Citation Nr: 20053833 Decision Date: 08/13/20 Archive Date: 08/13/20 DOCKET NO. 16-17 720 DATE: August 13, 2020 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The Veteran’s hypertension had its initial onset in service. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable service in the United States Army from April 1999 to April 2003. His claim comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In that decision, the RO found that new and material evidence had not been submitted to reopen his previously denied claim for service connection for hypertension since a final March 2011 rating decision. The Veteran attended a videoconference hearing in August 2019 before the undersigned Veterans Law Judge. In November 2019, the Board reopened the Veteran’s claim after finding that new and material evidence had been submitted to since the March 2011 rating decision. The Board then remanded the claim to obtain a medical opinion to determine the etiology of the Veteran’s hypertension. The case is once again before the Board for appellate review. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). With respect to the first element of a current disability, hypertension refers to persistently high arterial blood pressure. Medical authorities have suggested various thresholds ranging from 140 mm Hg systolic and 90 mm Hg diastolic to as high as 200 mm Hg systolic and 110 mm Hg diastolic as reflective of hypertension. See Dorland's Illustrated Medical Dictionary, 896 (32nd ed. 2012). And for VA rating purposes, the term "hypertension" means that the diastolic blood pressure is predominantly 90 mm Hg or greater. The term "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm Hg or greater with a diastolic blood pressure of less than 90 mm Hg. See 38 C.F.R. § 4.104, DC 7101, Note (1). For VA purposes, hypertension or isolated systolic hypertension is confirmed by readings taken two or more times on at least three different days. Id. In addition, certain chronic disabilities, including 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 presumption to apply, however, the evidence must indicate that the disability manifested to a compensable (10 percent) degree within one year of separation from service. See 38 C.F.R. § 3.307. 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; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Id. Analysis Applying these criteria to the facts of this case, the Board finds that the evidence is in equipoise as to whether the Veteran’s hypertension had its onset in service. Therefore, service connection for hypertension is warranted. The Veteran had no confirmed diagnosis of hypertension either in service or during the one-year presumptive period after service. Nevertheless, elevated blood pressure readings were documented in the Veteran’s service treatment records. Dental records from service show elevated blood pressure readings of 130/90 in September 1999, 130/89 in October 2000, and 152/100 in November 2001, at which time the dentist commented that the Veteran should be followed for elevated blood pressure. Thus, while no confirmed diagnosis of hypertension was documented in his service treatment records, elevated blood pressure readings were noted in service, with one dentist expressing concern and recommending that the Veteran be followed for high blood pressure. This evidence tends to support the Veteran’s claim. The first confirmed diagnosis of hypertension was not until 2008. Yet this five-year gap between service and the first diagnosis of hypertension is not fatal to the Veteran’s claim because, as noted by the Veteran’s representative, service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). And medical evidence indicates that the Veteran’s hypertension had its initial onset in service. In an October 2019 letter, B.M., M.D., indicated that he had reviewed the Veteran’s service treatment records and found that it is more than likely that the Veteran’s hypertension is related to his military service. Dr. B.M. explained that, based on his personal experience and medical literature, “Young people with elevated blood pressure[,], even those with a high diastolic number but a normal systolic number [,]may have an abnormality shift aorta, which should not be ignored, they should be closely followed with regular visits to a primary physician ot be treated correctly.” Dr. Wanpen Vongpatan, M.D., Lead Cardiologist, Texas Southern Medical Center. The Board finds Dr. B.M.’s opinion to be both competent and credible. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). In a September 2016 statement, the Veteran’s wife, a trained emergency medical technician, also attributed the Veteran’s hypertension to his military service. She explained that she first met the Veteran in 2003, during the one-year presumptive period after his separation from the military. She then stated that she had reviewed the service treatment records and determined that his elevated blood pressure readings in service were an initial manifestation of his chronic hypertension. She also stated that he had elevated blood pressure readings when hospitalized in 2004 after a motorcycle accident, although VA was unable to obtain these records. Considering her medical training, the Veteran’s wife is competent to provide a medical opinion concerning the etiology of her husband’s hypertension. Id. There is also no reason to question her credibility, despite being an interested party as the Veteran’s spouse. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a Veteran's testimony simply because he is an interested party; personal interest may, however, affect the credibility of the evidence). In contrast, a VA examiner reviewed the record in December 2019 before opining that the Veteran’s hypertension was less likely than not incurred in service. The examiner based his opinion on the fact that hypertension was not diagnosed until 2008 and that his blood pressure in service was not elevated to the point of a definitive diagnosis of hypertension. The examiner then dismissed the elevated blood pressure readings in his military dental records by stating that, given the stress that many people feel prior to any sort of dental procedure, elevated blood pressure readings are not uncommon. This examiner’s opinion is also competent and credible. Washington, 19 Vet. App. at 368. Based on the favorable medical opinions provided by Dr. B.M. and the Veteran’s wife, and the negative medical opinion provided by a VA examiner, the Board finds that the evidence is in equipoise as to whether the Veteran’s hypertension is related to service. Accordingly, after resolving all doubt in the Veteran’s favor, the Board finds that service connection for hypertension is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Douglas E. Massey 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.