Citation Nr: 18160008 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 10-07 185 DATE: December 20, 2018 ORDER Entitlement to service connection for diplopia (double vision), to include as secondary to service-connected cerebrovascular accident (CVA) is denied. Entitlement to service connection for hypertension, to include as secondary to posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. Diplopia was not present during the Veteran’s service, was not manifest within one year of discharge from service, and did not develop as a result of service, including service-connected CVA. 2. Hypertension was not present during the Veteran’s service, was not manifest within one year of discharge from service, and did not develop as a result of service, including service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for diplopia are not met. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1966 to March 1970. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a January 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was most recently before the Board in November 2017, when it was remanded for further development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. § 1110. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, 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 (Fed. Cir. 2004). Pursuant to 38 C.F.R. § 3.303(b), when a chronic condition, such as hypertension, is present, a claimant may establish the second and third elements by demonstrating continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Certain chronic diseases (e.g., hypertension) may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307(a)(3); 3.309(a). Any disability that is proximately due to or the result of a service-connected disease or injury is considered service connected, and when thus established, this secondary condition is considered a part of the original condition. 38 C.F.R. § 3.310(a). Additionally, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence. Service Connection for Diplopia The Veteran alleges service connection for diplopia is warranted on a direct and/or secondary basis due to service-connected CVA. Private and VA treatment records from 2009 to 2015, including an October 2009 VA examination, show inconsistent findings with regard to the presence of diplopia. The Veteran’s lay statements, during this time period, are also inconsistent as to the presence of diplopia. As such, the in November 2017, Board remanded this claim for a new examination to address the nature and etiology of his reported eye disability. In January 2018, the Veteran underwent a VA optometry examination. After reviewing the claims file and examining the Veteran, the examiner reported that the Veteran did not have dipoplia, but had age-appropriate cataracts, which were not caused by trauma. The examiner reported that the cataracts had been removed and replaced with intraocular (IOL) bilateral lens. The Board acknowledges that the Veteran has provided lay opinions that his current eye disorder is related to his active military service and/or service-connected CVA. The evidence does not show that the Veteran is qualified through specialized education, training, or experience to offer a medical diagnosis or opine as to the etiology thereto; therefore, his lay statements pertaining to diagnoses and etiology do not constitute competent evidence on this point. Id; see also 38 C.F.R. § 3.159. As such, the Veteran can neither support his claim, nor counter the probative medical opinion evidence of record, on the basis of his lay assertions as to diagnosis and medical nexus, alone. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability during the period of the appeal. See 38 U.S.C. § 1131. In the absence of proof of present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Therefore, in the absence of competent evidence showing a current diagnosis of diplopia, it is unnecessary to address the remaining elements of the claim for service connection. See Brammer, 3 Vet. App. at 225. Accordingly, service connection for diplopia must be denied. Service Connection for Hypertension The Veteran alleges that service connection for hypertension is warranted on a direct and/or secondary basis due to service-connected PTSD. In accordance with the November 2017 Board remand, the Veteran was scheduled for a VA examination in February 2018 to assess the nature and etiology of his hypertension. After reviewing the claims file and examining the Veteran, the examiner opined that the Veteran’s hypertension was not related to military service or PTSD. The examiner found sufficient evidence to render a diagnosis of hypertension; however, the examiner reported that the Veterans’ in-service hypertension was acute only and that the Veteran had no in-service diagnosis of hypertension. The examiner reported the Veteran had a one-time blood pressure elevated reading of 158/98 in 1966, with normal blood pressure readings a couple of days afterward. His separation examination in 1970 showed normal blood pressure. The Veteran’s elevated blood pressure reading in August 1966 did not represent the onset of early-stage hypertension. The examiner reported he was unable to verity that the Veteran’s elevated blood pressure had onset in June 1970 per the Veteran’s lay statements. The examiner concluded the Veteran’s hypertension is most likely from other risk factors, such as advancing age, diet, lack of exercise, and family history. Based on the competent medical evidence, the Board finds that service connection for hypertension is not warranted on a direct or secondary basis. Furthermore, there is no evidence that hypertension was manifest to a degree of 10 percent or more within one year of discharge. Thus, the Board finds that service connection on a presumptive basis is not warranted. Similarly, the Board also finds that the evidence fails to show a continuity of hypertensive symptoms since service. None of the Veteran’s treatment records has indicated a continuity of symptomatology following his military service. Moreover, no complaints were made at discharge from service and a normal vascular system was shown on his separation examination. The overall evidence of record weighs against a finding of hypertension being associated with the Veteran’s active duty. Without competent evidence of an association between hypertension and active duty, to include being secondary to service-connected PTSD, service connection is not warranted. Although lay persons are competent to provide opinions on some medical issues, see Kahana, 24 Vet. App. at 435, as to the specific issue in this case, the etiology of hypertension falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4. The Veteran’s own assertions as to etiology have no probative value. The Board concludes that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. As the preponderance of the evidence is against this issue, the benefit-of-the-doubt rule does not apply, and the Veteran’s claim is denied. See 38 U.S.C. §5107. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Norwood, Associate Counsel