Citation Nr: 18145203 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 10-23 023 DATE: October 30, 2018 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is denied. FINDING OF FACT The Veteran’s hypertension is neither proximately due to nor aggravated beyond its natural progression by his service-connected PTSD, and is not otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1968 to June 1970. The Veteran testified before the undersigned Veterans Law Judge at an August 2012 Travel Board hearing. Entitlement to service connection for hypertension, to include as secondary to service-connected PTSD The Veteran asserts that his hypertension is caused by his service-connected PTSD. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The April and May 2018 VA examiner opined that the Veteran’s hypertension is less likely than not due to or aggravated by his service-connected PTSD. The rationale was that there is no causal link in medical literature between PTSD or anxiety or depression and hypertension. The examiner explained that anxiety can cause temporary spikes in blood pressure, but it is not linked to hypertension. The examiner discussed Mayo Clinic literature supporting this point. The examiner also stated that the Veteran’s hypertension has been remarkably stable without any fluctuations that can be attributed to anxiety. The examiner concurred with the July 2016 VA examiner who opined that the Veteran’s hypertension was not secondarily connected to his PTSD. The examiner explained that the April 2014 VA examiner who believed that the Veteran’s medical records show that his blood pressure fluctuated in response to his anxiety levels was mistaken in equating hypertension with temporary blood pressure spikes. The examiner also noted that the April 2014 VA medical examiner recommended that the Veteran get a mental health evaluation in order to determine if there was a medical relationship between the Veteran’s hypertension and his PTSD. The Board finds that the July 2016 and April and May 2018 VA medical opinions are more probative than the April 2014 VA medical opinion due to the rationale expressed in the April and May 2018 VA medical opinions. [insert rationale/medical explanation]. [If there is conflicting evidence regarding the nexus, compare and weigh the conflicting medical opinions and find that one is more probative than the other - Nieves-Rodriguez, Barr, Stefl, Prejean.] While the Veteran believes his hypertension is proximately due to or the result of/aggravated beyond its natural progression by PTSD, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the July 2016 and April and May 2018 VA medical opinions. Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s hypertension is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). (Continued on next page) The Veteran’s service treatment records do not show any hypertension, and the Veteran has not identified any in-service injury or event. Therefore, service connection for hypertension on a direct basis is denied. JOHN Z JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Parke