Citation Nr: 20054634 Decision Date: 08/18/20 Archive Date: 08/18/20 DOCKET NO. 14-08 962 DATE: August 18, 2020 ORDER Service connection for hypertension, to include as due to service-connected dysthymic disorder (acquired psychiatric disability), bilateral shoulder disability, and bilateral knee disability, is denied. FINDINGS OF FACT 1. The Veteran’s hypertension did not have its onset during service, nor did it manifest to a compensable degree within a year of his separation. 2. The Veteran's obesity is not proximately due to, or the result of, or aggravated by the Veteran's service-connected orthopedic disabilities. 3. The Veteran’s hypertension is not proximately due to, or the result of, or aggravated by the Veteran’s service-connected dysthymic disorder (acquired psychiatric disability), bilateral shoulder disability, and bilateral knee disability. CONCLUSION OF LAW The criteria for service connection on any basis for hypertension are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from February 1977 to October 1982. This matter is before the Board of Veterans’ Appeal (Board) on appeal from an October 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in January 2019. The Board previously remanded the appeal in July 2019, and the matter has been returned for appellate consideration. As described below, there has been substantial compliance with the Board’s remand directives. Service connection for hypertension, to include as due to service-connected dysthymic disorder (acquired psychiatric disability), bilateral shoulder disability, and bilateral knee disability. The Veteran contends that his hypertension is a result of his service-connected bilateral knee, bilateral left shoulder, and dysthymic disorder. Specifically, the Veteran contends that due to pain of his orthopedic conditions, he is mobility is limited, thus limiting his exercise causing obesity, which has caused his hypertension. Accordingly, service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). To establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, for Veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption for certain chronic diseases, to include hypertension, if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. As to the first element of secondary service connection, the May 2015 VA examination confirmed the Veteran’s diagnosis of hypertension. Accordingly, the first element of secondary service connection a current disability, has been met with respect to this appeal. As to the second element, the Veteran is currently service connected for dysthymic disorder, bilateral shoulder disability, and bilateral knee disability. The question for the Board is whether the Veteran’s hypertension is proximately due to, or the result of a service-connected dysthymic disorder, bilateral shoulder disability, and bilateral knee disability, to include obesity. The January 2020 VA medical opinion found that the Veteran’s hypertension was less likely than not proximately due to, the result of, or aggravated by the Veteran’s service-connected disabilities. The VA examiner highlighted that the Veteran’s onset of hypertension, in 1984, predates the Veteran’s diagnoses of and treatment for his bilateral knee, bilateral shoulder, and dysthymic disorders. The examiner stated that the medical literature does not support a relationship between any of the conditions and hypertension. The VA examiner also found no evidence that the Veteran’s service-connected conditions, to include pain and obesity, aggravate the Veteran’s hypertension. He also found that the Veteran’s service-connected conditions do not impact the causality for obesity and ultimately the onset of hypertension. In this case, as to the issue of whether the Veteran’s hypertension is proximately due to or caused by the Veteran’s service-connected bilateral knee, bilateral left shoulder, and dysthymic disorder, the Board finds that the January 2020 VA examination report is the most probative evidence of record as it was definitive, based upon a complete review of the Veteran’s entire claims file, in consideration of the Veteran’s reported history, prior physical evaluation of the Veteran, and pursuant to the Board’s remand instructions. Furthermore, the January 2020 examiner provided a complete and thorough rationale in support of his opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no other competent evidence linking the Veteran’s hypertension to his service-connected disabilities. To the extent that the Veteran contends that such a link exists, the Board does not find his contention competent. Again, determining the etiology of a disability such as hypertension is complex, requiring medical knowledge or training. As to direct service connection, the Board acknowledges the Veteran’s contention that his hypertension had its onset during his active service. However, review of the Veteran’s service treatment records documents no evidence of chronic complaints, treatment or diagnosis related to hypertension while on active duty. The Veteran, however, has not provided details alleging any in-service event or diagnosis that could be related to his claimed hypertension. As discussed above, the service treatment records do not support the Veteran’s claim of onset of his disability during service. In fact, the Veteran was not diagnosed until after service discharge. The absence of post-service complaints, findings, diagnosis, or treatment for many years after service is one factor that tends to weigh against a finding of continuous symptoms after service separation. See Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (noting that the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible). Thus, any assertions that he may make as to onset during service with subsequent continuity of are not supported by the objective evidence of record. Regarding the presumption in favor of chronic diseases and the continuity of symptomatology, the Board notes that the Veteran has been diagnosed with hypertension. For VA purposes, diagnosis of hypertension is a chronic disease, thus warranting consideration under 38 C.F.R. § 3.309(a). However, in order for the presumption under 38 C.F.R. § 3.309 to apply the disability must manifest to a compensable degree within one year of discharge from service. However, in this case it appears that the earliest the Veteran’s blood pressure appeared as elevated was in February 1984. See February 1984 VA examination. As such, the objective medical evidence indicates that the Veteran’s hypertension did not manifest to a compensable degree within one year of discharge from service. Since the Veteran’s hypertension did not manifest to a compensable degree within one year of discharge from service and there is no evidence of a chronic disability in service, the presumption in favor of chronic diseases is not warranted in this case. Walker, 708 F.3d 1331; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The preponderance of the evidence is against the Veteran’s claim. There is no doubt to be resolved. Service connection for hypertension is therefore denied. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.R. Higgins, 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.