Citation Nr: 18158834 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-18 404 DATE: December 18, 2018 ORDER Service connection for hypertension as secondary to service-connected diabetes mellitus is denied. FINDING OF FACT The most probative evidence of record does not support the conclusion that the Veteran’s hypertension is caused or permanently aggravated by his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for hypertension as secondary to service-connected diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1133, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1952 to September 1955 and March 1956 to December 1978. Entitlement to service connection for hypertension as secondary to service-connected diabetes mellitus. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. 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 was incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For purposes of 3.303(b), where a Veteran asserts entitlement to a chronic condition but there is insufficient evidence of a diagnosis in service, he can establish service connection by demonstrating a continuity of symptomatology since service, but only if the chronic disease is listed under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331, 1337-39 (Fed. Cir. 2013). Hypertension is listed as a chronic condition under 38 C.F.R. § 3.309 (a) and any arthritis disability can be granted service connection on the basis of continued symptomatology since service under 38 C.F.R. § 3.303 (b) or presumed to have been incurred in service if it becomes manifest to a degree of 10 percent or more within one year of discharge from service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1133; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either: (a) proximately caused by; or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). A layperson is competent to report on the onset and continuity of observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). The Board’s duty is to assess the credibility and weight of the evidence. See Dalton v. Nicholson, 21 Vet. App. 23, 36 (2007); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Reasonable doubt concerning any matter material to the determination is resolved in the Appellant’s favor. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Board has considered the Veteran’s claim and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). While the Veteran has been diagnosed with hypertension, he does not assert that he incurred such during active service or that he has experienced hypertension symptoms continuously from the time of service to the present, or that he had such hypertension manifested within one year of separation from service. In his only lay statements of record, in his July 2014 Notice of Disagreement (NOD) and April 2017 Substantive Appeal, he asserted that his hypertension was secondary to his service-connected diabetes mellitus. The Veteran’s VA and private treatment records dated during the appellate period include numerous instances of treatment and/or monitoring for hypertension and diabetes mellitus. On VA examination of the Veteran’s diabetes mellitus in March 2012 and April 2014, the examiner reported that the only complication of the Veteran’s diabetes mellitus included peripheral neuropathy, and specifically did not find hypertension as due to or permanently aggravated by diabetes mellitus. On VA examination of the Veteran’s hypertension in January 2017, the examiner noted the Veteran’s post-service diagnosis of hypertension. The examiner opined that hypertension was not caused or permanently aggravated by diabetes mellitus. The examiner reasoned that such cause or aggravation is unlikely unless there is severe diabetic nephropathy with estimated glomerular filtration rate (EGFR) less than 25, indicating stage four or five chronic kidney disease, and that in the Veteran’s case, there was no evidence of diabetic nephropathy, as his EGFR is documented at more than 60. The VA examiner offered a reasonable medical basis for their conclusion that the Veteran’s hypertension was not related on a secondary basis to his service-connected diabetes mellitus. Absent credible evidence to the contrary, the Board is not in a position to further question the results of the examination. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). To the extent that the Veteran purports to offer lay statements as evidence that his hypertension is related on a secondary basis to his service-connected diabetes mellitus, the Board finds that such statements are not competent, as the etiology of this disability is a complex medical question. There is no evidence that he has the requisite medical expertise or training to opine as to such a relationship. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). His lay statements as to such a relationship thus lack probative value, as they are not competent. In this regard, the Board places greater probative weight on the opinion of the VA examiner, given his medical training. (Continued on the next page) In sum, there is no probative evidence showing that the Veteran’s hypertension was caused or permanently aggravated by his service-connected diabetes mellitus. The evidence in this case is thus not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The preponderance is against the Veteran’s claim of entitlement to service connection for hypertension as secondary to service-connected diabetes mellitus; the claim must be denied. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Purdum