Citation Nr: 18150584 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 12-05 046A DATE: November 15, 2018 ORDER Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for individual unemployability due to service connected disability (TDIU) is remanded. Entitlement to service connection for a back disability is remanded. Entitlement to service connection for an eye disability, to include glaucoma, is remanded. FINDING OF FACT The Veteran does not have hypertension. CONCLUSION OF LAW Hypertension was not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1131, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1987 to July 1990. The Veteran appeared at a Board hearing in February 2015; a transcript is of record. With respect to the Board hearing, the undersigned VLJ clarified the issues on appeal, identified potential evidentiary deficits, and clarified the type of evidence that would support the Veteran’s claim. These actions complied with any duties owed during a hearing. 38 C.F.R. § 3.103. The Board remanded the claim in December 2015. Regarding hypertension, the only issue decided here, the Board instructed that the Certification of Appeal (VA form 8) be completed after any appropriate development, as it was unclear at the time whether the RO had finished development and there was no evidence of certification. An October 2017 VA form 8 has been associated with the file. For these reasons, the Board’s prior remand instructions have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Hypertension The Veteran claims he has hypertension due to his back pain. During his Board hearing, he stated that during pain management class, a doctor told him he his backpain caused his high blood pressure. Service connection may be established for disability resulting from personal injury or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1131 (2012). To establish a right to compensation for a present disability, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511–12 (1995). For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). For VA compensation purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 or greater; and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 or greater with diastolic blood pressure less than 90. 38 C.F.R. § 4.104, Diagnostic Code 7101. VA treatment records do not show treatment, such as medications, or notations of hypertension and contain several denials by the Veteran of having hypertension in the middle of the 2000s. The Veteran does have occasional diastolic blood pressure readings between 90 to 100 with one reading at 103. However, diastolic pressure of 90 or greater cannot be said to predominate. There were several diastolic readings above 90 and the one at 103 from March 2011 to January 2012, most of the readings from January 2012 to July 2014 were below 90 diastolic and there was one reading of 138/94 in October 2014, which is the last reading in the treatment records. Systolic pressure was always below 140. The Veteran has not submitted any other evidence that he has hypertension, such as taking medication for hypertension. The Veteran has occasionally complained of chest pains in treatment records, such as in a March 2011 VA physical therapy note. The only relevant issue in that note’s assessment section was cardiovascular deconditioning. Additionally, the Veteran denied chest pains in later VA treatment records and denied palpitations or chest discomfort. The Veteran also stated he had been told he had high blood pressure. However, neither of these facts establish the Veteran has hypertension per VA regulation and the evidence of record does not show that medical professionals ever diagnosed hypertension or prescribed medications. The Veteran has reported he was told he had high blood pressure due to pain and reported he had headaches, which he associates with hypertension. While the Veteran is competent to testify as to his observations and ongoing symptoms, his testimony must be weighed against the other evidence of record. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). He is competent to report he was told he had high blood pressure. While the Board acknowledges the Veteran’s statements, the Veteran has not stated that he was diagnosed with hypertension or had blood pressure readings that met the definition of hypertension for VA purposes. The Board finds that the preponderance of the evidence is against a finding of entitlement to service connection for hypertension. The Board notes that the medical evidence is more probative and credible than the lay statements of record. VA treatment records show that the Veteran’s blood pressure readings do not meet the criteria required for hypertension. VA treatment records do not note hypertension. Thus, the more probative evidence of record indicates the Veteran does not have hypertension. Additionally, the Board has considered whether service connection is warranted on a presumptive basis as a chronic disease. 38 C.F.R. §§ 3.303, 3.307, 3.309. However, the Veteran does not have hypertension and is therefore not eligible for presumptive service connection or secondary service connection. 38 C.F.R. § 3.310. In addition, in weighing the evidence of record the Board finds the competent and credible evidence is against a finding of continuity of symptomatology, as the Veteran does not currently have hypertension, and specifically denied hypertension on VA treatment records in the mid-2000s. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for hypertension. The benefit-of-the-doubt doctrine is therefore not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Acquired psychiatric disorder A July 2010 examination found the Veteran had alcohol abuse disorder and did not have any other acquired psychiatric disorders per the DSM-IV. However, the Veteran’s representative submitted VA treatment records showing multiple years of treatment for psychiatric disorders after 2010. This includes a February 2015 VA psychiatry outpatient note reporting assessment of five different diagnoses including recurrent major depressive disorder, unspecified anxiety disorder, unspecified psychotic disorder, alcohol abuse disorder by history, and unspecified personality disorder. The Veteran has also been proscribed several medications, which would indicate some type of disorder. Given this, a new examination is necessary to consider this information and whether a current diagnosis is warranted under the DSM-5. 2. TDIU The Veteran does not have any current service-connected disabilities. Therefore, the issue of TDIU is intertwined with the claims being remanded, as TDIU is dependent on a grant of service-connection for at least one disability. Additionally, statements in the treatment records and during the Board hearing are inconsistent on whether the Veteran is currently employed and his income. The only VA Form 21-8940, Application for Increased Compensation Based on Unemployability, of record only has the Veteran’s name and file number, but no other information. 3. Eye disability The Veteran has been noted to have possible glaucoma in treatment records. A VA eye examination dated in November 2011 noted possible glaucoma, but did not give an opinion on glaucoma. The examiner did not either rule out or give an etiology for glaucoma. VA treatment records continue to note possible glaucoma. An opinion is necessary to clarify the issue. 4. Back disability The Veteran claims he had a back injury in service and continuous pain since. The Veteran’s ex-wife submitted a statement reporting the Veteran started to complain of back pain in service. A VA treatment record dated in November 2008, which is one of the first post-service treatment records available, reported the Veteran complained of backache with no onset date given. Later VA treatment records state back issues were a multiple decade problem. An MRI in July 2014 showed lumbar degenerative joint disease. A January 2012 MRI showed the Veteran also had sclerotic changes in the sacroiliac joints bilaterally. An examination is necessary to determine etiology of these issues. The matters are REMANDED for the following action: 1. Schedule the Veteran for examinations by appropriate clinicians to determine the nature and etiology of (1) an acquired psychiatric disorder, (2) an eye disability including possible glaucoma, and (3) a back disability. The examiner must opine whether any of these are at least as likely as not due to service.   2. Send the Veteran a VA Form 21-8940 to verify employment and income. 3. Obtain any outstanding VA treatment records and associate them with the file. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Yoffe, Associate Counsel