Citation Nr: 21002045 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-53 811 DATE: January 12, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT Hypertension was not manifest in service or within one year and is not otherwise attributable to service. CONCLUSION OF LAW Hypertension was not incurred in or aggravated by active service, nor may it be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1960 to October 1965. This case was previously before the Board in September 2020, at which time it was remanded for further development. The directives having been substantially complied with the matter again is before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for hypertension The Veteran contends that his hypertension was manifest during active service. To establish service connection a Veteran must generally show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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). Service connection may also be established for a current disability on the basis of a presumption that certain chronic diseases, to include organic diseases of the nervous system, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For hypertension, the disease must have manifested to a degree of 10 percent or more within one year of service. 38 C.F.R. § 3.307(a)(3). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” 38 C.F.R. § 3.303(b). When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. The Board concludes that, while the Veteran has a diagnosis of hypertension, and there were isolated instances of elevated blood pressure during service, the preponderance of the evidence weighs against finding that the Veteran’s hypertension was manifest during service or is otherwise related to service. Service treatment records show that the Veteran reported a history of high blood pressure upon entry to active duty. His blood pressure upon examination was 150/90. At separation the Veteran again reported a history of high blood pressure. The physician noted that the Veteran reported having hypertension in 1959 when weight was over 200 pounds and that it was diet controlled. His measured blood pressure was 128/88. The Veteran submitted a disability benefits questionnaire in October 2017. The DBQ indicated that the Veteran reported having high blood pressure readings at age 18 and began taking medication in 1978. Four other diagnoses were listed as being related to the hypertension (venous varices, venous insufficiency, CKD stage 3, and epistaxis), none of which are service-connected. No etiological opinion was provided. The Veteran received a VA examination in September 2020. The examiner opined that the Veteran’s hypertension is less likely than not related to his active service. The examiner noted that multiple elevated blood pressure readings on various days are required to render a hypertension diagnosis. Only at enlistment was the Veteran’s blood pressure elevated. There were no other instances of elevated blood pressure, including at separation. The examiner explained that random isolated elevations of blood pressure do not place an individual at great risk of developing hypertension in the future. Further, the Veteran reported having started medication for hypertension in 1978, well after service. The examiner indicated that the most likely causes of the Veteran’s hypertension are the combined risk factors of age, obesity, western diet and physical inactivity. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes his hypertension is related to his service. The Veteran is competent to report what he was told regarding elevated blood pressure prior to and during service. However, he is not competent to provide a nexus opinion regarding this issue as the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical opinion of record. The preponderance of the evidence weighs against a finding that the Veteran’s hypertension was manifest in service or is otherwise attributable to service. There is only one instance of elevated blood pressure in service, and the blood pressure reading at separation was normal. Further, the September 2020 medical opinion indicated that the Veteran’s hypertension is less likely than not related to his service, as a single elevated reading is not a risk factor for later developing hypertension. There is also not sufficient evidence to support presumptive service connection, as there is no evidence that hypertension was manifest to a compensable degree within one year of separation. The Veteran reported that he began taking medication for his hypertension in 1978, more than a decade after discharge. There is no record of hypertension prior to this time (other than the Veteran’s reported high blood pressure prior to service), either in the Veteran’s treatment records or per his reports. Lastly, the fact that he had an elevated reading at entrance does not establish that he had hypertension nor a diagnosis of hypertension at that time. See 38 C.F.R. § 3.303. He is entitled to the presumption of soundness, but the evidence fails to establish a reliable diagnosis of hypertension at entrance, at any time prior to service or during service. The pressure reading at separation clearly establishes that there was no increase in severity. In the alternative, if it is argued that hypertension pre-existed service, it is clear and unmistakable that there was no aggravation during or within one year of separation. For the foregoing reasons, the preponderance of the evidence is against the claim. The benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Creegan 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.