Citation Nr: 21002819 Decision Date: 01/15/21 Archive Date: 01/15/21 DOCKET NO. 14-37 168 DATE: January 15, 2021 ORDER Service connection for hypertension, to include as secondary to service-connected lumbar intervertebral syndrome (IVDS) and post-traumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. The most probative evidence of record weighs against a conclusion that the Veteran has hypertension due to service. 2. The most probative evidence of record weighs against a conclusion that hypertension is proximately due to or a result of IVDS or PTSD, to include with consideration of aggravation. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran service on active duty from August 1987 to July 1990. I. Legal Criteria When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an “approximate balance of positive and negative evidence” in order to prevail. The Court has also stated, “It is clear that to deny a claim on its merits, the evidence must preponderate against the claim.” Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § § 3.303(d). Where a Veteran served for at least 90 days during a period of war and manifests certain chronic diseases, including hypertension, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. § §§ 3.307, 3.309. Alternatively, service connection may be established under 38 C.F.R. § § 3.303 (b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. The United States Court of Appeals for the Federal Circuit clarified that the law providing for awards of service connection on the basis of continuity of symptomatology is limited to “chronic” diseases listed under 38 C.F.R. § 3.309(a), such as hypertension. A disability which is proximately due to or the result of a service-connected disease shall be service connected. 38 C.F.R. § 3.310(a). A claimant is also entitled to service connection on a secondary basis when it is shown that a service-connected disability has aggravated a nonservice-connected disability. 38 C.F.R. § 3.310(b). II. Analysis The Veteran believes that even though he was not diagnosed in service with hypertension or high blood pressure, he was seen for it and feels that his current diagnosis is due to military service. In his notice of disagreement of October 2013, he states that he things HBP is secondary to his now service-connected posttraumatic stress disorder (PTSD) and back disorders. The service treatment reports (STRs) almost predominantly reflect normal blood pressure readings with the exception of two occasions of acute emergency care, once in March 1989 when blood pressure was recorded at 128/94 when the Veteran was treated for back pain and the second recorded at 150/100 in February 1990 when the Veteran was treated for a sudden onset of sharp abdominal pain. No diagnosis of hypertension was made at that time or during service is shown. The first VA examination conducted after service was in October 1991, it was a general medical examination, contained no complaints or indicia of hypertension, and blood pressure was recorded at that time at 124/84, 120/76, and 122/78. Hypertension was ultimately diagnosed many years after service in 2005. A June 2013 VA examination to address the claim for service connection for hypertension, which noted the initial diagnosis of hypertension in 2005, detailed a clinical history as follows: The Veteran stated during military service [that] he had elevated blood pressure noted several times during his sick call visits. The Veteran stated he was formally diagnosed with hypertension approximately 15 years ago and started on medications about 4 years [ago]. Presently he states he is [taking] Benazepril 5 mg. daily. A review of the Veteran[s’] STRs revealed [that] between 09/20/1987 and 07/09/1990 he had transient elevated blood pressure readings above 130/80 on two occasions. Both blood pressure readings were documented when the Veteran was receiving emergent care for acute pain[]. The Veteran’s private medical records support a diagnosis of hypertension which requires continued medications. Based on a review of the history provided by the Veteran and the clinical record, the June 2013 VA examiner found that it was likely than not that the Veteran incurred hypertension due to service. The rationale for the opinion was as follows. The Veteran’s STRs reveled two separate occasions [of] transient elevated blood pressure readings which were due to “acute pain” related to abdominal pain, which resolved without recurre[nce,] and low back pain[] which resolved without recurrence. The elevated blood pressure readings returned to baseline [during service] once the cause of the pan was treated. Between 1990 until 2005, the [claims file] contained no medical documentation supporting a diagnosis of hypertension. In 2005, the Veteran was diagnosed with hypertension which requires continuous medication[]. The Veteran’s hypertension did not appear until 2005, many years after separation from military service. Thereafter, the Veteran was afforded a VA medical opinion in January 2018 to address his contention that service connection was warranted for hypertension as secondary to his service connected IVDS. The clinician found that it was likely as not that the Veteran developed hypertension due to IVDS and provided the following rationale. The two conditions are not medically related. The claimed disorder is a separate entity entirely from the service-connected condition and unrelated to it. The medical literature does not support a medical relationship. A nexus has not been established The January 2018 opinion did not address the matter of whether IVDS aggravated hypertension, and a July 2018 Board of Veterans’ Appeals (Board) remand requested that the Veteran be afforded such an opinion. The requested opinion was completed in August 2018, with the VA physician concluding that the Veteran’s hypertension was not aggravated beyond its natural progression by his service connected IVDS. The rationale for the opinion was as follows: There is no evidence of aggravation of HTN [hypertension] in [the] available medical records. HTN is well controlled in current therapy Following a grant of service connection for PTSD by a September 2018 rating decision, the Veteran asserted that service connection was warranted for PTSD. As such, a May 2019 Board remanded requested that the Veteran be afforded a VA examination that included an opinion as to whether hypertension was caused or aggravated by PTSD. The requested examination was completed in August 2019 and following a physical examination and review of the claims file, the examiner concluded that it was less likely than not that the Veteran’s hypertension was proximately due or a result of PTSD. The rationale for the opinion was as follows: The [V]eteran reported onset of PTSD symptoms in 2008 (and the [i]nitial PTSD DBQ [Disability Benefits Questionnaire] dated 9/3/2018 supports this year of onset of symptoms by indicating stressors in 1988 that support diagnosis of PTSD) and hypertension in 2000 while medical records indicate onset of hypertension even later in 2005. I opine this is too long a latency for the PTSD to be at least as likely as not a cause of the hypertension. The examiner also opined that the Veteran’s hypertension was less likely than not aggravated beyond its natural progression by PTSD. As rationale, the examiner noted that the Veteran reported that his hypertension has stayed the same over the years, and he observed that “blood pressure readings in the [claims file] over the past 14-15 years [] do not suggest a trend of aggravation beyond natural progression.” The examiner then listed numerous blood pressure readings from April 2005 thru August 2019 as support for this conclusion. The undersigned finds the above VA findings and opinions—which are not contradicted by any positive opinion to the contrary—to be definitive as to the matter for consideration as they are documented to be based on thorough review of the clinical history and history provided by the Veteran and are supported by detailed rationale. To the extent the assertions of the Veteran are advanced in an attempt to establish that he has hypertension as a result of service or IVDS or PTSD, such complex medical matters are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). As the Veteran is not shown to have the appropriate training and expertise, he is not competent to render a persuasive opinion as to such matters. While the Veteran is competent to describe any lay observable symptoms associated with hypertension since service, the undersigned finds the lack of a diagnosis of hypertension during service; the silent VA examination for such in October 1991; the lack of a diagnosis for hypertension for over 14 years after service; and the negative opinion with respect to direct service connection rendered by a VA cilician in June 2013 set forth above to be more probative than any lay assertions made in connection with the claim for service connection for hypertension, and that these facts weigh against a finding of continuity of relevant symptoms associated with this condition since service. Finally, as hypertension was not shown to a compensable degree within one year of separation from service, service connection for such on the basis of chronic disease, to include by way of continuity of symptomatology, is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.   Given all of the above, the Board finds that the preponderance of the evidence is against the claim for service connection for hypertension. As such, this claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Andrew Ahlberg, 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.