Citation Nr: 20046965 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 15-05 034 DATE: July 14, 2020 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for residuals of a heart attack, to include as due to service-connected disease or injury is denied. FINDINGS OF FACT 1. Hypertension did not manifest within one year of active service and was not caused or aggravated by any aspect of service. 2. The Veteran’s heart attack residuals are not causally or etiologically related to active service and are not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for heart attack residuals including as secondary to a service-connected disease or injury have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 1967 to July 1969. He was on the rolls in the standby Reserve until 1973. In July 2018, the Board remanded these issues to the RO for additional development. There has been substantial compliance with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). As an initial matter, the Board notes that the Veteran contends that part of his service treatment records (STRs) are missing. During the Veteran’s February 2018 Board hearing, he testified that he received treatment for high blood pressure while stationed in Germany and that he believed his claims file did not include his full personnel or service treatment records. At the hearing, the Veteran requested a further search be completed. Pursuant to the July 2018 Board remand directives, the AOJ requested the Veteran’s complete medical and dental records and his entire personnel file from the National Personnel Records Center. All of his available records were uploaded to the claims file in January 2020. The claims file contains treatment records while the Veteran was stationed in Germany, and other than the Veteran’s lay statements, there is no indication that the records are incomplete. While the Board has considered the Veteran’s lay statements, his STRs appear to be in chronological order and without any gaps. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110. To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disease shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in-service. 38 C.F.R. § 3.303(d). Service connection for chronic disease may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. 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). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. In addition to direct service connection, secondary service connection is warranted for a 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 or injury will be service connected. 38 C.F.R. § 3.310(b). Under applicable criteria, VA shall consider all lay and medical evidence of record in a case with respect to benefits under laws administered by VA. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for hypertension The Veteran contends that he is entitled to service connection for hypertension, because his condition began in service and continued to the present. Blood pressure measurements are expressed as diastolic divided by systolic pressure in mmHg. It should be noted at the outset that for VA compensation purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 or greater; and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 or greater with diastolic blood pressure less than 90. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Veteran’s service treatment records (STRs) are associated with the claims file. At induction in January 1967, his blood pressure was recorded at 130/78. There is no indication that the Veteran was diagnosed with hypertension or noted to have high blood pressure at any time during his service. At his July 1969 separation examination, his heart was determined to be normal, and there was a recorded blood pressure reading of 130/84. Furthermore, the Veteran denied ever having high blood pressure on his corresponding Report of Medical History form. On July 22, 1969, the Veteran signed a document stating that there had been no change in his medical condition. An undated personnel record reflects that the Veteran was not eligible to reenlist because of low battery scores. There is no indication that the Veteran was released from active duty early because of a medical condition. Military personnel records reflect that upon discharge he was transferred to the Reserve. He was discharged from the Army Reserve in July 1973. The Veteran contends that his blood pressure was high while he was stationed in Germany, “on the 20th of July in 1969.” See July 2018 correspondence. The Board notes that the Veteran’s personnel records reflect that he was en route to the United States on July 17th, 1969. Record of Discharge shows a discharge date of July 23, 1969. The earliest available treatment records following the Veteran’s discharge are dated March 1989, when the Veteran was treated by Dr. G. for a myocardial infarction. The corresponding private treatment records reflect that the Veteran self-reported a long history of hypertension. The treatment record reveals that the Veteran was started on blood pressure medication at that time. The record indicates that he was not being treated with medication to manage his blood pressure prior to that time. The claims file reflects that the Veteran first received medical attention at the VA in February 2009. VA treatment records show treatment for essential hypertension from 2009 forward. On his January 2010 application for compensation, the Veteran reported that he was diagnosed with hypertension in 1969, while in service. In February 2010 correspondence, the Veteran reported that he was released from the military because of his hypertension. In the January 2014 notice of disagreement, the Veteran reported that he was treated for high blood pressure in July 1969, and that at that time he should have been given medication and a referral to see a doctor. He argued that he should have been released on a medical discharge. The Veteran attended a Board hearing in February 2018. He testified that he was held over until July 25, 2969 and given the blood pressure medication clonidine in service. The Veteran stated that he was not provided with medication or a referral at his discharge. He also testified that he was never transferred to the Army Reserve because of his high blood pressure. The Veteran stated that following his discharge in 1970, he sought treatment from a doctor who told him that he had, “been crippled with high blood pressure for over 25 years.” In July 2018 correspondence, the Veteran reported that he sought medical attention for hypertension following his separation, but that the records were no longer available. He also reported