Citation Nr: 21005215 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 06-24 782A DATE: January 29, 2021 ORDER Entitlement to service connection for nerve damage of the left knee, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for nerve damage of the right knee, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected disability, is denied. Entitlement to service connection for hypertension, to include as secondary to a service-connected disability, is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a left knee nerve disability at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a right knee nerve disability at any time during or approximate to the pendency of the claim. 3. The Veteran’s left knee disability is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease. 4. The Veteran’s right knee disability is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease. 5. The Veteran’s hypertension is not secondary to a service-connected disability and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for nerve damage of the left knee are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for nerve damage of the right knee are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a left knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for a right knee disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1977 to May 1986. This appeal comes before the Board of Veterans’ Appeals (Board) from a February 2006 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The record reflects that you received a letter indicating that you could request a virtual tele-hearing instead of waiting for a travel board hearing. Upon further review, you do not have a pending hearing request. You provided testimony in a hearing with a Veterans Law Judge on February 2011. A transcript of the hearing is available in the record. The undersigned Veterans Law Judge has considered the transcript of that hearing as evidence in making a decision. This matter was previously remanded in December 2017 for further development, to include requesting the Agency of Original Jurisdiction (AOJ) to obtain VA medical opinions. These VA medical opinions were obtained; thus, the Board finds that its remand instructions were substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal, the Veteran’s claim of entitlement to service connection for a low back disability was granted in a September 2019 rating decision. This award constitutes a full grant of the benefit sought on appeal with respect to that issue. Therefore, the issue of entitlement to service connection for a low back disability is no longer before the Board. In August 2018, the Veteran submitted a signed RAMP Opt-In Election form and selected Higher-Level Review. Following receipt of the RAMP Opt-In Election form, the Board placed the Veteran’s appeal on its docket for review in the legacy appeals system. A clarification letter was sent to the Veteran in September 2020 seeking clarification as to whether the Veteran still wished to participate in RAMP or remain in the legacy appeals system. As the Veteran did not respond to the clarification letter within 60 days as indicated, the Veteran’s appeal has remained on the Board’s docket and a decision will be issued in the legacy appeals system. Service Connection 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; 38 C.F.R. § 3.303. 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 causal relationship (nexus) between the claimed in-service disease or injury and the present disability. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. § 1101, 1112, 1113, 1131, 1137; 38 C.F.R. § 3.307, 3.309. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As noted, arthritis is a chronic disease. 38 U.S.C. § 1101. Therefore, section 3.303(b) is potentially applicable. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for nerve damage of the left knee, to include as secondary to a service-connected disability is denied. The Veteran seeks service connection for a left knee nerve condition. The first requirement for direct or secondary service connection is the existence of a current disability. A VA medical opinion was obtained in May 2015. The VA examiner indicated that after a review of the Veteran’s records, there was no objective medical evidence, including imaging, nerve conduction velocity studies, or electromyography, to indicate the Veteran had a neurologic condition of the left knee to include peripheral neuropathy. The examiner considered the Veteran’s reports of lower extremity mild pain and explained the report of a nonspecific symptom of mild pain is not pathognomonic or any particular neurologic pathology to include peripheral neuropathy. A left knee nerve diagnosis was not found. The Board finds this opinion highly probative as the VA examiner reviewed all the Veteran’s records and gave a thorough rationale for his opinion. Another VA medical opinion was obtained in October 2016. The Board remanded this case in December 2017 for clarification as the October 2016 VA examiner indicated the Veteran did not have a peripheral nerve condition or peripheral neuropathy. However, the VA examiner also responded in a section entitled “Symptoms” in the affirmative as to the question of whether the Veteran had any symptoms attributable to a peripheral nerve condition. The examiner noted mild right lower extremity intermittent pain. As the opinion is unclear and contradictory, the Board does not afford it any probative value. This matter was sent to a February 2018 VA examiner in order to obtain a clarified medical opinion. The February 2018 VA examiner indicated that after a review of the record, she was unable to render an opinion as to whether the Veteran had a left knee nerve diagnosis without further testing. The Board