Citation Nr: 20056786 Decision Date: 08/27/20 Archive Date: 08/27/20 DOCKET NO. 14-38 900 DATE: August 27, 2020 ORDER Service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and major depressive disorder, is granted. FINDING OF FACT The competent and probative evidence is at least in equipoise that the Veteran’s current hypertension is proximately due to the Veteran’s service-connected PTSD and major depressive disorder. CONCLUSION OF LAW The criteria for secondary service connection for hypertension are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1978 to February 1985. This matter is before the Board of Veterans’ Appeals (Board) on appeal from August 2012 and October 2012 decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2018, the Veteran testified, sitting in St. Louis, Missouri, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. In May 2018, the Board remanded the above matter for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Regulations provide that service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disorder may be service connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439, 449 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990).   Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities. After review of the record, the Board finds that the criteria for service connection for hypertension, as secondary to service-connected disabilities, have been met. A June 2012 VA examination report noted the Veteran’s diagnosis of hypertension. Additionally, the Veteran is currently service connected for PTSD and major depressive disorder. 07/26/2010, Rating Decision; 09/12/2016, Rating Decision. Thus, the first two elements of secondary service connection are met. A June 2012 VA examination noted the diagnosis of hypertension. The examiner opined that the Veteran’s hypertension is less likely than not proximately due to his service-connected PTSD. Specifically, the examiner indicated that the Veteran’s hypertension pre-dated his diagnosis of PTSD by approximately three years, and that his hypertension is not aggravated by the medication used to treat his PTSD. 06/15/2012, VA Examination. A July 2012 VA medical opinion was completed by the same examiner, which opined that the Veteran’s hypertension is less likely than not related to his period of active service. Specifically, the examiner noted that there is no record of high blood pressure or related treatment during the Veteran’s period of service. 07/19/2012, VA Examination. A September 2012 private medical opinion was provided by Dr. B.R.V., the Veteran treating clinician, who opined that the Veteran’s hypertension is related to his PTSD. Additionally, the private clinician opined that the Veteran’s hypertension is worsened by his PTSD, and that his blood pressure has been better under control after he had been receiving treatment for PTSD. 09/17/2012, Third Party Correspondence. A May 2018 Board decision found that the June 2012 VA examination did not sufficiently consider the Veteran’s contentions made during the February 2018 Board hearing that his psychiatric symptoms began in 1983 when his best friend was killed and died in his arms. Additionally, the Board noted that VA treatment records reflect the Veteran indicating a history of depression in 2007 and was referred to a psychologist in 2008 in part for depression-related issues. The appeal was remanded and the Agency of Original Jurisdiction (AOJ) was directed to obtain outstanding VA treatment records and to notify the Veteran to submit the requisite forms to authorize the VA to obtain additional treatment records from any private medical provider, including Dr. B.R.V. The AOJ was also directed to request the SSA to provide the Veteran’s records. After the completion of the aforementioned development, the AOJ was directed to obtain a medical opinion to determine the etiology of the Veteran’s hypertension, to include opinions as to direct and secondary service connection. 05/09/2018, BVA Decision. Subsequently, the AOJ obtained the Veteran’s records from the SSA, which were associated with the claims file. 01/17/2019, Medical Treatment Records – Furnished by SSA. Additionally, the AOJ made a request to the Veteran to provide authorization for the VA to obtain additional treatment records from any private medical provider, including Dr. B.R.V. 01/16/2019, Subsequent Development Letter. The record does not show that the Veteran responded to this request. An October 2019 VA medical opinion was completed, which opined that the Veteran’s hypertension is less likely than not related to his active service, noting that the service treatment records and other medical records do not support that the onset of hypertension occurred during active service or within one year of separation. The clinician also opined that the Veteran’s hypertension is less likely than not proximately due to his service-connected PTSD. The clinician acknowledged the existence of medical literature regarding the relationship between PTSD and hypertension, but there is not sufficient consensus in the medical literature to rise to a 50 percent or greater likelihood that hypertension is related to PTSD. The clinician also considered other risk factors for hypertension, to include the Veteran’s race. The clinician also opined that the Veteran’s hypertension is less likely than not aggravated by his service-connected PTSD, noting that the Veteran’s hypertension is stable. However, the clinician did not explicitly consider whether the Veteran’s hypertension stabilized only following his treatment for PTSD. 10/19/2019, C&P Exam. The Board finds the evidence is at least in equipoise regarding whether the current hypertension is proximately related to his service-connected PTSD and major depressive disorder. The Board places probative weight on the September 2012 private medical opinion, which noted that the Veteran’s hypertension stabilized after he began receiving treatment for PTSD. And, despite the negative opinion as to secondary service connection, the Board places probative weight on the October 2019 VA medical opinion, which acknowledged that some medical literature supports the relationship between PTSD and hypertension, despite the lack of a definitive consensus in the medical community. As such, with resolution of doubt in the Veteran’s favor, the Board finds that the Veteran’s hypertension is proximately due to or aggravated by his service-connected PTSD and major depressive disorder. 38 C.F.R. §§ 3.102, 3.310. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han 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.