Citation Nr: 20049968 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 16-28 463 DATE: July 28, 2020 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT A preponderance of the evidence indicates that hypertension is not due to service, was not caused by service-connected diabetes mellitus type 2 (diabetes), and is not aggravated by diabetes. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1969 to June 1971. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Board remanded this matter for additional medical inquiry. The case is again before the Board for appellate review. Service Connection The questions before the Board are whether the Veteran incurred hypertension during service and whether he developed the disorder as the result of service-connected diabetes. Laws and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 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 active service – the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For veterans who served 90 days or more of active duty during a war period or after December 31, 1946, certain chronic disorders such as hypertension are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307 (a), 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. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38 C.F.R. § 3.309 (a)). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Evidence and Analysis The evidence in this matter consists of lay statements from the Veteran, service treatment records (STRs), private and VA treatment records, and reports from a VA examiner who issued medical opinions dated in August 2012, September 2012, and June 2019. The evidence establishes that the Veteran has hypertension. This is demonstrated most recently in the June 2019 VA report. A preponderance of the probative evidence indicates, however, that hypertension was not incurred in service, did not develop within a year of discharge from service, and is not secondary to diabetes. The STRs are negative for complaints, diagnosis, or treatment of hypertension. The May 1971 separation report of medical examination notes the Veteran’s cardiovascular system as normal and noted blood pressure of 110/70. The May 1971 separation report of medical history is negative for hypertension problems in the past. There is no evidence indicating hypertension in the years following service, moreover. In fact, the earliest evidence of record of hypertension is found in treatment records noting a diagnosis of hypertension in the early 1990s, over 20 years after discharge from service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of years between discharge from active service and the medical documentation of a claimed disability may be considered in evaluating a claim of service connection). In short, the objective record does not document the existence of hypertension during service or for many years following service. Rather, a preponderance of the probative evidence indicates that, for approximately 20 years following service, the Veteran did not have characteristic manifestations sufficient to identify a chronic disease entity. See 38 C.F.R. § 3.303. Moreover, the only medical opinions addressing this matter counter the claim. With regard to the issue of secondary service connection, the VA examiner indicated in the August 2012 report that diabetes likely did not cause hypertension. In support of the opinion, the examiner noted that the Veteran’s hypertension was diagnosed in the early 1990s while diabetes was diagnosed in the early 2000s. In the September 2012 addendum report, the examiner indicated that diabetes likely did not aggravate, or worsen beyond normal progression, the hypertension. The examiner noted the Veteran’s assertion that medication used for diabetes worsened his hypertension. But the examiner stated that the diabetes “regimen is a normal progression for the treatment of mild diabetes.” The examiner further supported the opinion by stating that the Veteran’s “blood pressure is controlled, and his kidney function has been consistently normal.” Finally, with regard to the issue of direct service connection, the VA examiner stated in the June 2019 addendum report that service likely did not cause hypertension because no evidence indicated problems during service or for many years after service. Each of these medical findings is of probative value because they are provided by a medical professional who demonstrated a familiarity with the Veteran’s case and with the medical issues presented. Further, each opinion is explained and is supported by the evidence of record. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician’s statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). In assessing this claim, the Board has considered the Veteran’s lay assertions. He is competent to report observable symptoms such as lightheadedness and fatigue associated with hypertension. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he is not competent to determine issues such as diagnosis and etiology. Cardiovascular disorders such as hypertension are internal pathologies beyond his capacity for observation. They involve complex medical issues. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). On the complex question of whether the Veteran has this disorder as the result of service or of diabetes, or of medication used for diabetes, his lay statements are of limited probative value and are outweighed by the medical findings noted in August and September 2012 and June 2019 VA reports. As the preponderance of the probative evidence is against the claim of entitlement to service connection, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee, 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.