Citation Nr: 20044964 Decision Date: 07/07/20 Archive Date: 07/07/20 DOCKET NO. 13-05 277 DATE: July 7, 2020 ORDER Entitlement to service connection for the aggravation of hypertension is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, the evidence supports a finding that the Veteran has hypertension that has been aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 1132, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air force from February 1974 to February 1975. The Veteran also served on active duty in the United States Army from August 1981 to March 1990 and from July 1991 to January 1992. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Saint Petersburg, Florida. In September 2016, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. In January 2017, the Board remanded the claim to the Agency of Original Jurisdiction for additional action. In a letter received by VA in May 2020, the Veteran reported that the service-connected disabilities impaired her ability to work. The Agency of Original Jurisdiction should forward the Veteran a claim form for individual unemployability. 1. Entitlement to service connection for hypertension Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.30. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in-service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist 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. Secondary service connection may be established for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. §§ 3.159(a)(2). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and may provide sufficient support for a claim of service connection. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Therefore, the Board must assess the competence and credibility of lay statements. Barr v. Nicholson, 21 Vet. App. 303 (2007). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while weight and credibility are factual determinations going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Veteran contends that currently diagnosed hypertension was first diagnosed in-service and continues to the present. In the alternative, the Veteran contends that current hypertension is secondary to or aggravated by service-connected posttraumatic stress disorder (PTSD) with major depressive disorder and generalized anxiety disorder. The Board finds that, after a review of the relevant and competent medical evidence of record, resolving all reasonable doubt in the Veteran’s favor, the evidence of record supports a finding that hypertension has been aggravated by a service-connected psychiatric disability. Consequently, the claim for service connection must be granted. The service medical records were reviewed and noted several instances of high blood pressure while in-service, including in May 1979, January 1986, and December 1991. However, none of those instances appears to have resulted in a chronic hypertension diagnosis. During VA examination in July 2007, the examiner noted that the patient was first diagnosed with hypertension in 1978 but didn’t receive treatment for the condition until 2001. In support of the claim, in addition to several written statements, from the Veteran and those closest to the Veteran, the Veteran testified before the Board in September 2016 detailing her cardiovascular disabilities and what she believed to be their cause. The Veteran has also provided an opinion from her private physician from October 2019. During private examination in October 2019, after review of the service, VA and civilian medical records, the examiner, a family medicine physician, opined that, in his professional medical opinion, the Veteran's hypertension was most likely contributed to and worsened by a service-connected psychiatric disability. The examiner explained that depression and anxiety, along with inability to cope with stress, can cause increases in blood pressure. Additionally, as a result of the psychiatric disability, the Veteran adopted unhealthy coping mechanisms which could further increased the risk for and control of high blood pressure and cardiovascular disease. The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Board has considered the private October 2019 private medical opinion and finds it to be credible, competent, and probative as it is supported by rationale and provided by a trained medical professional who specifically identified and discussed the Veteran’s contentions and theory concerning service and the claimed disability. The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993). There are no other competent medical nexus opinions of record. The Board acknowledges that January 2018, October 2019, and April 2020 VA medical examiners found that the Veteran’s hypertensive disability was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.  However, in all three cases, the Board finds the examinations to be incomplete or inadequate as all three examiners relied on the absence of symptoms or treatment in-service for the negative opinion concerning the claimed disability. To the extent that contradictory opinions of record may be credible, competent and probative, the Board finds that they are outweighed by the October 2019 private physician’s opinion. The Board cannot ignore the medical evidence finding that the Veteran's hypertension has been aggravated by her service-connected psychiatric disability. Accordingly, after a careful review of the evidence of record, the Board finds that the evidence is at least in equipoise in regard to a finding that the Veteran's hypertension has been aggravated by a service- connected disability. In light of the medical treatment records which document hypertension, including the positive opinion found in the October 2019 private examination, and the lay statements of record, the Board resolves reasonable doubt in favor of the Veteran and finds that service connection for hypertension which has been aggravated by a service-connected disability is warranted. Therefore, the Board concludes that service connection for the aggravation of hypertension is warranted as the evidence shows that it is at least as likely as not that the hypertension has been aggravated by a service-connected disability. Accordingly, as the evidence is in equipoise for the claim of entitlement to service connection for hypertension, the claim must is granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.