Citation Nr: 18150252 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-48 621 DATE: November 14, 2018 ORDER Service connection for hypertension is denied. Service connection for a low back disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from October 1989 to October 1999. 2. Hypertension was not shown in service or within a year of service separation; the current diagnosis of hypertension is not causally or etiologically related to service. 3. A chronic low back disorder was not shown in service, or arthritis within a year of service separation; the current low back disorder is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by active service, was not shown to a compensable degree within one year of service, and symptoms of hypertension were not continuous since service. 38 U.S.C. §§ 1110, 1112, 5103(a), 5103A (2014); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2017). 2. A low back disorder was not incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1112, 5103(a), 5103A (2014); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Hypertension In addition to the above laws and regulations, hypertension is listed among the “chronic diseases” under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. In addition, hypertension is subject to the one-year presumption if it becomes manifest to a degree of 10 percent or more within one year after the date of separation from such service. Hypertension for VA purposes is defined as diastolic blood pressure 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. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101. As an initial matter, the medical evidence reflects that the Veteran was diagnosed with hypertension in 2009. As such, a current disorder is shown and the first element of service connection is satisfied. Service treatment records (STRs) indicated that the Veteran had a single blood pressure reading of 140/92 in February 1998 and a familial history of hypertension was noted. Multiple readings were then obtained over a three-day period and the examiner concluded that the Veteran did not have hypertension. STRs do not indicate any further elevated blood pressure readings supporting a diagnosis of hypertension and the Veteran repeatedly denied hypertension at various examinations during service between 1989 and 1998. At his August 1999 separation examination, his blood pressure was 146/74. Therefore, in-service hypertension was not shown. Next, post-service treatment records showed that the Veteran was examined in January and August 2000. At that time, his blood pressure was within normal limits and no evidence of hypertension was found. The record remained largely silent to any more incidents of elevated blood pressure readings until the Veteran was diagnosed with hypertension in 2009. Thus, hypertension was shown within one year of service and continuous symptoms of hypertension were not shown. Accordingly, the appeal is denied on a presumptive basis. To the extent that the Veteran asserts a medical nexus between service and hypertension, the medical evidence does not support the claim. At a January 2014 VA examination, the Veteran reported that he first went to the doctor approximately three years prior and was diagnosed with hypertension at that time. He further asserted that he had not had a blood pressure reading in approximately twelve years but that he was on constant medication. The examiner opined that the Veteran’s hypertension was less likely than not a result of, or began in, active service. The examiner acknowledged that the Veteran had a single instance of high blood pressure record in service, but reasoned following that time, his blood pressure readings continued to be within normal limits. The examiner pointed to another reading in March 1998, one month following the elevated blood pressure reading, which was normal, as well as at his separation examination. Finally, the examiner noted that at a post-service January 2000 evaluation, the Veteran’s blood pressure continued to be within normal limits. Significant probative value is afforded to this opinion, which is based upon the nature of the Veteran’s hypertension and analyses of his service and medical histories. There is no indication that the examiner was not fully aware of the Veteran’s past medical history or misstated any relevant fact in offering the above conclusion. Moreover, the examiner has the requisite expertise to render a medical opinion regarding the etiology of the Veteran’s hypertension and had sufficient facts and data on which to base the conclusion. Therefore, the medical evidence does not support the claim. Low Back Disorder The Veteran also seeks service connection for a low back disorder. He has been diagnosed with lumbar spondylosis, lumbago and degenerative disc disease (DDD). Accordingly, the first element of service connection has been met. Further, the Veteran’s STRs reference treatment for a low back disorder after a car accident in 1992. A review of his STRs show that he complained of acute low back pain intermittently during his time in service. However, a May 1996 shows that he reported that his back disorder had resolved completely. Furthermore, at his August 1999 separation examination, his spine was found to be normal upon examination and he explicitly denied recurrent back pain. However, these records constitute competent evidence of in-service injuries, such that the second element of service connection has been met. However, the medical evidence weighs against the finding of a nexus between the current disorder and the in-service incurrence. Specifically, while back treatment is documented following service, no treating examiners have related it to the Veteran’s in-service injury. Specifically, in conjunction with this appeal, the Veteran was afforded a VA examination in January 2014. At that time, he was diagnosed with lumbar strain, and reported limitations in movement. However, he also reported lifting up to 75 pounds daily at his job at the post office. After reviewing the medical record, the examiner opined that the Veteran’s current low back disorder was less likely than not a result of his active service. The examiner reasoned that while the STRs contained notations regarding back pain, they seemed acute in nature and that his in-service back pain appeared to have fully resolved. The examiner pointed to the Veteran’s separation examination where he denied recurrent back pain, as well as a chronic care flowsheet which was silent for a low back disorder. The examiner also referenced medical literature in reasoning that most episodes of low back pain were believed to be due to mechanical problems such as muscle or joint strain which resolve with conservative treatment. Lastly, the examiner noted that were the Veteran’s low back disorder chronic in nature, he would have been unable to lift such heavy weights as are required by his employment. With respect to the above opinion, the examiner further cited to clinical experience and review of the medical records and relevant literature in support. Significant probative value is afforded to this opinion, which is based upon the nature and onset of the Veteran’s in-service complaints and current disorders. As above, there is no indication that the examiner was not fully aware of the Veteran’s medical history or misstated any relevant facts. Moreover, the examiner possesses the requisite medical expertise to render competent opinions regarding the etiology of diagnosed disorders and had sufficient facts and data on which to base the conclusion. In addition, the Veteran has been diagnosed with DDD of the back; however, DDD is not on the list of disorders subjected to the one-year presumption or to the continuity of symptomatology provisions; therefore, presumptive service connection is not for application. With respect to both claims, the Board has considered the Veteran’s lay statements that his claims were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the examination report and clinical findings than to his statements. As such, the medical records are more probative than the Veteran’s lay assertions of a connection with service. In sum, after a careful review of the evidence, the benefit of the doubt rule is not applicable and the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not   required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Yacoub, Associate Counsel