finds this opinion inadequate for adjudicatory purposes and affords it no probative value. Barr v. Nicholson, 2 Vet. App. 303, 311-12 (2007). The RO then sent the Veteran’s file to another VA examiner in order to obtain an adequate opinion. A VA medical opinion was obtained in August 2019. The VA examiner indicated that after a review of the Veteran’s records, there was no medical evidence to support a left knee nerve damage diagnosis during service or the present. The VA examiner indicated that as the August 2004 Electromyography (EMG) test was negative, the Veteran did not have a left knee nerve condition. The VA examiner instead attributed the Veteran’s reports of knee pain to his diagnosis of degenerative joint disease which the examiner indicated was related to the natural aging process. The Board finds this opinion highly probative as it is based on a review of the Veteran’s records and includes a thorough rationale for the opinion. The Board finds that the August 1987, May 2015, and August 2019 examiner’s opinions are highly probative, as they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, there is no other medical opinion of record that contradicts the examiners’ findings. While the Veteran believes that he has a left knee nerve condition that is related to service, he is not competent to provide a diagnosis in this case, as the pathology of his condition falls outside of the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the examinations and opinions of record. The Board also acknowledges that pain can cause disability to the extent that it produces functional limitation. Saunders v. Wilkie, 886 F.3d 1356 (2018). However, the relevant statute here, 38 U.S.C. § 1110, requires that for the grant of service connection the disability must be due to an identified disease or residual of injury. This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Here, the probative evidence relates the Veteran’s complaints to arthritis rather than any neurological disability, which has been ruled out on diagnostic testing. Thus, the greater weight of the evidence is against the Veteran’s left knee nerve disability claim. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 2. Entitlement to service connection for nerve damage of the right knee, to include as secondary to a service-connected disability is denied. The Veteran seeks service connection for nerve damage of the right knee. The Veteran has already been granted service connection for radiculopathy of the right lower extremity associated with his service-connected degenerative disc disease of the lumbar spine in a September 2019 rating decision. In August 1987, the Veteran underwent a VA examination for his right knee. The examiner noted the Veteran complained of knee pain, however, he indicated films of the right knee showed no evidence of fracture, arthritis or other abnormality. The impression given was a normal right knee. See August 1987 VA Examination. However, at the bottom of the examination report, the VA examiner indicated the Veteran had a right knee condition “probably due to degenerative joint disease.” Id. A VA medical opinion was obtained in May 2015. The VA examiner indicated that after a review of the Veteran’s records, there was no objective medical evidence, including imaging, nerve conduction velocity studies, or electromyography, to indicate the Veteran has a neurologic condition of the right knee to include peripheral neuropathy. The examiner considered the Veteran’s lay statements regarding lower extremity mild pain and explained it was a report of a nonspecific symptom which is not pathognomonic or any particular neurologic pathology to include peripheral neuropathy. As the examiner considered the lay statements of the Veteran, reviewed the Veteran’s records and provided a thorough rationale for his opinion, the Board affords this opinion high probative value. Another VA medical opinion was obtained in October 2016. The Board remanded this case in December 2017 for clarification as the October 2016 VA examiner indicated the Veteran did not have a peripheral nerve condition or peripheral neuropathy. However, the VA examiner also responded in a section entitled “Symptoms” in the affirmative as to the question of whether the Veteran had any symptoms attributable to a peripheral nerve condition. The examiner noted mild right lower extremity intermittent pain. As this examination is contradictory and unclear, the Board affords it no probative value. This matter was sent to a February 2018 VA examiner in order to obtain a clarified medical opinion. The February 2018 VA examiner indicated that after a review of the record, she was unable to render an opinion as to whether the Veteran had a right knee nerve diagnosis without further testing. The Board finds this opinion inadequate for adjudicatory purposes and affords it no probative value. Barr v. Nicholson, 2 Vet. App. 303, 311-12 (2007). The RO then sent the Veteran’s file to another VA examiner in order to obtain an adequate opinion. The August 2019 VA examiner indicated that after a review of the Veteran’s records, to include lay statements by the Veteran, there was no evidence to support a right knee nerve damage diagnosis. The VA examiner noted a May 2019 Clinic Note which referenced a positive right lower extremity electromyography showing evidence of chronic right L4/L5 radiculopathy. However, the VA examiner indicated the Veteran has lumbar radiculopathy, which is a nerve root disease due to lumbar spine disc disease and not a right knee nerve damage condition. Prior testing and medical records did not show evidence of a separate right knee nerve damage condition or diagnosis. As the VA examiner provided an explanation that contains clear conclusions and supporting data, the