflects that he was diagnosed with hypertension after passing out during a run. Specifically, in the September 1966 STR, the Veteran’s blood pressure was measured as 138/60, 174/102, and 150/110. At that time, the treatment provider concluded that the Veteran had probable hypertension. However, there is no documentation of hypertension in the remaining STRs, which indicates that the September 1966 diagnosis was an isolated incident and not reflective of the chronicity required for service connection under See 38 C.F.R. 3.303 (b). Indeed, additional STRs contain blood pressure readings of 128/72 (on February 18, 1967) and 130/70 (on February 24, 1967). Although the separation examination report is difficult to read, it appears that the Veteran’s systolic pressure was noted as 126, with the diastolic pressure listed as a double-digit figure. See March 1968 Separation Examination p. 2. Thus, the evidence of record does not reflect that the Veteran presented with hypertension upon separation, nor that he had diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more during active duty service. Additionally, regarding direct service connection, the Board notes that the Veteran was afforded a VA examination for his hypertension in November 2012. The examiner concluded that his hypertension was less likely than not related to his military service. He acknowledged the in-service incident of elevated blood pressure, but reasoned that he was not treated for long-term hypertension during service. The examiner further noted that the Veteran was not being treated for hypertension upon separation from service. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. In this regard, the Board places great probative weight on the November 2012 examiner’s opinion that the Veteran’s hypertension was less likely than not related to his military service. The examiner clearly reviewed the claims file and thoroughly summarized pertinent clinical records, indicating that he was fully aware of the extent of the Veteran’s claimed condition, as well as his in-service episode of hypertension and reported symptomatology. He offered a discussion analyzing the pertinent evidence of record and explaining the basis for the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As there have been no opinions submitted in favor of the Veteran’s claim, the November 2012 VA opinion is the only probative medical opinion of record. The Veteran has contended on his own behalf that his hypertension is related to his military service. The Board appreciates that the Veteran believes that his current disability is related to service, and that he is competent to report his personal observations. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Board affords the lay opinion no probative value. Although lay persons are competent to provide opinions on some medical issues, see Kahana, supra, as to the specific issue in this case, determining whether a cardiovascular disability is due to military service, falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As such, the preponderance of the evidence is against entitlement to service connection for hypertension. Reasonable doubt does not arise, and the benefit-of-the-doubt doctrine does not apply; the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Erin J. Trojanowski, Associate Counsel