Citation Nr: 21003125 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 14-18 326 DATE: January 19, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected post-traumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran’s hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not secondary to his service-connected PTSD or otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for hypertension, to include as secondary to service-connected PTSD, are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1968 to April 1970 and February 1979 to March 1981. This matter came before the Board of Veterans Appeals (Board) on appeal from a January 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The case was remanded in January 2018, February 2020, and August 2020 for additional development, and is now back before the Board for adjudication. Entitlement to service connection for hypertension, to include as secondary to service-connected post-traumatic stress disorder (PTSD) is denied. The Veteran claims that he is entitled to service connection for hypertension as his hypertension is related to his active duty service, to include his service-connected PTSD. The Veteran is currently service connected for PTSD which is rated at 70 percent. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).  Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 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). Under VA rating criteria, hypertension means that the diastolic pressure is predominantly 90 or greater, and isolated systolic hypertension means that the systolic pressure is predominantly 160 or greater with a diastolic pressure of less than 90. A diagnosis must be confirmed by readings taken two or more times on three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. Here, the Board finds that, although the Veteran has a current diagnosis for hypertension, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by his service-connected PTSD. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a). The Veteran underwent VA examinations in April 2018 and March 2020, and an addendum opinion was obtained in October 2020. Taken together, the VA examiners opined that the Veteran’s hypertension is more likely due to the Veteran’s multiple other risk factors for hypertension, including his weight, family history of hypertension, age, high sodium diet, and physical inactivity. The March 2020 examiner also opined that the Veteran’s PTSD did not aggravate his hypertension since the Veteran had elevated blood pressure readings prior to reporting panic symptoms and entering behavioral healthcare, and that there is no pattern of worsening of blood pressure readings after onset of behavioral health symptoms, diagnosis and treatment. The October 2020 VA examiner also addressed the Federal Register statement of June 28, 2005, 70 F.R. 37040, which amended 38 C.F.R. § 3.309(c) to allow presumptive service connection of certain diseases, including hypertensive heart disease, for veterans who were former prisoners of war. Although the record does not support a finding that the Veteran was a prisoner of war and thus presumptive service connection under 38 C.F.R. § 3.309(c) is not available, the Federal Register statement indicates that “veterans who have a longterm history of PTSD have a high risk of developing cardiovascular disease and myocardial infarction, particularly if such veterans suffer from other major psychiatric disorders or inflammatory diseases in addition to PTSD.” The October 2020 VA examiner opined that, while a clear causal relationship between PTSD and hypertension is not established, there is noted to be an increased risk particularly in those veterans with severe PTSD and those with untreated PTSD. The October 2020 VA examiner reviewed studies linking PTSD and hypertension among soldiers and opined that in this case, there is no indication the veteran had severe PTSD or untreated PTSD, and further noted that The studies supporting a connection between PTSD and hypertension did not discuss the other comorbid health issues that are relevant to the risk of developing hypertension such as was noted in this veteran’s situation. Also, the Board finds that the Veteran’s hypertension was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Veteran’s service treatment records (STRs), including his April 1968 entrance examination and April 1970 separation examination from the Veteran’s first period of service are silent for complaints or treatment for hypertension. Additionally, the STRs from the Veteran’s second period of service, including his March 1981 separation examination, do not show a diagnosis for hypertension. The Veteran also answered in the negative for any complaints of high or low blood pressure in the Report of Medical History accompanying the April 1970 separation examination. The Veteran’s VA treatment records show that he was diagnosed with hypertension in April 2000, approximately 19 years after separation from his last period of service, and at that time was not taking medications for his hypertension. By April 2003 the Veteran was prescribed medication to treat his hypertension. Based upon the Veteran’s STRs and VA treatment records, the April 2018 and March 2020 VA examiners also opined that the Veteran’s hypertension did not begin during service or within one year of service as there is no medical evidence that the Veteran’s hypertension began during service or within one year of service. The Board similarly finds that there is no lay evidence that the Veteran’s hypertension began during service or within one year of service. The Veteran believes that his hypertension is either proximately due to or the result of, or aggravated beyond its natural progression by, his service-connected PTSD. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and anatomical relationships as well as interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training 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). Finally, If a Veteran was exposed to an “herbicide agent,” such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116, 1131; 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e).   The Board finds that the Veteran had active duty service in the Republic of Vietnam during the presumptive period, and there is no affirmative evidence of the contrary, so exposure to herbicide agents is conceded.  However, in this case, hypertension not among the list of diseases that are presumed to be related to herbicide agent exposure under 38 C.F.R. § 3.309 (e). As such, presumptive service connection for these disabilities based on herbicide agent exposure is not warranted.  Accordingly, the Board finds that the preponderance of the evidence is against the (Continued on the next page)   claim of entitlement to service connection for hypertension and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Boal, 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.