Citation Nr: 18153841 Decision Date: 11/29/18 Archive Date: 11/28/18 DOCKET NO. 16-29 993 DATE: November 29, 2018 ORDER Service connection for hypertension is denied. REMANDED Service connection for tinnitus is remanded. FINDING OF FACT 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. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a) (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1999 to May 2000 and from May 2006 to May 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. 1. Service connection for hypertension The Veteran asserts that he has hypertension that began during his active duty military service. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has hypertension, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Elevated blood pressure was noted in an August 2007 Reserves record and the Veteran was referred to his civilian provider for follow up. The record does not include any such follow up showing sustained elevated blood pressure and/or a diagnosis of hypertension. At the time of his July 2014 VA examination, the Veteran reported a diagnosis of hypertension until 2013, years after his separation from service and years outside of the applicable presumptive period. Later VA treatment records confirm a diagnosis of hypertension. The Veteran specifically denied any history of hypertension at the time of his December 2009 VA treatment when he was applying to be a firefighter. Service connection for hypertension may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s hypertension and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The July 2014 VA examiner opined that the Veteran’s hypertension is not at least as likely as not related to an in-service injury, event, or disease, including instances of elevated blood pressure during his ative duty service. The rationale was that the documentation did not support a diagnosis of hypertension during active duty. The two isolated episodes of Grade I hypertension were associated with foot pain episodes. Thus, the examiner did not find an in-service injury, event, or disease to which the Veteran’s current hypertension could be attributed. While the Veteran reported developing high blood pressure in service, he is not competent to provide a diagnosis as high blood pressure and hypertension require specific blood pressure findings. Similarly, while the Veteran believes his hypertension is related to an in-service injury, event, or disease, including elevated blood pressure readings during active service, he is not competent to provide a nexus opinion in this case. Again, this issue is medically complex, as it requires specific blood pressure findings sustained over a period of time and, as demonstrated by the examiner, requires an ability to differentiate high blood pressure indicative of hypertension from acute bouts of elevated blood pressure related to other injuries or ailments. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for hypertension and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. 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. Service connection for tinnitus is remanded. The Board cannot make a fully-informed decision on the issue of tinnitus because no VA examiner has opined whether this was caused by the Veteran’s noise exposure in service. The matter is REMANDED for the following action: 1. Ensure that all VA treatment records are associated with the claims file, to include results of a hearing test conducted on or about September 2015, as referenced in a September 16, 2015 Audiology Consult. (Continued on the next page)   2. Then, ensure that the Veteran is scheduled for an examination by an appropriate clinician to determine the nature and etiology of any tinnitus. The examiner must opine whether it at least as likely as not (a) began during active service, (b) manifested within one year after discharge from service, (c) was noted during service with continuity of the same symptomatology since service, or (3) is at least as likely as not related to an in-service injury, event, or disease, including noise exposure. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Houbeck, Counsel