Citation Nr: 19173003 Decision Date: 09/19/19 Archive Date: 09/18/19 DOCKET NO. 11-08 011 DATE: September 19, 2019 ORDER Service connection for hypertension is granted. REMANDED The issue of service connection for irritable bowel syndrome (IBS) is remanded. FINDING OF FACT The Veteran’s hypertension began during active service. CONCLUSION OF LAW The criteria for service connection for hypertension are met. 38 U.S.C. § §1131, 5107; 38 C.F.R. §§ 3.303(a)(b), 3.307(b), 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1980 to January 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from January 2008 and November 2008 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In the Veteran’s March 2011 VA Form 9, he requested a Board hearing. He withdrew his hearing request. Accordingly, the hearing request is deemed withdrawn. In January 2019, the Board, in pertinent part, remanded the Veteran’s appeal for additional development. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Service connection for hypertension. Certain chronic diseases, including hypertension, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. For VA purposes, hypertension is defined as diastolic blood pressure that is predominantly 90 mm or greater, or systolic blood pressure that is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 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. At the outset, the Veteran’s January 1980 enlistment examination report contains a crossed-out diagnosis of hypertension, but no active diagnosis. Furthermore, the January 1980 enlistment examination report contains 3 blood pressure readings that do not meet the definition of hypertension as defined by VA. To this extent, every veteran who served in the active military, naval, or air service after December 31, 1946, shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § § 1111, 1137; 38 C.F.R.§ 3.304(b). In this case, there is no diagnosis of hypertension noted at entry as it was crossed-out and the blood pressure readings did not meet the definition of hypertension as defined by VA. Thus, the presumption of soundness attaches. The presumption of soundness can be rebutted with clear and unmistakable evidence that a disorder preexisted service and that the disorder was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Here, the evidence does not show that the Veteran had hypertension prior to service. As such, the Board finds that there is not clear and unmistakable evidence that the Veteran had hypertension prior to service. Thus, the presumption of soundness has not been rebutted, and the Veteran is presumed sound at entry. A September 2017 VA treatment record shows that the Veteran has a current diagnosis of hypertension. Hypertension was diagnosed during service. Specifically, a June 1980 service treatment record (STR) reflects a provisional diagnosis of hypertension after a 5-day blood pressure check. Therefore, the Veteran’s hypertension was shown during active duty military service. In conclusion, hypertension is listed a chronic disease, the Veteran was diagnosed with hypertension in service and has a current diagnosis of hypertension. Therefore, service connection for hypertension is warranted. REASONS FOR REMAND The issue of service connection for IBS is remanded. The Veteran’s seeks service connection for IBS. Specifically, he claims his IBS is secondary to service-connected disabilities, such as degenerative spondylosis of the lumbar spine and cervical spine and due to the medication used to treat such disabilities. In a June 2009 VA opinion, a VA physician’s assistant provided a negative nexus opinion with regards to causation but did not offer an opinion as to aggravation. In January 2018, the Board remanded the service connection claim for IBS for a VA examination to determine the nature and etiology of the Veteran’s IBS. The Veteran failed to appear for the scheduled VA examination. See report of general information dated July 2019. In sum, questions remain as to the etiology of the Veteran’s IBS. Therefore, a remand is necessary to obtain a VA opinion to address to the etiology of the Veteran’s IBS. The matter is REMANDED for the following action: The claims folder should be referred to an appropriate physician for an opinion as to the nature and etiology of the Veteran’s IBS. The physician should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s IBS had its onset in service or is otherwise related to service or manifested within one year of his separation from service. The physician should also provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected disabilities and the medication used to treat the service-connected disabilities, to include Vicodin, caused or aggravated his IBS. The physician must provide reasons for each opinion given. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Castillo, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.