Citation Nr: 19190243 Decision Date: 11/29/19 Archive Date: 11/29/19 DOCKET NO. 11-20 759 DATE: November 29, 2019 ORDER Service connection for hepatitis C, to include as secondary to in-service venereal disease, is granted. Entitlement to service connection for hypertension, to include as secondary to service-connected anemia, is denied. FINDINGS OF FACT 1. The Veteran’s hepatitis C is related to his period of service. 2. The preponderance of the evidence is against finding that hypertension began during active service, manifested to a compensable degree within one year of service or is otherwise related to an in-service injury or disease, or was caused or aggravated by service-connected anemia. CONCLUSIONS OF LAW 1. The criteria for service connection for hepatitis C are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from June 1972 to May 1975, from December 1981 to October 1988, and again from December 1988 to May 1989. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic 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 (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Hepatitis C The Veteran contends that he has hepatitis C stemming from an in-service diagnosis of gonorrhea. The Board concludes that during the appeal period, the Veteran manifested hepatitis C that is related to his period of service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service treatment records reflect that the Veteran was diagnosed and treated for gonorrhea on one occasion. See Service Treatment record dated February 22, 1985. There were no complaints, treatments, or diagnoses related to hepatitis. The Veteran was first noted to have abnormal liver tests and hepatitis C in the 1990s. Subsequent treatment records reflect periodic treatment for hepatitis C; however, treating clinicians did not provide an etiology for the Veteran’s disability. At the July 2019 VA examination, the examiner found that while the Veteran did not currently manifest symptoms of hepatitis C, the examiner found that the Veteran suffered hepatitis C due to his in-service sexual activity that lead to gonorrhea. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s hepatitis C that manifested during the appeal period is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hepatitis C is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Hypertension The Veteran contends that his hypertension was caused by his period of service or alternatively, his service-connected anemia. The question for the Board is whether the Veteran’s hypertension that began during service or is at least as likely as not related to an in-service injury, event, or disease or alternatively, was caused or aggravated by a service-connected disability. For reference purposes, VA considers systolic pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more, to be indicative of hypertension. 38 C.F.R. § 4.104, Diagnostic Code 7101. A compensable, 10 percent rating for hypertension is warranted for hypertension with diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Id. The Board concludes that service connection is not warranted on either a direct or secondary basis, as the Veteran’s hypertension was not caused or otherwise etiologically related to his period of service, nor was it caused or aggravated by his service-connected anemia. Service treatment records are silent for complaints, treatments, or manifestations of hypertension. Periodic examinations reflect that the Veteran had normal blood pressure and all relevant systems were clinically normal. See Reports of Medical Examination dated October 28, 1981 and March 7, 1988. VA treatment records reflect that the Veteran started treatment for hypertension in 2009, over two decades after his separation from service. Prior to that, there was no evidence of manifestations or diagnosis of hypertension. While the Veteran is competent to report having experienced symptoms of elevated blood pressure periodically since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of hypertension. The issue is medically complex, as it requires medical training and knowledge of the innerworkings of the human body along with the ability to interpret of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, service connection cannot be awarded based on continuity of symptomatology under 38 C.F.R. § 3.303(b) or as a chronic disease manifesting to a compensable degree within one year of service discharge under 38 C.F.R. § 3.309(a). Further, the July 2019 VA examiner opined that the Veteran’s hypertension is not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the Veteran did not manifest hypertension during service or for over 21 years after discharge. There was nothing to positively link his hypertension to his period of service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board also concludes that the Veteran’s hypertension was not caused or aggravated by his anemia. The Jul 2019 VA examiner noted that the Veteran has mild anemia, which does not cause symptoms of hypertension. The Board acknowledges the articles the Veteran submitted, which suggest a correlation between anemia and hypertension. However, the Board finds that July 2019 VA examiner’s opinion more probative as it discusses the specific facts of the Veteran’s case. In sum, the Veteran’s hypertension was not manifested in or otherwise etiologically related to service, nor was it caused or aggravated by his anemia. Accordingly, the claim is denied. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Orie, 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.