Citation Nr: 20042794 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 16-54 276 DATE: June 24, 2020 ORDER New and material evidence having been received to reopen a claim of service connection for hypertension, to that extent only, the appeal is granted. Entitlement to service connection for hypertension as secondary to service-connected posttraumatic stress disorder (PTSD) is granted. FINDINGS OF FACT 1. In a November 2009 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for hypertension; the Veteran did not appeal the decision and new and material evidence was not received within the one year appeal period. 2. Evidence associated with the record since the November 2009 decision relates to unestablished facts and raises a reasonable possibility of substantiating the claim for entitlement to service connection for hypertension. 3. The Veteran’s hypertension is proximately due to his service-connected PTSD. CONCLUSIONS OF LAW 1. New and material evidence has been received and the claim seeking service connection for hypertension is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156(a). 2. The criteria for service connection for hypertension have been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from April 1965 to January 1969, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision issued by a VA RO. In July 2019, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) that is no longer available to participate in the Veteran’s appeal. 38 U.S.C. § 7107; 38 C.F.R. § 20.106. The Veteran was notified that the VLJ was no longer available to participate in his appeal and that he had a right to a new hearing. The Veteran elected not to appear at another Board hearing and for his case to be considered based on the evidence of record. Claim to reopen If a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The credibility of the evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for reopening is low. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The RO denied the Veteran’s claim of service connection for hypertension in a November 2009 rating decision, finding that the evidence does not support hypertension began or was caused by his active duty service. The Veteran was provided notice of this decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.156, 20.302, 20.1103 (2009). The evidence received since the November 2009 rating decision includes evidence that is both new and material to the claim. See 38 C.F.R. § 3.156. For example, an August 2019 private medical opinion shows that the Veteran’s hypertension is secondary to his service-connected PTSD. This new evidence addresses the reason for the previous denial; that is, a nexus to service, and raises a reasonable possibility of substantiating the claim. The credibility of this evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Accordingly, the claim is reopened and will be considered on the merits. Service Connection for Hypertension The Veteran contends that his hypertension was caused by his active duty service, or in the alternative is the result of his service-connected PTSD. See August 2019 Statement in Support of Claim, see also July 2019 Hearing Tr. at 2. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran has current hypertension. See August 2019 Private Medical Opinion by Doctor A.C. Thus, the remaining question is whether the current hypertension is related to service or a service-connected disability. Service treatment records show no complaints, diagnosis, or treatment related to hypertension. During the January 1969 separation examination, evaluation of the heart was normal. In a corresponding report of medical history, the Veteran specifically denied having had high or low blood pressure. His blood pressure readings at separation appeared normal, noted as 128/70. The Veteran submitted a September 2016 private medical opinion by Doctor C.C. who noted that the Veteran was seen in her office for chronic hypertension and was also diagnosed with PTSD. Doctor C.C. opined that it is possible that the PTSD is affecting the Veteran’s hypertension as studies have shown that stress can contribute to the development of hypertension. In August 2019, the Veteran also submitted a private medical opinion by Doctor A.C, who indicated having treated the Veteran since at least 2009. Doctor A.C. noted that the Veteran has been treated for hypertension although he showed a clear absence of the usual risk factors that would be expected of someone who has hypertension. For instance, the Veteran was not a smoker, not overweight or obese, and does not consume too much salt or alcohol. With genetics, Doctor A.C. indicated that while the Veteran’s mother did have hypertension at an advanced age, the Veteran, in contrast, does not suffer from chronic kidney disease, adrenal, or thyroid disorders, or sleep apnea. Further, the Veteran’s past medical history includes episodes of anxiety that was service-related and recently determined to be a result of PTSD that he suffered while in the military. Doctor A.C. reviewed literature that included an article in the American Medical Association Journal which showed that PTSD does certainly appear to increase the risk of hypertension. The study further showed that in comparison with patients with no record of PTSD, those with notations in their life with PTSD were 15 times more likely to develop hypertension, suggesting that the diagnosis of hypertension can be related to patients with PTSD. Thus, Doctor A.C. opined that based on the facts presented, the onset of the Veteran’s hypertension, due to lack of clear factors, is more than likely or highly likely to have been related to his condition of PTSD. The Board finds the latter opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and who have previously treated the Veteran. In addition, Doctor A.C. supported his nexus opinion by citing to medical literature. There is no medical opinion or competent and credible evidence in significant conflict with that medical opinion. Additionally, the Veteran cited a medical article which in part discussed the association between hypertension and PTSD in military veterans, and how treatment for PTSD reduced the risk for hypertension. See August 2019 Statement in Support of Claim. This article appears to support Doctor A.C.’s opinion. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current hypertension is proximately due to his service-connected PTSD. Accordingly, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.