Citation Nr: 20060289 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 12-26 763 DATE: September 14, 2020 ORDER Entitlement to service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran’s hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The Veteran’s hypertension is not secondary to service-connected heart disabilities. CONCLUSION OF LAW The criteria for service connection for hypertension due to service or service-connected heart disabilities are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 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 Navy from December 1961 to January 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a September 2013 Travel Board hearing; a transcript of this hearing is associated with the claims file. This matter was previously before the Board in April 2015, June 2017, and June 2019. Entitlement to service connection for hypertension The Veteran contends that hypertension is manifested in service. Alternatively, he asserts that it is due to in-service lead-paint exposure, consumption of salt pills, mononucleosis, and/or secondary to service-connected heart disability. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Hypertension is one such condition and service connection is presumed when it manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307(a), 3.309(a). The Veteran has a current diagnosis of hypertension as evidenced by multiple VA examinations such as one dated December 1998. Hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The disability was not shown as chronic in service, however, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA examinations reported that the Veteran was not diagnosed with hypertension until 1983, years after his separation from service and more than a decade outside of the applicable presumptive period. One VA examination, the December 1998 VA examination, listed the Veteran’s date of diagnosis as 1993, however that VA examination did not have the claims file available for review. Thus, the Board gives greater weight to the November 2011 and July 2015 examinations and finds that the Veteran’s hypertension was diagnosed in 1983. The Board notes that the Veteran’s representative also indicated in a December 2016 Informal Hearing Presentation that the Veteran’s hypertension was diagnosed in 1983. At an October 2001 Board hearing, the Veteran testified that he could not remember if he had high blood pressure readings in service: “I can’t remember. I just remember going to sick bay with, uh, chest pains and it shows that on my service records that [I] reported to sick bay with chest pains but it . . . doesn’t say in my records what they did to me.” A January 1964 service treatment record noted that the Veteran complained of “Chest pain [with] pain in LRQ (sometimes).” His lungs and abdomen were assessed but blood pressure was not recorded; the Veteran was prescribed donnatal. The only blood pressure results in the Veteran’s service treatment records are those at the December 1961 enlistment examination (136/78) and the January 1966 separation examination (128/78). Neither blood pressure reading meets the definition of hypertension in the regulations (38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1)), which require “diastolic blood pressure [that] is predominantly 90mm. or greater.” Isolated systolic hypertension is defined as “systolic pressure [that] is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.” While the Veteran is competent to report experiencing symptoms of chest pain in service, the Board notes that he only sought treatment for chest pain once in service and that his blood pressure was normal at separation. Further, while the Veteran asserts that the reported symptom was a manifestation of hypertension, he is not competent to determine that this symptom was a sign of hypertension because the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires specialized medical education and testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, such as the July 2015 VA examination, which reviewed the Veteran’s claims file and found it less likely than not that the Veteran’s hypertension was related to service, citing the lack of blood pressure readings consistent with a diagnosis of hypertension in service or within 12 months of service. A December 2018 VA examination made the same finding, noting that the Veteran’s condition “occurred many year [sic] post service and values in the service” did not meet the criteria for hypertension. Accordingly, the Board finds that the Veteran’s hypertension did not manifest in service or within one year of separation from service. Service connection for hypertension may still be granted on a direct basis, and the Veteran contends that hypertension is due to in-service exposure to lead-based pain, consumption of salt pills, or diagnosis of mononucleosis. The preponderance of the evidence is against finding that a medical nexus exists between exposure to lead-based paint, consumption of salt pills, or a diagnosis of mononucleosis. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. Regarding lead-based paint exposure, the November 2011 VA examination stated that hypertension was not caused by this exposure because “lead poisoning or exposure to lead is not a known cause of hypertension in the field of medicine.” The July 2015 VA examination similarly found that hypertension was less likely than not related to in-service exposure to lead, noting “no repeated peer review articles relating lead exposure to [hypertension].” As to salt-pill consumption and the diagnosis of mononucleosis, a July 2019 VA examination found it was less likely than not incurred in service or caused by in-service mononucleosis or consumption of salt tablets because “Mononucleosis is not an established etiology of [hypertension] in the medical literature. While consumption of salt tablets can cause transient increases in blood pressure they are not established etiologies of long term [hypertension] in the medical literature.” Although the Veteran believes his hypertension is related to an in-service injury, event, or disease, including lead-based paint exposure, salt-pill consumption, and a diagnosis of mononucleosis, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical knowledge. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent medical evidence and finds that the Veteran’s hypertension is not directly related to an in-service injury, event, or disease. Finally, the Veteran asserts that his hypertension is secondary to his service-connected heart disabilities. To establish a right to compensation for a present disability secondary to a service-connected disability, a veteran must demonstrate the existence of (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. 38 C.F.R. § 3.310(a); Wallin v. West, 11 Vet. App. 509 (1998). The question for the Board is whether the Veteran’s hypertension is proximately due to, the result of, or aggravated beyond its natural progress by service-connected heart disability. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to, the result of, or aggravated beyond its natural progression by service-connected heart disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). A July 2017 VA examination found it less likely than not hypertension was proximately due to the Veteran’s heart disabilities, citing medical research and the medical record. The VA examination indicated first that “per Dynamed (research tool of VA)” secondary causes of hypertension “include renal parenchymal disease, renal artery stenosis, [obstructive sleep apnea], coarctation of aorta and certain endocrine diseases such as hyperthyroidism.” The VA examination noted that the Veteran’s “heart conditions were not listed.” The VA examination also referred to the Veteran’s positive family history of hypertension and that there was “No end organ damage that could affect hypertension.” The December 2018 VA examination additionally found it less likely than not that hypertension was secondary to service-connected heart disabilities because hypertension was diagnosed the same year as the Veteran’s first acute myocardial infarction. Regarding aggravation by the heart disabilities, the July 2017 VA examination referenced the Veteran’s blood pressure readings, which were “stable and under good control,” to find that it was less likely than not that that hypertension was aggravated beyond its natural progression by the disabilities. In addition, the December 2018 VA examination found it less likely than not that the Veteran’s hypertension was aggravated beyond its natural progression by his heart disabilities, citing “medical literature that a vast majority of hypertensive patients require multiple medicines to control [blood pressure] and is [sic] [blood pressure] has been relatively stable.” The Veteran believes his hypertension is proximately due to, the result of, or aggravated beyond its natural progression by service-connected heart disabilities. As stated previously, the Veteran is not competent to provide a nexus opinion regarding this issue because it is medically complex and requires knowledge of complex organ systems. Therefore, it is outside the competence of the Veteran because the record does not show that has the skills or medical training to make such a determination. Jandreau, 492 F.3d at 1377; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examinations and finds that hypertension was not proximately due to, the result of, or aggravated beyond its natural progression by service-connected heart disabilities. In sum, the Board finds that service connection is not warranted for hypertension as a chronic disability because hypertension did not manifest in service or within one year after separation. The Board also finds that service connection is not appropriate on a direct basis, including as due to lead-based paint exposure, consumption of salt pills, and diagnosis of mononucleosis. Finally, service connection is not warranted on a secondary basis because hypertension is not caused or aggravated beyond its natural progression by service-connected disabilities. Accordingly, the Veteran’s claim for service connection is denied. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Ripplinger, 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.