Citation Nr: 20050188 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 12-10 539 DATE: July 28, 2020 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s hypertension began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active duty service with the United States Army from July 1992 to April 1993, and from January 2003 to August 2005. In an April 2012 substantive appeal, the Veteran requested a video conference hearing. In October 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. Pursuant to a January 2018 Board decision, this matter was remanded to obtain VA opinion addressing both direct and secondary service connection. As the requested development is now complete, this matter has been returned to the Board for appellate consideration. Duty to Assist and to Notify VA is required to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2018). Copies of compliant VCAA notices were located in the claim’s file. VA’s duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). In this case, neither the Veteran nor her representative has raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Thus, upon careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Service connection, generally Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) and (b) (2018). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order 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). Furthermore, 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. 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for hypertension The Veteran contends that she is entitled to service connection for hypertension. As discussed in more detail below, the preponderance of the evidence is against her claim. In analyzing the Veteran’s claim for service connection, the threshold inquiry before the Board is whether the Veteran’s current diagnosis was incurred in or otherwise casually related to active service, to include as due to an in-service injury or disease. While the Board acknowledges that the Veteran has a current diagnosis of hypertension, there is no evidence that the condition is casually related active service, to include as secondary to a service-connected psychiatric condition. As a preliminary matter, the Board notes that hypertension is defined as diastolic blood pressure that is predominantly 90 millimeters (mm) or greater, or systolic blood pressure that is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. To support a diagnosis of hypertension, the blood pressure readings must be taken two or more times on at least three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101 (Note 1) (2018). In this case, there is no evidence of treatment or diagnosis of hypertension during active service. Service treatment records are silent for any episodes of high blood pressure or a diagnosis of hypertension. A report of medical examination, dated March 1995, revealed normal findings. No complaints of high or low blood pressure were noted in a corresponding report of medical history. Subsequent medical examinations, in May 1999 and September 2004, were also silent for a current diagnosis of hypertension. A color doppler echocardiogram, dated February 2003, found no evidence of pulmonary hypertension. Post-service treatment records reference hypertension dating back to October 2011. Specifically, between October 2011 and August 2013, mental health treatment records list current diagnoses including depression, a mood disorder, diabetes, and hypertension. A psychiatry record, dated August 2013, listed the Veteran’s current conditions as hypertension, a mood disorder, depression and chronic sleep disturbance. The Veteran was assigned a global assessment functioning (GAF) score of 60. A GAF score between 51 and 60 corresponds with the experience of moderate symptoms, including difficulty functioning in social environments. In February 2014, current diagnoses included generalized anxiety disorder, persistent depressive disorder, chronic pain syndrome, and hypertension. In September 2015, the Veteran was afforded a VA examination. A current diagnosis of hypertension was confirmed. An initial diagnosis was rendered at a VA medical facility in 2012. Prescribed medications included Hydrochlorothiazide and Verapamil. No functional impact was reported. Following the examination, the examiner opined that it is less likely than not (less than 50 percent probability) that the Veteran’s hypertension is proximately due to or the result of her service-connected depressive disorder. In support of the stated conclusion, the examiner indicated that the cause of hypertension is well known. Nearly 90 percent of hypertension diagnoses are described as “essential hypertension” with no clearly identifiable cause. It is believed that such diagnoses are likely related to genetics, poor diet, lack of exercise and obesity. While the possibility of secondary causes is acknowledged, anxiety is not known to “cause” hypertension. In October 2017, the Veteran testified at a Board hearing. Therein, it was suggested that the VA examiner’s opinion was incomplete. Thereafter, the Board remanded the Veteran’s claim pursuant to a January 2018 decision. The decision noted the examiner failed to adequately address whether the Veteran’s hypertension was directly related to service. As such, a new opinion was deemed necessary to address both direct and secondary service connection. In a July 2018 addendum opinion, the examiner noted that “essential hypertension” is the term applied to 95 percent of hypertension diagnoses with no known clear etiology. Multiple risk factors are known to aggravate essential hypertension. Similarly, physical conditions can be affected by psychiatric conditions. However, in consideration that essential hypertension has no known etiology, the examiner opined that a causal linkage could not be established between the Veteran’s hypertension and her psychiatric disability. Additionally, the examiner acknowledged that the Veteran reported an initial diagnosis of hypertension in 2012, approximately 7 years after separation. Review of service treatment records revealed normal physical examinations with no documented history of high blood pressures. Therefore, the examiner opined that a nexus could not be established between the Veteran’s hypertension and active service, to include any service-related events. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, as to the etiology of a particular claimed disability, the issue of causation of a medical condition is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the instant case, there is no evidence that Veteran possesses the required training to diagnose hypertension or opine as to its etiology. To the extent her statements may be competent, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. While the Board recognizes the Veteran’s subjective belief that her condition is causally related to active service, the evidence of record does not support her assertion. Review of the record fails to show that the Veteran was diagnosed with hypertension in service or within one year of separation. No related abnormalities were noted at induction or at separation. Post-service treatment records do not suggest any causal linkage between the Veteran’s hypertension and active service, to include any service-connected disability. The Board notes that a disability benefits questionnaire was associated with the claims file in January 2020. However, findings suggested an in-service diagnosis of hypertension and identified medications prescribed to treat the condition. Considering the evidence of record, the Board will accord no probative weight to the opinion as the diagnostic findings directly contradict the record. Accordingly, as the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for hypertension must be denied. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Whitaker, 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.