Citation Nr: 18147242 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 13-12 091 DATE: November 2, 2018 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The evidence of record fails to support a finding that the Veteran’s hypertension is etiologically related to his period of active military service, to include in-service herbicide exposure, and as due to his other service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309(e), 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service in the U.S. Army from February 1966 to February 1968, including active service in the Republic of Vietnam. The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claims. In this regard, the Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). 1. Entitlement to service connection for hypertension The Veteran alleges that his diagnosed hypertension is due to active military service, including in-service herbicide exposure and/or caused or aggravated by his service-connected disabilities, particularly diabetes mellitus, type II and prostate cancer. In this regard, the Board concedes in-service herbicide exposure as his maritime service in the Republic of Vietnam has been previously corroborated. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain diseases, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of a 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, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). Cardiovascular-renal disease, including hypertension, is deemed a chronic disease under 38 C.F.R. § 3.309(a). For reference purposes, the term hypertension means that diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is 160mm. or greater with a diastolic blood pressure less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101. Hypertension or systolic hypertension must be confirmed by readings taken on at least three different days. Id. Hypertension is manifest to a compensable degree when (1) diastolic pressure is predominately 100 or more; (2) systolic pressure is predominately 160 or more; or (3) minimum evaluation for an individual with a history of diastolic pressure predominately 100 or more who requires continuous medication for control. Id. Service connection may be granted, on a secondary basis, for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Aggravation means a permanent worsening beyond natural progression. Davis v. Principi, 276 F.3d 1341 (Fed. Cir. 2002). A temporary or intermittent flare-up of a pre-existing disease does not constitute aggravation. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). At entry and exit of service, the Veteran was examined as normal, and denied experiencing instances of high or low blood pressure. The Veteran did not demonstrate blood pressure readings indicative of hypertension during service or within one year of discharged. VA treatment records reflect that the Veteran was diagnosed with essential hypertension in 2001. A March 2010 VA examination of record notes that the Veteran’s essential hypertension required continuous medication to manage. However, it was not a complication of his diabetes mellitus, type II, as it pre-dates the date of diagnosis. Moreover, the examiner indicated there was no increase or worsening as caused by his diabetes mellitus. The claim was remanded by the Board in July 2017 to seek an opinion on whether there was any direct causation between the Veteran’s in-service herbicide exposure and his hypertension. The November 2017 opinion of record reflects that the Veteran’s hypertension is less likely related to service including herbicide exposure, as the Veteran’s records do not reveal hypertension began in service or within a proximity to service. The Veteran’s essential hypertension was diagnosed in 2001, decades after service. Moreover, essential hypertension is a form of hypertension that by definition has no identifiable cause, but there was no affirmative medical evidence directly linking hypertension to Agent Orange or herbicide exposure. In reference to, the specified medical articles in the remand, the examiner stated that one study in and of itself, is not, and should not be considered conclusive evidence of whether a true causal relationship exists. An additional opinion was sought in March 2018 addressing the Veteran’s claim under a theory of secondary service connection. In this regard, the examiner stated that it is less likely the Veteran’s hypertension was caused by or aggravated by his service-connected diabetes mellitus and/or prostate cancer, including their medications. The Veteran’s diagnosis of hypertension pre-dates his diabetes diagnosis by eight-years, and per medical literature, there is no objective evidence for hypertension being due to prostate cancer. Lastly, the examiner concluded that there is also no objective evidence of aggravation caused by either condition. The Board notes that the Veteran is competent and credible with respect to his report of his diagnosis of hypertension. However, a person making a determination that is medical in nature must have the appropriate medical training or expertise in order for his opinion to be considered as competent evidence. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration, and that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). Because the Veteran has not been shown to have such specialized training or expertise, his lay opinion regarding the etiology of his hypertension is not competent and therefore has no probative value. See Id. Additionally, the Veteran’s has not specifically alleged the onset of hypertension in service or within one year of service discharge. To the extent his testimony can be construed otherwise, the Board observes that such testimony in and of itself would be insufficient to establish service connection based on continuity of symptomatology under 38 C.F.R. § 3.303(b) or presumptively under 38 C.F.R. § 3.309(a) in the absence of blood pressure readings meeting the standard for diagnosing hypertension within these time periods. As hypertension is not deemed presumptive due to herbicide exposure, a grant of benefits under 38 C.F.R. § 3.309(e) is also not warranted. The Board has also considered various studies considering a possible association between herbicide exposure and hypertension. These articles do not specifically discuss the applicability of these potential relationships in this particular Veteran’s case, and the probative value of such evidence is greatly outweighed by the opinions of medically qualified and trained VA examiners who applied any information contained in these studies to the particular facts of this case. Thus, the competent medical evidence does not support a finding that the Veteran’s hypertension is due to active military service and/or his service-connected disabilities. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Consequently, entitlement to service connection for hypertension is denied. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309(e), 3.310 (2017). T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.L. Reid, Associate Counsel