Citation Nr: 18157977 Decision Date: 12/14/18 Archive Date: 12/13/18 DOCKET NO. 16-54 624 DATE: December 14, 2018 ORDER Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran’s hypertension was not incurred during, and is not otherwise related to, the Veteran’s period of active service. 2. Symptoms of the Veteran’s hypertension have not been continuous since separation from service, and the disability did not manifest to a compensable degree in the year following separation from service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5017; 38 C.F.R. §§ 3.1, 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served in active duty in the United States Marine Corps from December 1985 to March 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, a veteran must establish: “(1) evidence 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 or aggravated during service.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for certain chronic diseases, such as cardiovascular-renal diseases like hypertension, may be established on a presumptive basis if the chronic disease was shown as (1) chronic in service; (2) manifested to a compensable degree within a presumptive period, usually one year, after separation from service; or (3) was noted in service with continuity of symptomatology since service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Even if a veteran does not receive the presumption, the veteran may nevertheless be entitled to compensation if direct service connection can be established. In other words, a failure to establish service connection on a presumptive basis does not bar a veteran from compensation for direct service connection. 38 U.S.C. § 1113(b); see Combee v. Brown, 34 F.3d. 1039 (Fed. Cir. 1994). In deciding any matter on appeal, the Board must consider all evidence of record and make appropriate determinations of competence, credibility, and weight. 38 U.S.C. § 7104(a); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). This includes all lay and medical evidence. 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Furthermore, a claim may be denied only if the evidence preponderates against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996) (citing Gilbert, 1 Vet. App. at 54). Entitlement to service connection for hypertension The Veteran contends that service connection is warranted for his current diagnosis of hypertension as it is attributable to his time in service. The Veteran claims that his hypertension had onset during service and that his service treatment records (STRs) and post-service medical records show elevated blood pressure readings. As noted, a veteran must present evidence of a current disability. The determination of whether a veteran has a disability based on hypertension is governed by 38 C.F.R. § 4.401. VA considers systolic pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more, to be indicative of Stage 1 hypertension. See Veterans Benefits Administration (VBA) Training Letter 00-07 (July 17, 2000) (citing to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (1997)). A diagnosis of hypertension requires 2 or more readings on at least 3 different days. See 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, n.1. The medical evidence of record shows that the Veteran has hypertension that is considered disabling for VA purposes, and, therefore, the current disability requirement has been met. See August 2014 VA Examination. Nonetheless, for the following reasons, a grant of service connection for hypertension is not warranted. The Veteran claims, and his STRs confirm, that he had some elevated blood pressure readings during service. However, the Veteran was not diagnosed with hypertension during service, and his STRs are silent on any complaints or treatment for hypertension. 38 C.F.R. § 3.303(b). The Veteran’s enlistment examination, annual examinations, re-enlistment examinations, and exit examination were all silent on any diagnosis of hypertension. The Veteran’s exit examination specifically noted that his blood pressure was 131/88, which was considered “normal” by the examiner. The evidence of record does not indicate that hypertension manifested to a compensable degree during service or within the one-year presumptive period. 38 C.F.R. §§ 3.303(b), 3.307(a)(3). At the Veteran’s VA examination, he reported that he began taking blood pressure medication sometime after service. The Veteran’s post-service treatment records show that in November 2006 it was noted that the Veteran had elevated blood pressure but hypertension was not diagnosed at that time. In December 2009, the Veteran was diagnosed with hypertension (systemic) stage 1, and that same note indicated that he had no prior history of hypertension. For these reasons, the evidence of record weighs against a finding that the Veteran’s hypertension manifested to a compensable degree during service or within a year of separation from service. A grant of service connection on a direct basis is also not warranted because there is no competent evidence linking hypertension to the Veteran’s service. Here, the Board finds the report from the Veteran’s VA examination report to be probative. In that report, the VA examiner indicated that the Veteran has continuously taken medication for his hypertension, however, he concluded that “the condition claimed is less likely than not (less than 50% probability) incurred in or caused by” service. VA Examination at 4. The examiner noted that the majority of the Veteran’s in-service blood pressure readings were normal, and acknowledged that the Veteran’s blood pressure was mildly elevated during service but this occurred when he was seen in the emergency room for a sore throat, foot pain, and an upper respiratory condition. The examiner explained that “[p]ain is a common cause of elevation of blood pressure which can account for most of [the Veteran’s] blood pressure elevations on active duty.” The examiner also noted that he did not see any diagnoses for hypertension made during active duty. Finally, the examiner concluded that the Veteran’s “hypertension is much more likely due to weight gain and deconditioning since his discharge from the service than to any condition incurred or caused by active duty,” and explained that the Veteran weight 179 pounds in June 2000 and was 221.7 pounds in February 2014. Id. Thus, the Board finds that the probative evidence of record weighs against a nexus between the Veteran’s current diagnosis and service. For the reasons discussed above, the Board finds the evidence weighs against the Veteran’s claim that there is a causal relationship between the present disability and service. Thus, the preponderance of the evidence is against the claim and entitlement to service connection for hypertension is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.302; see also Gilbert, 1 Vet. App. 49. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.B.Y. Nguyen, Law Clerk