Citation Nr: 20005138 Decision Date: 01/24/20 Archive Date: 01/22/20 DOCKET NO. 13-27 539 DATE: January 24, 2020 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT Hypertension was not shown during active duty service or for many years thereafter, and is not related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army with active duty from September 1982 to August 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2009 of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In April 2014, the Veteran was afforded a video conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. This claim was previously before the Board in July 2017, at which it was remanded for further development. The Board notes that in the July 2017 remand, the issue of entitlement to service connection for a left ankle condition, claimed as residuals of a left ankle injury was again referred to the Agency of Original Jurisdiction (AOJ) for adjudication. To date, the issue has not been adjudicated by the AOJ and the Board is again referring it for appropriate action. 38 C.F.R. § 19.9(b) (2016). Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 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). Generally, to establish service connection for a disability resulting from a disease or injury incurred in service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). Service connection for certain chronic diseases may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year (three years for active tuberculous disease and Hansen’s disease; seven years for multiple sclerosis) from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). The term “chronic disease” refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C. § 1101(3); 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where a chronic disease under 3.309(a) is “shown as such in service” (“meaning clearly diagnosed beyond legitimate question,” Walker, 708 F.3d at 1339) or in the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). In cases where a chronic disease is “shown as such in service,” the Veteran is “relieved of the requirement to show a causal relationship between the condition in service and the condition for which service connected disability compensation is sought.” Walker, 708 F.3d at 1336. Instead, service connection may be granted for subsequent manifestations of the same chronic disease without any evidence of link or connection between the chronic disease shown in service and manifestations of the same disease at a later time. In other words, “there is no ‘nexus’ requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease.” Id. If evidence of a chronic condition is noted during service or during the presumptive period, but the chronic condition is not “shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned,” i.e., “when the fact of chronicity in service is not adequately supported,” then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and service, and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed.” Walker, 703 F.3d at 1336; 38 C.F.R. § 3.303(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Hypertension The Veteran also seeks entitlement to service connection for hypertension, which is defined as high arterial blood pressure. Dorland’s Illustrated Medical Dictionary 801 (28th ed. 1994). Various criteria for its threshold have been suggested, ranging from 140 systolic and 90 diastolic to as high as 200 systolic and 110 diastolic. Id. For purposes of rating the disease, VA defines the term as meaning “that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.” See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). It must be confirmed by readings taken two or more times on at least three different days. Id. During an October 1992 VA medical examination, two months after separation, the Veteran’s blood pressure was 124/82. At the April 2014 Board hearing, the Veteran testified that he was treated for headaches in service but that his examiners did not notice that he had hypertension. Upon separation, he went to a private doctor who told him that his “blood pressure was up” and he had been on medication for the condition for over 20 years. The doctor, however, no longer had the records. Pursuant to the July 2017 Board remand, the Veteran received a VA examination in September 2019 and the examiner noted a diagnosis of hypertension. The Veteran remembered having elevated blood pressure readings in service but was not given medication for the condition. Based on the results of the examination, the examiner concluded that the condition was less likely than not incurred in or caused by service. The first documented diagnosis of hypertension was in 2002, 10 years after the Veteran separated from service in 1992. Although there were isolated elevated blood pressure readings in service, there was no diagnosis. Rather, the examiner noted that isolated elevation in blood pressure could be caused by pain, alcohol consumption, and smoking. The Veteran’s hypertension was more than likely from his aging and weight gain. Unfortunately, the Board finds the July 2017 VA examination highly probative evidence against the Veteran’s claim. The examiner’s findings are credible and competent, as they were provided with thorough rationales in regards to the Veteran’s hypertension disability and its lack of connection to service. The Veteran is competent to report that he had elevated blood pressure readings during service; however, such isolated episodes do no establish an in-service diagnosis per se, and the Veteran, as a lay person, does not have the training or background to link such isolated findings to his current diagnosis. In light of the competent medical evidence indicating that the Veteran’s hypertension disability is not related to service, the Board finds that service connection is not warranted. The Board also notes that hypertension is a chronic disease subject to presumptive service connection under 38 C.F.R. § 3.309(a). However, the most probative evidence indicates that the Veteran was not symptomatic in October 1992, two months after discharge. The evidence of record indicates that the Veteran was first diagnosed with hypertension in 2002, about 10 years after separation. Furthermore, the Veteran did not have any symptoms attributable to hypertension until long after separation. As the disability did not manifest to a compensable degree within one year from the date of separation, the Board finds that presumptive service connection is also not warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Daniels, Associate Attorney 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.