Citation Nr: 21004222 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 17-21 289 DATE: January 26, 2021 ORDER Service connection for hypertension is denied. Service connection for hypothyroidism is denied. FINDINGS OF FACT 1. The service treatment records are negative for hypertension; the initial diagnosis of hypertension was first made many years after discharge from service and there is no competent opinion to relate this disability to active service. 2. The service treatment records are negative for hypothyroidism; the initial diagnosis of hypothyroidism was not made until many years after discharge from service and there is no medical opinion to relate this disability to active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met, and hypertension may not be presumed to have been incurred in service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for hypothyroidism have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1972 to July 1974. The matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. This case was remanded in February 2020 for examination and opinions. Service Connection General laws and regulations that pertain to service connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). Hypertension is presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from active duty. 38 C.F.R. §§ 3.307, 3.309(a). Finally, service connection for chronic disabilities listed under 38 C.F.R. § 3.309 (a), also to include hypertension, may be warranted based on continuity of symptomatology. See 38 C.F.R.§ 3.303 (b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Service connection for hypertension 2. Service connection for hypothyroidism The Veteran claims that service connection is warranted for hypothyroidism and hypertension. He maintains that these disabilities arose from an incident in which he inhaled fumes of acetone and other chemicals during an inservice rocket launcher accident. VA treatment and examination reports include diagnoses of essential hypertension and hypothyroidism. Therefore, this satisfies the first element of the Holton analysis, current disability. Concerning the second element, evidence of incurrence or aggravation of a disease or injury in service, the RO has conceded that an inservice incident occurred in which the Veteran was pinned by a rocket launcher. The June 1974 separation examination report, the blood pressure reading was 124/62. The vascular and the endocrine systems were considered clinically normal. This does not suggest that he had hypertension or hypothyroidism in service. Further, there is no clinical evidence of hypertensive problems within a year of the Veteran’s discharge from service in July 1974, let alone manifested to a compensable degree of at least 10-percent disabling. It may not be presumed that hypertension incurred in service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. It was not until many years later that any of the claimed conditions were first shown, either by complaint or objective clinical finding. VA records show that in November 2008, the Veteran reported a history of hypertension since 1997, which is 23 years after service discharge. He also reported that hypothyroidism was not diagnosed until 2000, this is over 26 years after service discharge, an extended period. This, too, is probative evidence against the claims. See Maxon v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxon v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). Most importantly, though, after reviewing the e-folders for the pertinent medical and other history there is no nexus opinion by any medical professional that links either the hypothyroidism or hypertension to service. The Veteran has not provided any competent medical evidence of a nexus between current disability and disease or injury during service, as required by Holton analysis. The only medical opinions of record are against the claims. The Veteran was examined by VA contract physician who determined that it was less likely than not that hypertension was relate to service. The physician noted that a review of the literature showed no significant correlation or cause and effect relationship between acetone and the development of hypertension. The examiner noted that it was difficult to consider as there is a myriad. Notwithstanding this, the examiner noted that the common risk factors for the development of either hypertension or hypothyroidism does not typically include fumes or other environmental exposures. The Mayo clinic lists common risk factors for hypertension. The examiner noted the Veteran had several of these risk factors. In regard to hypothyroidism, the major risk factors include being female, over 60 years of age, family history of thyroid disease, history of autoimmune disease, radioactive iodine treatment, anti-thyroid treatment, radiation exposure and surgery. While none of these apply to Veteran, there is an increase in hypothyroidism in African Americans. The examiner noted that it was an extended period of time between any chemical exposure in service and the onset of hypothyroidism in 2000. The physician found that it would be difficult to establish that a potential chemical exposure that occurred 26-28 years prior to the onset of symptoms caused his hypothyroidism in the absence of strong epidemiological data. To attribute the Veteran’s hypothyroidism or hypertension to military service without objective medical evidence of inservice treatment, or continuity of treatment after service discharge, or a medical opinion providing a nexus, would require excessive speculation. Accordingly, the Board concludes that the preponderance of the evidence is against the claims for service connection for hypothyroidism and hypertension. And since the preponderance of the evidence is against the claims, there is no reasonable doubt to be resolved in his favor, and these claims must be denied. 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.D. Jackson, 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.