Citation Nr: 20036611 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 06-39 427 DATE: May 28, 2020 ORDER Entitlement to service connection for hypertension, to include as secondary to a service-connected condition, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a service-connected condition, is denied. FINDINGS OF FACT 1. Hypertension was not demonstrated until years after service and is not etiologically related to an incident of active military service. 2. The preponderance of the evidence is against finding that the Veteran’s acquired psychiatric disorder began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by active service nor may its incurrence or aggravation be presumed. 38 U.S.C. §§ 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 1965 to June 1967, and from June 1986 to September 1986. These matters come before the Board of Veterans’ Appeals (Board) from a March 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Previously the case was before the Board in March 2018. These issues were most recently remanded for additional development and a VA examination addressing service connection which has been obtained. For these reasons, the Board’s prior remand instructions have been substantially complied with, and the case is again before the Board for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163,1166-67 (Fed. Cir. 2004). Hypertension and psychoses are identified as a “chronic” disease under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309(a). “For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim.” 38 C.F.R. § 3.303(b). Except as provided in § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). 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). 1. Service Connection for Hypertension The Veteran contends that service connection is warranted for hypertension as it is etiologically related to active duty service or a service-connected condition. The Veteran has a current diagnosis of hypertension. However, there is no in-service injury or event associated with the cause of this disorder. Service treatment records are silent for any complaints or treatment of hypertension, and blood pressure was reported as normal. Post-service treatment records also weigh against a finding of service connection. There is no competent medical evidence of hypertension until several years after service. VA medical records document the presence of hypertension beginning in 1997. The Veteran has not contended that this condition began any sooner, and confirmed at a VA examination that he first learned of his hypertension when he had a heart attack in 1997. Here, the evidence indicates that the condition did not develop until several years after his discharge from active service. The absence of any clinical evidence for several years after service is one factor that weighs the evidence against a finding that the Veteran incurred hypertension in service. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). As such, the Board cannot conclude that the Veteran manifested hypertension to a compensable degree within a year after his separation from active military service. Thus, service connection for hypertension on a presumptive basis as a chronic disease is not warranted. 38 U.S.C. §§ 1101, 1131; 38 C.F.R. §§ 3.307(a), 3.309(a). Service connection is also possible for certain chronic disabilities under 38 C.F.R. § 3.303(b) based on a continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As noted above, hypertension is a chronic disease listed in 38 C.F.R. § 3.309(a). However, the Veteran has not reported a history of continuous symptoms since service. Service connection for a chronic disability based on a continuity of a symptoms is therefore not possible. The Board also notes that the Veteran is not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board acknowledges that the Veteran is competent to report observable symptoms but finds that his opinion as to the cause of his symptoms simply cannot be accepted as competent evidence in this case. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007). The record also does not contain any competent medical opinions in favor of the service connection. The Veteran was afforded a VA examination in accordance with the Board’s March 2018 remand. The October 2018 VA examiner provided a medical opinion against the claim for service connection for hypertension. After reviewing the record and physically examining the Veteran, the VA examiner concluded that the Veteran’s hypertension was less likely than not related to active duty service. The examiner noted that service records did not contain any findings of hypertension or treatment for the condition, and that none appeared until several years after service. The Veteran also contends that his hypertension is secondarily related to a service-connected condition, particularly his service-connected diabetes. The October 2018 examiner also evaluated this possibility and concluded that the Veteran’s hypertension is less likely than not due to a service-connected condition. The rationale provided was that the Veteran’s diabetes and hypertension seemed to appear at the same time in 1997, and that if diabetes were to cause hypertension, there would be evidence that the diabetes existed prior to the hypertension. However, as there is no medical evidence of diabetes prior to hypertension, it was concluded that one condition cannot cause the other if they develop at the same time. Lastly, the examiner assessed aggravation and determined that it was less likely than not that the Veteran’s service or service-connected disabilities aggravated his hypertension. The reasoning provided was that the Veteran has essential hypertension, and the natural course of the disease is gradual progression over time. This examiner determined that the mild progression of the Veteran’s hypertension over the past 21 years is consistent with the natural course of the disease, and has not been aggravated beyond its natural state. The Board finds that October 2018 VA opinions were accompanied by a well-reasoned and well-supported rationale and are entitled to significant probative value. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, there is no medical opinion offered to the contrary. The competent evidence of record is therefore against a nexus between the Veteran’s hypertension and active duty service or a service-connected disability. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim for service connection and it is denied. 2. Service Connection for an Acquired Psychiatric Disorder The Veteran contends entitlement to service connection for an acquired psychiatric disorder. While the medical evidence reflects the Veteran’s history of limited psychiatric treatment, to include for depression, there is no evidence to support a connection between this condition and the Veteran’s service. Service treatment records are silent for any chronic psychiatric disorder. In accordance with the Board’s March 2018 remand, the Veteran was afforded a VA examination to determine the etiology of any psychiatric condition. The notes from this examination showed that the Veteran reported for the assessment, inquired what the examination was for, and then stated that he believed he had attempted to cancel the claim for his psychiatric condition in the past. While the record shows that the Veteran had expressed a desire to cancel his claim in July 2017, this was never confirmed in writing. Accordingly, the Board will proceed with adjudication. However, the Veteran expressed the same desire to cancel his psychiatric disorder claim again at the October 2018 examination, he declined to proceed with an evaluation and, therefore, no opinion was rendered. Accordingly, there is no medical evidence to support any link between the Veteran’s psychiatric disorder and his military service or a service-connected disability. As there is no evidence of record in support of the claim, entitlement to service connection must be denied. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ferrando 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.