Citation Nr: 21002569 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 13-02 212 DATE: January 14, 2021 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s hypertension had its onset in service. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1112, 1131, 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 in the United States Air Force from July 1987 to May 1995. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran indicated in his December 2012 substantive appeal that he wanted to appear at a Board hearing at the RO. However, he later withdrew his request and asked that the Board adjudicate his claim based on the evidence of record. 38 C.F.R. § 20.704(e). This case was previously before the Board in November 2017 and October 2019, when it was remanded to the RO for additional development. After taking further action, the RO confirmed and continued the prior denial and returned the case to the Board. The Board notes that the Veteran originally appealed claims of service connection for a right knee disability and a right ring finger disability. See December 2012 VA Form 9. However, those claims were denied in the November 2017 Board decision and are no longer in appellate status. The Board also notes that there may be missing relevant records. However, as the instant decision constitutes a full grant of benefits on the claim this does not result in any prejudice to the Veteran. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic disabilities, including hypertension, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. The option of establishing service connection through a demonstration of continuity of symptomatology is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309 (a). See 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For VA compensation purposes, the term “hypertension” means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. Multiple blood pressure readings are required to confirm the diagnosis of hypertension with two or more readings on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. The Veteran asserts that he suffered from hypertension, with its onset in service to the present. See February 2011 Notice of Disagreement (NOD). More specifically, the Veteran, through is representative, argues that his disability is related to elevated blood pressure readings taken during service. See October 2017 (Informal Hearing Presentation) IHP. Here, a current diagnosis of hypertension is confirmed by the evidence of record. See e.g., June 2019 VA treatment record. Accordingly, the first element of service connection is met. Turning to the second element, in-service incurrence of a disease or injury, the Veteran’s service treatment records (STRs) do not identify any complaints, treatment for, or diagnosis of hypertension or high blood pressure. However, the Veteran asserts that during his time on active duty he became hypertensive, and there is a notation in his STR towards the end of the active service of an elevated blood pressure reading on August 1994 of 130mm/88mm Hg supporting his argument. In further support of his claim, the Veteran submitted an article from Federal Occupational Health noting pre-hypertension as ranging from 120-139/80-89 mm Hg. As the August 1994 blood pressure reading is an indication of hypertension, the Board will concede, resolving any reasonable doubt in favor of the Veteran, that his hypertension was at least as likely as not manifested in service. Thus, element two of service connection is established. The Board notes that although the Veteran’s blood pressure readings were elevated during his entrance examination, it was determined that he did not have hypertension upon entry. Next, while no treatment records exist during the applicable presumptive period, the Board finds that the Veteran continued to experience the same symptoms from August 1994 to September 2009, the date the record reflects that he was assessed with hypertension. See September 2009 CAPRI Record. In this regard, the Veteran is competent, and the Board him credible, to report that he experienced symptoms of high blood pressure, to include receiving treatment during that period. Regarding element three, medical nexus, there is an opinion in favor of the claim and two opinions against the claim. The Veteran presented for a VA examination in February 2018. He was diagnosed with hypertension and isolated hypertension. The examiner noted the date of onset as 1996, and 1997 as when the medication first began, noting he took Lisinopril for his hypertension. The examiner opined that the Veteran’s hypertension was related to service and reasoned that the Veteran had no issues with hypertension prior to military service, the condition was onset in service, and that there is evidence of continuing treatment of care. The examiner also noted that the Veteran was placed on blood pressure medication while on active duty and still continues today with medication. The Veteran presented for another VA examination in August 2019. The examiner conceded an established diagnosis of hypertension. The examiner opined that it was less likely than not that the Veteran’s hypertension was related to service. In reviewing the blood pressure readings during the Veteran’s service, the examiner stated that there were no blood pressure readings which met VA’s criteria for service connection. The examiner noted that the Veteran had occasional systolic blood pressure readings in service, but collectively there was no evidence of elevated blood pressure during service that qualified for hypertension. The examiner also noted that there are no records establishing treatment for hypertension prior to 2009. The Veteran presented for another VA examination in January 2020. He was diagnosed with hypertension, noting the date of onset as 2009. During that examination the Veteran noted that he was diagnosed with hypertension in 1996, shortly after being discharged from service and that he started on medication in 2000. The examiner opined that it was less likely than not that the Veteran’s hypertension was related to, caused by, or aggravated by his active service. The examiner reasoned that the Veteran was not treated in service and that his blood pressure was normotensive in service. The examiner concluded by noting that there was no additional data until after a decade of separation from the military. The Board finds that all of the VA examinations are inadequate. The initial February 2018 VA examination is inadequate as it notes that the Veteran was placed on blood pressure medication in-service, which is not supported by the actual STRs. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based upon an inaccurate or incomplete factual premise is not probative). The subsequent August 2019 and January 2020 VA examinations are inadequate as they premise their opinions on the lack of continuity of care, although the Veteran has competently reported that he has been on medication prior to 2009 and the Board finds him credible in this regard. Moreover, the final two examinations do not indicate that the examiners considered elevated blood pressure readings as a manifestation of high blood pressure, particularly given his subsequent diagnosis of hypertension, but rather that the Veteran had hypertension for VA purposes, which places a higher burden on the Veteran and is the incorrect legal standard. Given the STRs showing of an elevated blood pressure in service, the Veteran’s competent and credible lay statements that his symptoms have continued since service, and his current diagnosis, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s hypertension had its onset in service or during the one-year presumptive period following his discharge from active is service. Thus, resolving all reasonable doubt in his favor, the Board finds that service connection for hypertension is warranted on the basis of continuity of symptomatology for a chronic disease. 38 U.S.C. § 5107. ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.