private treatment from Dr. G., who treated him for his March 1989 heart attack. The Veteran stated that Dr. G. told him that his heart had, “been out of shape for 30 years,” and the Veteran should never have been drafted. Pursuant to the Board remand directives, the AOJ sent the Veteran correspondence in March 2019, requesting information regarding any private treatment the Veteran received for hypertension. In February 2020 correspondence, the Veteran stated that at his discharge he was held several days until his blood pressure came down. He stated that Dr. G told him that he had heart trouble for over 15 years. He also stated that there were no private treatment records during the time frame immediately following discharge. The objective evidence indicates that the Veteran’s current hypertension did not manifest until many years after service. The earliest post-service clinical evidence of hypertension is in March 1989. The medical evidence is more probative and credible than the lay opinions of record. The Board gives more probative weight to the competent medical evidence. The Board finds the Veteran’s STRs to be highly probative. Not only is there no recording of a single high blood pressure reading, but the Veteran explicitly denied high blood pressure on his July 1969 self-reported medical history form. See 38 C.F.R. § 4.104. Moreover, the Veteran is an inconsistent historian. The Veteran has reported contradictory statements regarding when he started medication for his hypertension. Private treatment records reflect that the Veteran reported taking no medication prior to 1989, however the Veteran testified that he started medication in service and continued taking medication consistently from that point forward. In this case, the Board finds the medical records to be more probative. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The Board has also considered the Veteran’s statements that Dr. G told him that he had been suffering from hypertension between 15 and 30 years, however the corresponding private treatment records reflect that the Veteran’s history of hypertension was entirely self-reported. The absence of any clinical evidence of hypertension for nearly 20 years after the Veteran’s separation from service in July 1969 weighs against a finding that his current hypertension was present in service or in the year or years immediately after service. As such, entitlement to service connection for hypertension is not warranted on the basis of a chronic disease in service or on the basis of the presumption related to chronic diseases. See 38 C.F.R. § 3.309(a). The Board recognizes that the Veteran has not been afforded VA compensation examination for hypertension. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: (1) contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that an event, injury, or disease occurred in service or certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) indicates that the disability or symptoms may be associated with the established event, injury or disease in service or with another service-connected disability. McClendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds that the standards of McClendon are not met in this case. The evidence of record fails to show that the Veteran had high blood pressure in service, or that the Veteran’s current hypertension is related to his service. Other than the vague and generalized claim of entitlement to service connection, there is no other evidence of onset or cause by service. VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to, and a mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Board considered his statements and testimony that he was diagnosed and treated in service shortly before discharge and immediately thereafter, but the Board places low probative weight on this lay evidence as it is inconsistent with the service records and post-service clinical records. The service records show blood pressure in the normal range from entry to discharge. Even if he experienced elevated pressure right before discharge, the records do not show that he was held over two days, issued medication, or was diagnosed with a chronic disease at that time. Thus, the Board finds that a VA examination for hypertension is not warranted. In sum, the Board finds that hypertension was not manifest during active service or within one year of active service and is not caused by the Veteran’s active service. As such, the Board concludes that the criteria for entitlement to service connection for hypertension have not been met and, to this extent, the Veteran’s claim is therefore denied. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. Entitlement to service connection for residuals of a heart attack, to include as due to service-connected disease or injury The Veteran contends that he is entitled to service connection for the residuals of a heart attack because his heart attacks were directly caused by his hypertension. The Veteran does not contend that he is entitled to direct service connection for residuals of a heart attack nor does he offer a medical opinion from a qualified medical professional providing a nexus between his heart conditions and active duty service (other than as secondary to hypertension). Furthermore, the Board notes that the Veteran’s STRs do not reveal any treatment for or manifestations of a heart condition. As noted above, at his July 1969 separation examination, the Veteran’s heart was determined to be normal. The Veteran was diagnosed with myocardial infarction in March 1989. See March 1989 private treatment records. Corresponding private treatment reflect that he had no history of myocardial infarction prior to that time. In February 2010 correspondence, the Veteran reported that he had a heart attack in 1989 that was due to his uncontrolled hypertension. During his February 2018 Board hearing, he testified that his heart attack was connected to his hypertension. He did not provide any testimony regarding direct service connection for his heart. The Veteran’s hypertension, as discussed above, is not shown to be related to service in any way. The Veteran’s heart conditions therefore cannot be secondary to a service-connected disability, as the Veteran does not have any service-connected disabilities. The Board has also considered other theories of entitlement, however as discussed above, the Veteran did not have any heart conditions in service and did not have any myocardial infarctions until two decades following his discharge. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Fitzgerald, 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.