Citation Nr: 21062896 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 14-30 449 DATE: October 12, 2021 ORDER Service connection for hypertension is denied. Service connection for insomnia is denied. FINDINGS OF FACT 1. The Veteran had active duty from August 1964 to May 1966. 2. Hypertension has not been medically associated with a service connected disability. 3. Insomnia is part and parcel of the already service-connected posttraumatic stress disorder (PTSD); further, insomnia has not been medically associated with any other service connected disability. CONCLUSIONS OF LAW 1. Hypertension is not secondary to a service connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2020). 2. Insomnia is not secondary to a service connected disability. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In February 2018, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In 2019, the Board denied the claims. The Veteran appealed to the Veterans Claims Court. In August 2021, the Court Clerk remanded the claims. In January 2021, the Board remanded the claims for further development. These actions stem the basis for the current appeals. The Veteran contends that insomnia and hypertension were caused or aggravated by service-connected PTSD. As reflected in the August 2021 Joint Motion for Partial Remand, he does not assert, and the evidence does not show, that these disorders were incurred in service or that hypertension was presumptively incurred in service. Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The record reflects that the Veteran has been diagnosed with hypertension. Further, while he denied insomnia in a June 2020 clinical record, he was diagnosed with insomnia in 2010. In addition, he is service connected for PTSD. Therefore, the first two elements of secondary service connection, a current disorder and a service connected disability, are met. As to a nexus between hypertension and service-connected PTSD, in a March 2019 VA examination, the examiner opined that hypertension was not caused or aggravated by PTSD. She reasoned that hypertension and PTSD were separate entities. This evidence weighs against the claim. Further, in a May 2021 VA opinion, the clinician opined that hypertension was not caused or aggravated by service connected PTSD. He reasoned that hypertension was not caused by any other condition. Further, he explained that while current medical literature showed a possible association between hypertension and PTSD, it did not show cause or aggravation between the two. In addition, he explained that while anxiety may temporarily elevate one's blood pressure, it resolves following abatement of the stimulus. This evidence weighs against the claim. In sum, the medical evidence does not support that hypertension was caused or aggravated by PTSD or any other service connected disability. As to a nexus between insomnia and a service connected disability, in a December 2016 clinical record, the clinician diagnosed the Veteran with "insomnia due to a mental health condition." However, no rationale was provided. Further, in a June 2017 clinical record, the clinician diagnosed the Veteran with "insomnia due to pain." However, the clinician did not specify as to whether insomnia was caused or aggravated by service connected PTSD or any other service connected disability. In a May 2021 VA opinion, the clinician opined that insomnia was not caused or aggravated by service connected PTSD. She reasoned that insomnia was a symptom of the Veteran's PTSD with onset occurring prior to PTSD diagnosis in 2011. Further, she explained that professional literature supported that insomnia was one of the earlier symptoms of PTSD. Therefore, she concluded that insomnia is as likely as not subsumed in the already-diagnosed PTSD. A reasonable reading of this opinion is that insomnia is part and parcel of the already service-connected PTSD. The Board has the responsibility of weighing conflicting medical opinions and may place greater weight on one physician's opinion over another depending upon factors such as reasoning employed by the physicians and the extent to which they reviewed prior clinical records and other evidence. In this case, the Board assigns more probative weight to the VA opinion. The December 2016 clinician wrote that insomnia was due to a mental health condition but no rationale was provided. Further, the June 2017 clinician wrote that insomnia was due to pain but it was not specified as to whether the pain was from a service connected disability. Instead, the May 2021 clinician provided a detailed rationale for the opinion rendered. Therefore, the medical evidence weighs in favor of a finding that insomnia was not caused or aggravated by PTSD or any other service connected disability. In sum, hypertension and insomnia were not caused or aggravated by a service connected disability. The Board has considered the Veteran's assertions and testimony that hypertension and insomnia are related to a service connected disability. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to offer etiologies of these disorders. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ragofsky, 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.