Board afford this opinion high probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes that he has a right knee nerve condition that is related to service, he is not competent to provide a diagnosis or nexus opinion in this case, as the pathology of his condition falls outside of the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the examinations and opinions of record. The Board also acknowledges that pain can cause disability to the extent that it produces functional limitation. Saunders v. Wilkie, 886 F.3d 1356 (2018). However, the relevant statute here, 38 U.S.C. § 1110, requires that for the grant of service connection the disability must be due to an identified disease or residual of injury. This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that “a veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Here, the probative evidence relates the Veteran’s complaints to arthritis rather than any neurological disability, which has been ruled out on diagnostic testing. Thus, the greater weight of the evidence is against the Veteran’s right knee nerve disability claim. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Entitlement to service connection of the left knee, to include as secondary to a service-connected disability is denied. 4. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected disability is denied. The Veteran contends that he is entitled to service connection for a bilateral knee disability as the condition had its onset in 1977 during service. See October 2016 VA Examination. The Veteran has a current diagnosis of bilateral degenerative joint disease. See June 1992 X-Ray. Therefore, the first element of service connection has been met. The Veteran reported the onset of his bilateral knee pain as 1977, which was during service. See October 2016 VA Examination. The Veteran’s service treatment records (STRs) are silent for any diagnosis, complaint or abnormal finding pertinent to the Veteran’s knees. A February 1986 report of medical history indicates the Veteran marked “no” with regard to tricked or locked knee. The February 1986 separation examination did not show lower extremity abnormalities. In addition, the February 1986 STR indicates the Veteran denied knee pain or arthritis. However, as the evidence is in relative equipoise, the Board will give the Veteran the benefit of the doubt and find that the second element of service connection has been established. 38 U.S.C. § 5107 (b). The Veteran underwent a VA examination of his right knee in August 1987. The Veteran reported right knee pain. X-rays were taken of the right knee and the VA examiner indicated that films of the right knee showed no evidence of fracture, arthritis or other abnormality. The impression given was a normal right knee. The examiner later in the report indicated that the Veteran’s right knee condition was “probably due to degenerative joint disease.” The Board finds this opinion inadequate for adjudicatory purposes. Barr v. Nicholson, 2 Vet. App. 303, 311-12 (2007). The VA examiner first states no arthritis is found based on the x-ray of the right knee but later attributes the Veteran’s complaints of right knee pain to possible degenerative joint disease without an accompanying rationale or explanation for this inconsistency. As such, the Board affords this opinion no probative value with regard to the etiology of the Veteran’s right knee condition. A private x-ray record from March 2005 noted the impression of mild medial joint spacing consistent with early osteoarthritis of the left knee, and mild osteoarthritic changes of the medial and patellofemoral compartments of the right knee. A VA medical opinion was obtained in May 2015. The VA examiner indicated that after a review of the Veteran’s records, there was no objective medical evidence, including imaging, nerve conduction velocity studies, or electromyography, to indicate the Veteran has a chronic debilitating bilateral knee condition. The Board finds this opinion inadequate for adjudicatory purposes with regard to the etiology of the Veteran’s bilateral DJD. Id. The May 2015 VA examiner ignored the Veteran’s previous diagnosis of bilateral DJD and did not offer an etiology opinion. Therefore, the Board does not afford this opinion any probative value. Another VA medical opinion was obtained in October 2016. The VA examiner indicated it was less likely than not that the Veteran’s bilateral knee condition was incurred in or caused by the claimed in-service injury, event, or illness. He indicated that the Veteran’s STRs did not contain any records reflecting evaluation and treatment for bilateral knee pain. He additionally noted that the February 1986 STR indicated the Veteran denied knee pain or arthritis. He pointed out that at that time, there were no abnormalities of the knee present. He also indicated that the Veteran reported to the August 1987 VA examiner that he experienced right knee pain, however the right knee x-ray at the time was normal. The VA examiner also indicated it was less likely than not that the Veteran’s bilateral knee DJD was proximately due to, the result of, or aggravated beyond its natural progression by the Veteran’s service-connected disabilities. The examiner based this opinion on a review of the Veteran’s records as well as X-rays from 2005 and 2016 both showing mild arthritis only. Another VA medical opinion was sought in February 2018.The VA examiner indicated that after a review of the record, she was unable to render an opinion as to the Veteran’s bilateral knee disability without further testing. The Board finds this opinion inadequate for adjudicatory purposes and it is not probative. Id. The VA examiner failed to provide an explanation or rationale as to why the medical evidence of record was not sufficient to