Citation Nr: 21002099 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 13-16 152 DATE: January 12, 2021 ORDER Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran had active service from May 1965 to April 1969, including service in Vietnam; he has been rated at 100 percent disabled since May 1999 plus in receipt of special monthly compensation. 2. Hypertension was not shown in service, was not shown to a compensable degree within one year of service, symptoms not continuous since service, hypertension is not causally or etiologically related to service, and has not been medically associated with a service connected disability. CONCLUSION OF LAW Hypertension was not incurred in service, is not presumed to have been incurred in service, and is not related to a service connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In June 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In November 2019, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. 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). In order 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). As an initial matter, hypertension is a chronic disease under 38 C.F.R. § 3.309. Therefore, both direct and presumptive service connection will be addressed. Further, the Veteran contends that hypertension is related to service connected diabetes mellitus type II (DM). Therefore, secondary service connection is also for application. Turning first to direct service connection, in a March 2003 VA examination, the Veteran reported being diagnosed with hypertension in 1993. Further, clinical records reflect that hypertension was first diagnosed in 1999. Therefore, a current disorder is shown, and the first element of direct service connection is met. As to an in-service incurrence, service treatment records (STRs) are absent of complaints, diagnoses, or treatment of hypertension or symptoms of hypertension. Specifically, the Veteran sought treatment for a variety of medical complaints including back pain, a respiratory infection, and swollen feet, among others, but did not report hypertension or symptoms of hypertension and there are few blood pressure readings in the STRs. An August 1968 blood pressure reading was 120/78 but there is no separation examination of record. Nonetheless, the second element of service connection is not met, and the medical evidence does not support the claim of direct service connection. Turning to presumption service connection, hypertension did not manifest to a compensable degree within one year of separation from service. Specifically, hypertension was not diagnosed until 1999. As hypertension was not shown until 1999, 30 years after separation, this is well outside the one-year legal presumption for chronic diseases such as hypertension. Next, the record does not establish continuity of symptomatology under 38 C.F.R. § 3.309(a). Specifically, in a March 2003 VA examination, the Veteran reported being diagnosed with hypertension in 1993. Even assuming symptoms of hypertension as early as 1993, this was two decades after discharge which does not support a finding that hypertension was continuous since service. In light of the above, the medical evidence does not support presumptive service connection based on chronicity/continuity. Turning to secondary service connection, the Veteran has been diagnosed with hypertension and is service connected for DM. Therefore, the first two elements of secondary service connection, a current disorder and a service connected disability, are met. As to nexus, clinical records reflect that hypertension was noted to be co-morbid with DM; however, this does not suggest that hypertension was caused or aggravated by DM. Rather, it only reflects that the disorders were simultaneously shown. Further, in a July 2009 VA examination, the examiner opined that hypertension was not caused or aggravated by DM, as the cause was idiopathic. A reasonable understanding of idiopathic is that the cause is unknown. This evidence weighs against the claim. In a March 2013 private examination, the clinician opined that hypertension was caused by DM; however, no supporting rationale was provided. In an October 2020 VA examination, the Veteran reported being diagnosed with hypertension prior to being diagnosed with DM. Upon examination, the examiner opined that hypertension was not caused or aggravated by DM. The examiner reasoned that the Veteran had been diagnosed with hypertension prior to being diagnosed with DM and that clinical evidence did not support a causal relationship between DM and hypertension. This evidence weighs against the claim. The Board has the responsibility of weighing conflicting medical opinions and may place greater weight on one physician’s opinion over another depending upon factors such as reasoning employed by the physicians and the extent to which they reviewed prior clinical records and other evidence. In this case, the Board affords the October 2020 VA examiner’s opinion more probative weight. The July 2009 VA examiner found that the cause was unknown and March 2013 private clinician offered a conclusion without a rationale. Moreover, the October 2020 VA examiner provided a detailed rationale for the opinion rendered. The Veteran has also submitted clinical records where he noted that that his blood pressure was higher when his glucose levels were higher, in order to show that hypertension was caused or aggravated by DM; however, he is not competent to say that this is indicative of a causal relationship between hypertension in DM and no medical provider has offered such a conclusion. Therefore, the medical evidence does not support the claim that hypertension was caused or aggravated by service connected DM, as the Veteran was diagnosed with hypertension prior to DM and clinical evidence did not show a casual relationship between the two disorders. In sum, the medical evidence does not support the claim that hypertension was incurred in service or was caused or aggravated by a service connected disability. The Board has considered the Veteran’s lay statements and testimony that hypertension began in service and/or is related to a service connected disability. He is competent to report symptoms because this requires only personal knowledge, as it comes to him through his senses; however, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to the lay statements that have been submitted. Therefore, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.