Citation Nr: 18157600 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 10-35 991 DATE: December 13, 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. 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 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service in the U.S. Marine Corps from June 1998 to April 2006. 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 contends that his hypertension began during active military service. 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, VA considers hypertension to exist when elevated diastolic blood pressure is predominantly 90 mm Hg or more, and isolated systolic hypertension means systolic blood pressure is predominantly 160 mm Hg or more. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. A 10 percent rating is warranted for hypertensive vascular disease (hypertension and isolated systolic hypertension) where diastolic pressure is predominantly 100 or more, or systolic pressure is predominantly 160 or more, or where the individual has a history of diastolic pressure predominantly 100 or more and requires continuous medication for control. At entry of service in 1998 the Veteran’s blood pressure was 112/72, and he denied a history of high or low blood pressure. Periodically throughout service, the Veteran’s blood pressure readings are as follows: 134/73 in November 1998, 122/88 in May 2000, 130/67 in May 2001, 126/78 in March 2002, 154/86 in June 2002, 160/98 in August 2002, 140/90 in February 2003, 130/60 in June 2005, 141/84 in October 2005, 124/80 in January 2006, and on his March 2006 separation examination his blood pressure was 124/80. He again denied a history of high or low blood pressure. Pertinently, the February 2003 service treatment records note that the Veteran sought treatment and labs for increased weight of fifteen pounds, fatigue, and “? HTN.” Post-service records reflect that the Veteran was diagnosed with hypertension in 2010, which required medical intervention and was prescribed daily medication to treat his condition. Thus, the Board notes that the Veteran has a current diagnosis of hypertension. The remaining issue is whether the condition is related to active military service. To this point, the claim was remanded by the Board in October 2015 to afford the Veteran a VA examination and etiology opinion. On examination in April 2018, the examiner indicated that the Veteran had a diagnosis of hypertension beginning in 2008 or 2010, and due to his date of diagnosis his condition was less likely incurred or related to active military service. The examiner failed to specifically address the Veteran’s in-service notations of elevated blood pressure, to determine whether his current hypertension is related to those instances. As such, an additional opinion is necessary to consider all the Veteran’s contentions. The July 2018 medical opinion notes that it is less likely than not that any current diagnosed hypertension is a service-connected condition, as the condition neither had its onset during nor is etiologically related to the Veteran’s period of active military service. Specifically, the examiner stated that for a diagnosis of hypertension to be made there had to be an event of hypertensive urgency or emergency (systolic blood pressure greater than 180, diastolic greater than 120), or a reading of greater than 160/100 with evidence of organ damage, or undergo ambulatory blood pressure testing outside of the clinic that on average is above 130/80. The Veteran had not meet any of the criteria in his medical chart during service. The Veteran had elevated readings in June 2002 that were repeated the same day, and resulted in normal ranged readings. The August 2002 elevated reading of 160/98 was in relation to the Veteran also complaining of acute musculoskeletal pain from a motor vehicle accident, and lastly the February 2003 elevated reading were also in relation to the Veteran seeking care for acute pain in his wrists. None of the dates in the Veteran’s medical history met the criteria for a diagnosis of hypertension during service. Moreover, a repeat assessment was also completed at the Veteran’s separation, which was within the normal range. The Board acknowledges that this examiner did not correctly use the language coincident with the general principles of service connection as laid out in 38 C.F.R. § 3.303, however the intent of the examiner’s opinion and further explanation provided are unambiguous in dissociating the Veteran’s elevated blood pressure readings with an actual in-service diagnosis of hypertension. 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 onset or etiology of his hypertension is not competent and therefore has no probative value. See Id. Additionally, while the Board notes that the Veteran alleges the onset of hypertension to begin during service or within one year of service discharge, 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. Which as stated above, is not present. (continued on next page) Thus, the competent medical evidence does not support a finding that the Veteran’s in-service elevated blood pressure readings met the criteria for hypertension during service, or that his currently diagnosed hypertension is due to active military service. 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 (2017). T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.L. Reid, Associate Counsel