render an etiology opinion. A final VA medical opinion was obtained in August 2019. The VA examiner indicated it was less likely than not that the Veteran’s bilateral knee condition was incurred in or cause by an in-service injury, event, or illness. The examiner indicated the Veteran’s service treatment records (STRs) were silent for knee complaints during service. The examiner additionally noted that a February 1986 report of medical history indicated the Veteran’s denial of tricked or locked knee, and that the February 1986 examination did not show lower extremity abnormalities. He noted that a June 1992 bilateral knee x-ray showed degenerative joint disease (DJD) bilaterally although minimally on the left and very slight on the right. The VA examiner indicated this DJD was consistent with natural aging. The August 2019 VA examiner also opined it was less likely than not that the Veteran’s bilateral DJD was proximately due to or the result of the Veteran’s service-connected disabilities. The examiner again indicated that the Veteran’s DJD was consistent with the natural aging process. He also indicated it was less likely than not that the Veteran’s bilateral knee DJD was aggravated beyond its natural progression by the Veteran’s service-connected disabilities. The VA examiner offered the rationale that the natural progression of knee arthritis was a slow and degenerative process leading to cartilage breakdown, joint space narrowing, and bone damage. He noted that the Veteran’s bilateral knee x-rays from June 1992 to October 2016 had shown mild degenerative changes. He indicated that, while the Veteran’s file showed multiple complaints and evaluations for knee pain, the objective evidence was consistent with the natural progression of the condition. He determined that the evidence did not support aggravation of the knee arthritis beyond its natural progression as the degenerative changes were not moderate to severe with significant loss of knee joint space (bone on bone). The Board finds that the October 2016 and August 2019 VA examiner’s opinions are highly probative, as they are based on an accurate medical history, the Veteran’s lay statements, and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, there is no other probative medical opinion of record that contradicts the examiners’ findings. While the Veteran believes that his bilateral knee DJD condition is related to service or a service-connected disability, he is not competent to provide a nexus opinion in this case, as the pathology of his condition falls outside of the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the examinations and opinions of record that deny a nexus for both direct and secondary service connection. Additionally, with respect to a diagnosis of degenerative joint disease, the Board has considered whether there is competent credible evidence of continuity of symptomatology of degenerative joint disease of the right knee, as arthritis, since service, or whether such manifested to a compensable degree within one year of separation; but finds in each case that there is not. The Board finds that the contemporaneous medical records are more probative. In this case, the only indication of a bilateral knee condition disability in service is the Veteran’s lay report of bilateral knee pain in 1977. However, the Board notes that there was no indication of a knee disability in the Veteran’s service treatment records, or on the Veteran’s separation examination in 1986. While the Veteran did report right knee pain to the August 1987 VA examiner, the VA examiner indicated the right knee x-ray showed no arthritis, and it had been more than year since separation from service at the time of examination. Thus, the greater weight of the evidence is against the Veteran’s bilateral knee disability claim. Since the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claims are denied. 5. Entitlement to service connection for hypertension, to include as secondary to a service-connected disability is denied. The Veteran contends he is entitled to service connection for hypertension as it began during service. In the alternative, the Veteran contends his hypertension was caused or aggravated by his service-connected disabilities. The Veteran has a current diagnosis of hypertension. See June 2015 VA Examination. Accordingly, the first element of service connection has been satisfied. Next, the Veteran reported that his hypertension onset in 1978 or 1979 and he was treated with medicine in Germany during service. Id. He further stated he did not stay on medication for hypertension at that time because he did not feel as though he had blood pressure problems. However, in about 1981, he reported he was told he had hypertension again and had been treated with medication ever since. In contrast, the Veteran’s STRs do not contain treatment for hypertension, and all blood pressure readings were within normal limits. See March 1977 and March 1978 STRs. In addition, a February 1986 STR indicates the Veteran responded “no” to having high or low blood pressure. The Veteran’s blood pressure upon examination was 98/78 with no mention of hypertension. See February 1986 Report of Medical History. As the evidence is in relative equipoise, the Board will give the Veteran the benefit of the doubt and find the second element of service connection has been met. See 38 U.S.C. § 5107 (b). The last element needed for direct service connection is a nexus. A June 2015 VA examiner opined the Veteran’s hypertension was less likely than not incurred in or caused by the claimed in-service event, injury or illness. The Board finds this opinion inadequate for adjudicatory purposes however as the VA examiner’s only rationale was that the Veteran’s STRs had no notations of hypertension. Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 2 Vet. App. 303, 311-12 (2007). As the VA examiner’s opinion is conclusory in nature and without an adequate rationale, the Board affords it no probative value. Another VA opinion was sought in February 2018. The VA examiner indicated that after a review of the record, she was unable to render an opinion as to the Veteran’s hypertension without further testing. The Board finds this opinion inadequate for adjudicatory purposes and it is not probative. Id. The VA examiner failed to provide an explanation or rationale as to why the medical evidence of record was not sufficient to render an etiology opinion. A VA medical opinion was obtained in October 2016. The VA examiner opined that it was less likely than not that the Veteran’s hypertension was incurred in or caused by the claimed in-service injury, event, or illness, or that his service-connected disabilities caused or aggravated his hypertension beyond its natural progression. The VA examiner indicated that the Veteran’s STRs did not contain any records of abnormal blood pressure during service. He pointed out that on February 1986 separation examination, the Veteran denied a history of hypertension. His blood pressure was normal at that time. He also noted that the Veteran underwent a VA examination in August 1987, and the three separate blood pressure readings were normal. He concluded, given the fact that no STR’s documented abnormal blood pressure or any treatment with anti-hypertensive medications, the claimed hypertension was less likely than not incurred in service. A VA medical opinion was obtained in May 2019. The VA examiner indicated it was less likely than not that the Veteran’s hypertension was incurred in or caused by the claimed in-service injury, event, or illness, or that the Veteran’s service connected disabilities caused or aggravated his hypertension beyond its natural progression. The VA examiner indicated there was no objective medical evidence of record to indicate the Veteran’s hypertension did not resolve without residuals. The Veteran marked “no” on his February 1978 separation examination with regard to high or low blood pressure. In addition, his blood pressure was noted to be within normal limits at 98/78. There was no immediate treatment following service for hypertension to indicate it is a chronic ongoing problem since service. Another VA medical opinion was obtained in August 2019. The VA examiner indicated that it was less likely than not that the Veteran’s hypertension was incurred in or caused by the claimed in-service injury, event, or illness. A review of the Veteran’s file did not show hypertension during service. His February1986 separation examination did not show evidence of hypertension during service. The Veteran’s discharge summary dated November 1988 shows a reported past medical history of hypertension while he was in the military and notes he stopped his medications more than three years ago without a doctor’s order. The Veteran’s discharge summary from July 1991 shows a reported history of high blood pressure in 1978. The blood pressure readings from March 1978 were within normal limits and the service treatment records did not show a diagnosis of hypertension or medication for hypertension in 1978. Therefore, a nexus cannot be established. The August 2019 VA examiner The Veteran’s hypertension is less likely than not proximately due to, caused by or aggravated by the Veteran’s service-connected conditions. The medical literature does not support that the Veteran’s service-connected conditions are risk factors for hypertension. A review of the Veteran’s file shows multiple other risk factors for the hypertension condition including cigarette smoking, illicit drug use, cocaine use, and alcohol use. A nexus has not been established. In addition, the Veteran’s hypertension was not aggravated beyond its natural progression by the Veteran’s service-connected disabilities. While temporary elevation/fluctuations of blood pressure readings are associated with physical stress and pain which can occur with the Veteran’s service-connected disabilities, these are temporary in nature. There is no evidence to support aggravation of the Veteran’s hypertension beyond its natural progression. The Board finds that the October 2016, May 2019, and August 2019 VA examiner’s opinions are highly probative, as they are based on an accurate medical history, the Veteran’s lay statements, and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, there is no other probative medical opinion of record that contradicts the examiners’ findings. The Board has also considered whether the Veteran is entitled to service connection based on a secondary service connection theory of entitlement. However, the October 2016, May 2019, and August 2019 VA examiners all also found that the Veteran’s service-connected disabilities did not cause or aggravate the Veteran’s hypertension beyond its natural progression. There is no positive medical opinion of record. The Board has also considered the lay statements by the Veteran that his hypertension was caused by his service-connected disabilities. The Veteran is competent to report the occurrence of lay-observable events such as symptoms or certain readily-observable disabilities. 38 U.S.C. § 1153 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, the Veteran is not competent to provide nexus opinions for his own medical condition, as it is medically complex. The Board finds the credible medical evidence of record outweighs the Veteran’s lay statements as to the etiology of his hypertension. Therefore, the claim is denied. J. Barone Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Holcombe, 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.