Citation Nr: 18145235 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-30 007 DATE: October 26, 2018 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for headaches, to include as secondary to service-connected PTSD, is denied. FINDINGS OF FACT 1. 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, event, or disease. 2. The preponderance of the evidence is against finding that headaches began during active service, or are otherwise related to an in-service injury, event, or disease. 3. The Veteran’s hypertension and headaches are neither proximately due to nor aggravated beyond their natural progression by her service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension, to include as secondary to service-connected PTSD, 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), 3.310(a). 2. The criteria for service connection for headaches, to include as secondary to service-connected PTSD, are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1997 to January 1998 and from January 2002 to February 2003. Service Connection The Veteran seeks service connection for hypertension and headaches. Her postservice VA treatment records show that she has a diagnosis of hypertension. They also reflect complaints of headaches, for which she has been prescribed medication. Accordingly, the question for the Board is whether the Veteran has a current disability that is etiologically related to her service or proximately due to or the result of, or is aggravated beyond its natural progress by a service-connected disability. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases, which are listed in 38 C.F.R. § 3.309(a) may also be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Hypertension is a chronic disease listed under 38 C.F.R. § 3.309(a). With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. Id. However, if chronicity in service is not established or where the diagnosis of chronicity may be legitimately questioned, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may nonetheless be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Veteran’s service treatment records are silent for any complaints, findings, treatment, or diagnosis of hypertension or headaches. Her postservice treatment records also do not indicate that the Veteran’s hypertension manifested in service or within the first postservice year. In fact, during the Veteran’s August 2016 VA examinations, she reported that she developed hypertension and headaches in 2011 and 2010, respectively. Based on the foregoing, the Board finds that service connection for hypertension on the basis that it became manifest in service and persisted is not warranted. As there is also no competent and credible evidence that the Veteran’s hypertension became manifest in the first postservice year, there is no basis for considering (and applying) the 38 U.S.C. § 1112 chronic disease presumptions. Similarly, there is no evidence in the claims file to suggest that the Veteran’s headaches are directly related to her service. Notably, it is not the Veteran’s contention that her hypertension and headaches are directly related to her military service. Rather, she contends service connection is warranted for both disabilities because they are caused or aggravated by her service-connected PTSD. Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. In her June 2016 VA Form 9, substantive appeal, the Veteran asserted that her headaches and hypertension were associated with her service-connected PTSD. In her March 2015 notice of disagreement, she stated that she had high blood pressure because of the anger she experienced related to daily issues. In support of her claim, the Veteran also submitted a letter dated October 2015 from her treating VA psychiatrist. Her psychiatrist noted that she had been treating the Veteran since March 2013 for PTSD and a major depressive disorder. Her symptoms included significant sleep disturbance, nightmares, flashbacks, avoidance, hypervigilance, hyperstartle and depressed mood. The psychiatrist also noted that the Veteran had developed hypertension and migraine headaches. In the psychiatrist’s opinion, these conditions were developed from or made worse by the Veteran’s PTSD and mood symptoms, as they could develop from her severe anxiety symptoms. The Veteran was also afforded VA examinations in August 2016. After examining the Veteran and reviewing the claims file, which included the October 2015 statement from the Veteran’s treating psychiatrist, the examiner opined that the Veteran’s hypertension and headaches were less likely than not proximately due to or the result of her service-connected condition. With respect to hypertension, the examiner explained that a physiological response to stress could cause a rise in blood pressure. However, it would normally return to its normal baseline reading. Hypertension that was sustained with the need for medical management was instead normally related to genetics, age, or hypertensive heart disease. The examiner also noted that there was no current clinical data in the medical literature that supported PTSD as a causative or aggravating agent in the development or worsening of hypertension. With respect to headaches, the VA examiner similarly explained that there was no clear current clinical data in the medical literature that supported PTSD as a causative or an aggravating agent in the development or worsening of headache. After reviewing the foregoing medical opinions, the Board affords greater weight to the VA examiner’s opinions because they are based on a review of the claims file and includes a more thorough explanation for the rationale of his medical opinions. Specifically, with respect to both headaches and hypertension, the VA examiner explained that there was no clinical data in medical literature to support finding a causal or aggravating relationship between PTSD and headaches or hypertension. The Veteran’s treating VA psychiatrist, on the other hand, made conclusory statements without providing any support for her opinion. Hence, the VA examiner’s opinions are more probative than that of the Veteran’s treating psychiatrist. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) While the Veteran believes her headaches and hypertension are proximately due to her service-connected PTSD, she is not competent to provide a nexus opinion in this case. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Whether one disability may be related to another is a medical question not capable of resolution by mere lay observation; it requires medical expertise. Consequently, the Board gives more probative weight to the VA examiner’s opinions. In conclusion, the preponderance of the evidence is against finding that the Veteran’s headaches and hypertension are proximately due to or the result of, or aggravated beyond their natural progression by a 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). Accordingly, the claims are denied. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.Vemulapalli, Associate Counsel