Citation Nr: 18146744 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 12-10 665 DATE: November 1, 2018 ORDER Service connection for hypertension is denied. Service connection for erectile dysfunction is denied. FINDINGS OF FACT 1. Hypertension was not shown in service or within a year of service discharge; and the weight of the evidence fails to establish that the Veteran’s diagnosed hypertension is etiologically related to his active service, to include his presumed herbicide agent exposure therein, or was caused or aggravated by the Veteran’s service-connected diabetes mellitus and/or posttraumatic stress disorder. 2. Erectile dysfunction was not shown in service; and the weight of the evidence fails to establish that the Veteran’s diagnosed erectile dysfunction is etiologically related to his active service, to include his presumed herbicide agent exposure therein, or was caused or aggravated by the Veteran’s service-connected diabetes mellitus and/or posttraumatic stress disorder. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.309, 3.310. 2. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from September 1966 to September 1968. In April 2012, the Veteran requested a hearing before a Veterans Law Judge. A review of the file indicates that the Veteran submitted a request to withdraw the request for a hearing on September 5, 2012. Thus, the hearing request is deemed withdrawn. 38 C.F.R. § 20.704(d). Service Connection 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 military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 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). Service connection may also be established under 38 C.F.R. § 3.303(b), where a condition in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service connected disability; and (3) medical nexus evidence establishing a connection between the service connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. The Veteran’s service records show that he served in the Republic of Vietnam. As such, exposure to herbicide agents, such as Agent Orange, is presumed. However, hypertension and erectile dysfunction are not among the list of diseases that are presumptively related to herbicide agent exposure under 38 C.F.R. § 3.309(e). As such, presumptive service connection based on herbicide agent exposure is not warranted. The Veteran filed his service connection claims for hypertension and erectile dysfunction in June 2009, which were denied by May 2010 and June 2010 rating decisions. The Veteran asserts that hypertension and erectile dysfunction are due to his active service or were caused or aggravated by his service-connected diabetes mellitus (diabetes) and/or posttraumatic stress disorder (PTSD). For VA compensation purposes, the term “hypertension” means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. Multiple blood pressure readings are required to confirm the diagnosis of hypertension with two or more readings on at least three different days. 38 C.F.R. § 4.104, DC 7101, Note 1. The Veterans STRs show that at his April 1966 entrance examination, his blood pressure was 117/74 and he denied having high blood pressure. His STRs do now show that he had any symptoms, complaints, or diagnoses for hypertension or erectile dysfunction. At his August 1966 separation examination, his blood pressure was 117/68 and he again specifically denied having then, or having ever had, high blood pressure. After his separation from active service, the Veteran was first diagnosed with hypertension in 1997, almost three decades after his separation from active service. He was diagnosed with erectile dysfunction in 2001, more than three decades after his separation from service. Furthermore, he was diagnosed with diabetes in 2003, after both his diagnoses of hypertension and erectile dysfunction. As such, the record contains no diagnosis of hypertension or erectile dysfunction either in service or within one year after service, which would preclude service connection on the basis of continuity of symptomology or on any presumptive basis. The Veteran has not argued to the contrary and instead argues his hypertension and erectile dysfunction are the result of his service-connected diabetes and/or PTSD. There is also no medical evidence linking the Veteran’s current hypertension or erectile dysfunction to his active service, and he has not submitted any medical opinion that even suggests that his hypertension or erectile dysfunction either began during or was otherwise caused by his military service. See Shedden, 381 F.3d 1163, 1167. In May 2010, the Veteran was afforded a VA examination. After reviewing the Veteran’s claims file, interviewing the Veteran, and conducting an examination, the examiner opined that the Veteran’s hypertension was not caused or aggravated by his diabetes. The examiner also opined in an addendum opinion that the Veteran’s erectile dysfunction was not caused or aggravated by his diabetes. In August 2016, the Veteran was afforded a VA examination, but the examiner was unable to opine on whether the Veterans diabetes caused or aggravated the Veteran’s hypertension or erectile dysfunction. In response, the Board solicited an expert medical opinion from an internist. In May 2018, a VA physician reviewed the claims file, then opined that the Veteran’s hypertension was less likely than not due to his active service, to include his presumed herbicide agent exposure. The VA physician opined that the Veteran’s hypertension was less likely than not caused or aggravated by his diabetes or PTSD. The VA physician explained that for diabetes to cause hypertension, the Veteran should have renal failure, which was not present in this case. The VA physician reported that there was no medical literature available to support the assertion that the Veteran’s hypertension was aggravated by his diabetes or PTSD. The VA physician opined that the Veteran’s erectile dysfunction was less likely than not due to his active service, to include his presumed herbicide agent exposure. The VA physician opined that the Veteran’s erectile dysfunction was less likely than not caused or aggravated by his diabetes or PTSD. The VA physician noted that the Veteran’s erectile dysfunction was diagnosed in 2001 and that the Veteran had normal kidney function tests in 2002 and 2009. The VA physician reported that the Veteran had multiple other comorbidities which could worsen erectile dysfunction. After weighing all the evidence, the Board finds great probative value in the May 2018 VA physician’s opinions. These negative opinions are sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence which appears to support the Veteran’s position. Wray v. Brown, 7 Vet. App. 488, at 492-93 (1995). Consideration has been given to the Veteran’s personal assertion that his hypertension and erectile dysfunction were caused by his service-connected diabetes and/or PTSD. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the etiology of hypertension and erectile dysfunction, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Hypertension and erectile dysfunction are not the type of conditions that are readily amenable to mere lay diagnosis or probative comment regarding its etiology, as the evidence shows that physical examinations that include multiple blood pressure readings and kidney function studies are needed to properly assess and diagnose the disorders. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). That is, although the Board readily acknowledges that Veteran is competent to report perceived symptoms of hypertension and erectile dysfunction, he has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that he has received any special training or acquired any medical expertise in evaluating disorders such as hypertension, erectile dysfunction, diabetes, or psychiatric disorders. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the Veteran’s assertions do not constitute competent medical evidence. The Veteran’s representative argued in May 2018 that there were numerous articles in which hypertension and diabetes mellitus were noted to be diagnoses that occurred at the same time. The representative also noted that high blood pressure or hypertension are often associated with diabetes mellitus. However, as was explained in the expert medical opinion, for hypertension to be associated with diabetes mellitus, a person would need to have renal problems which are not shown by the record here. The Representative also suggested that the Veteran’s hypertension was the result of his PTSD, pointing to several studies, and also suggesting that the medication prescribed to treat the Veteran’s PTSD might have affected his hypertension. However, the Board’s opinion requested the medical professional to specifically address these questions and such was done. The same holds true for the erectile dysfunction claim. The Veteran has not offered any medical opinion of record that refutes the conclusions of the expert medical opinion. As such, that opinion is given great weight. Accordingly, as the criteria for service connection for hypertension and erectile dysfunction have not been met, the Veteran’s claims are denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berryman, Counsel