Citation Nr: 20042016 Decision Date: 06/19/20 Archive Date: 06/19/20 DOCKET NO. 12-11 733 DATE: June 19, 2020 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for headaches is granted. FINDINGS OF FACT 1. The evidence is at least in relative equipoise as to whether the Veteran’s hypertension is related to his active service. 2. The Veteran’s headaches are proximately due to his service-connected hypertension. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for headaches as secondary to service-connected hypertension are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1979 to September 1999. The Board of Veterans’ Appeals (Board) notes that this matter was most recently remanded in April 2018 for additional development. It now returns for further appellate review. 1. Hypertension The Veteran contends that he is entitled to service connection for hypertension. See September 2007 Correspondence. Legal Criteria Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for a disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1110, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Factual Background The Veteran’s August 1979 enlistment examination indicated normal vascular system clinical findings. See Service Treatment Records ( STR)-Medical. His blood pressure taken during the examination was recorded 116/78 (slightly illegible). Id. During active service, the Veteran’s STRs reflect elevated blood pressure readings at various times. For instance, in January 1985 it was noted to be 145/98. In April 1986 treatment for an ankle injury, the Veteran’s blood pressure was 150/100. See STR-Medical. In December 1989, it was recorded as 134/96. During a December 1996 treatment for sinusitis reflected the Veteran’s blood pressure was 134/90. Id. Following active service, the earliest blood pressure measurement was from October 2001, which indicated his blood pressure was 122/90. See October 2011 Private Treatment Record. The private physician noted the Veteran had a prior history of hypertension, and also diagnosed the Veteran with hypertension. The next elevated blood pressure was recorded in May 2003, which reflects that his blood pressure was 132/98. See May 2003 Private Treatment Record. The Veteran’s VA treatment records confirm he was diagnosed with hypertension. See January 2014 VA Primary Care record in CAPRI received October 2014. The Veteran was provided a VA examination related to his claim in August 2017. See August 2017 VA Medical Opinion Disability Benefits Questionnaire (DBQ). In providing a negative nexus opinion, the examiner noted that the Veteran August 1979 entrance examination did not show any condition, and that his blood pressure was 116/78 during the October 1995 separation examination. Id. She further noted that the Veteran was not treated for hypertension during active service and denied having hypertension at time of separation. Additionally, she noted that the Veteran’s post-service records reflect the onset of hypertension was after active service. Id. As noted above, the Board remanded the claim in April 2018 for a new VA examination to determine whether the Veteran’s in-service elevated blood pressure readings during active service was related to his current hypertension. See April 2018 Board Remand. Pursuant to the Board remand, the Veteran was provided another VA examination in February 2020. The Veteran reported an onset date of 1995 and stated he had frequently elevated blood pressure readings during active service but was not prescribed any medication. See February 2020 Hypertension DBQ. The examiner indicated the approximate date the Veteran was diagnosed with hypertension was 2002, which is also when he was prescribed an anti-hypertensive medication. Id. The examiner opined that the Veteran’s hypertensive was less likely than not related to active service. Id. Analysis Based on the foregoing, the Board finds that the first and second elements of service connection have been met. In this regard, the Veteran has a current diagnosis of hypertension, and his in-service treatment records demonstrate that he had elevated blood pressure readings. The question for the Board is whether the Veteran’s currently diagnosed hypertension is related to active service, i.e. whether there is a nexus between his disability and in-service occurrence. Regarding the issue of nexus, there are two VA medical opinions from August 2017 and February 2020. Both opinions provide negative nexus opinions regarding the Veteran’s claim for hypertension. A nexus may also be established presumptively on the basis of chronicity or continuity of symptomology. The Board notes that hypertension is one of the chronic diseases listed for presumptive service connection. 38 C.F.R. § 3.309(a)(identifying hypertension as a chronic disease). In this regard, service treatment records show the Veteran had elevated blood pressure readings in January1985, April 1986, December 1989, and December 1996, during active service. Post-service, private treatment records dated in October 2001 reflect that within two years of the Veteran’s separation from service, he was diagnosed with hypertension. Furthermore, the physician in October 2001 noted the Veteran had a prior history of hypertension. Thus, based on the foregoing, and considering his lay statements of continuous symptoms since service, the evidence shows the Veteran had elevated blood pressure during active service which later developed into hypertension shortly after service. The Board accords great probative weight to the Veteran’s reports of high blood pressure since service, and finds that service connection is established under continuity of symptomology. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309; Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Therefore, based on the unique facts of this case, the Board finds that entitlement to service connection for hypertension is warranted. 2. Headaches The Veteran seeks service connection for headaches. See September 2007 Correspondence (informal claim). Legal Criteria To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); 38 C.F.R. § 3.310 (2018). Relevant Facts and analysis The Veteran has a current diagnosis of headaches. See August 2017 VA Headaches DBQ. Thus, he meets the first element of secondary service connection. The Veteran was provided a VA examination in February 2020 to address whether the Veteran’s headaches were related to an August 1980 motor vehicle accident during service. See February 2020 VA Medical Opinion DBQ. The examiner provided a negative nexus opinion regarding his headaches and the August 1980 accident. Id. However, the examiner stated that “it is at least as likely as not that his headache condition was caused or chronically worsened beyond its natural progression (aggravated) the Veteran’s hypertension.” Id. The second element on the issue of entitlement to secondary service connection is also met, as the Veteran is newly service connected for hypertension. Finally, the nexus element is met, because the January 2020 VA examiner opined that the Veteran’s headaches were caused or aggravated by his service-connected hypertension. Notably, there is no negative secondary nexus opinion of record. Therefore, after resolving reasonable doubt in the Veteran’s favor, the Board finds that the January 2020 VA opinion supports the finding that the Veteran’s headaches is related to service-connected hypertension, at least to an evidentiary position of equipoise. See Gilbert v. Derwinski, 1 Vet. App. at 49 (1990). Accordingly, service connection for headaches has been granted on a secondary basis. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Gunella Lilly, Associate 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.