Citation Nr: 21067142 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-22 462 DATE: November 3, 2021 ORDER Service connection for hypertension is denied. FINDING OF FACT The Veteran's hypertension did not have it onset in service, did not manifest within one year of service, was not caused by in-service event, injury, disease, nor was it caused or aggravated by any service-connected disability. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from December 1986 to August 1995, including service in the Persian Gulf from April 1993 to July 1993. The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge in March 2018. In February 2019, the Board remanded this issue for additional development. After a November 2019 Board decision denied the issue of entitlement to service connection for hypertension, the Veteran appealed the decision to the Court of Appeals for Veterans Claims (CAVC). In the December 2020 partial joint motion for remand, the parties determined that the Board, in making its decision, erred by not providing an adequate statement of reasons or bases for its determination. However, the Veteran, through his attorney, proffered that the limitation caused by his service-connected disabilities caused or contributed to his weight gain and therefore his hypertension. See January 2021 Appellate Brief. VA has determined that obesity may be an intermediate step between a service-connected on a secondary basis under 38C.F.R. §3.310(a). In April 2021, the Board remanded this matter for compliance with the Court's December 2020 order granting the parties' partial joint motion to remand. Service Connection Service connection may be established for a disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of 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) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. § 3.310). Entitlement to service connection for hypertension. The Veteran seeks service connection for hypertension which he asserts is due to his service-connected disabilities. See May 2018 VA Form 21-4138, Statement in Support of Claim. Specifically, the Veteran asserts that his service-connected disabilities caused or contributed to his weight gain and therefore his hypertension. See January 2021 Appellate Brief. The Board finds that the most probative evidence of record weighs against the claim. The Veteran's treatment records show treatment and diagnosis of hypertension. See May 2021 Hypertension DBQ; see also September 2018 Hypertension C&P Examination. In April 2021, the Board remanded this issue for a VA examination. A VA opinion was provided in May 2021. The May 2021 VA examiner opined that it is less likely than not that the Veteran's hypertension was proximately due to or the result of the Veteran's service-connected conditions. The VA examiner acknowledged the Veteran's history of hypertension. The examiner noted that in the Veteran's medical history, he was noted to be a non- smoker; however, he admitted to using chewing tobacco in his medical report. The examiner noted that the Veteran's weight was normal in service and that the Veteran's slight blood pressure elevations in his file were an intermittent problem. The examiner further noted that the Veteran had several visits for different types of pain with normal blood pressure recorded, indicating the elevated readings were intermittent but independent of pain or stress. In September 2018 medical opinion, it was noted that the Veteran was treated for alcohol dependence in service and the May 2021 VA examiner reasoned that this is most likely the cause of the of the Veteran's elevated blood pressure in service. The examiner reasoned that the Veteran's weight gain later in life played a role in his continued hypertension. Regarding secondary service connection, the VA examiner reasoned that the Veteran's service-connected obstructive sleep apnea (OSA) has been shown to be an independent risk for hypertension, but in the Veteran's case, the hypertension began intermittently before 1995 and was also diagnosed and treated in 2006, well before the Veteran's sleep apnea was diagnosed and treated which signifies these two conditions are separate issues. Further, he opined that the Veteran's hypertension is most likely the result of the alcohol dependence. She added, the Veteran's hypertension was not severe or consistent or consistent enough to treat until 2006, making it unlikely that his OSA (which had its onset in 1995) aggravated it beyond normal progression Regarding the Veteran's service-connected anxiety disorder, the examiner acknowledged that anxiety could lead to elevated blood pressure but that the Veteran was not diagnosed with anxiety disorder until 2018, which was well after his 2006 diagnosis of hypertension. The May 2021 VA examiner addressed the Veteran's hypertension was independent of pain in service and was therefore not related to his service-connected knee disabilities. The Veteran's had elevated blood pressure prior to the onset of his knee pain and no significant increase on or after 1997. The examiner noted that there is no literature to suggest GERD or tinnitus can increase or aggravate hypertension. The examiner reasoned that while anxiety issues can lead to elevated blood pressure, the Veteran was nor diagnosed with unspecified adjustment disorder in 2018, well after the 2006 diagnosis of hypertension. Regarding the Veteran's right knee and left replacements, the examiner reasoned that the Veteran's hypertension was independent of pain in service. She reasoned that hypertension could cause esophageal stricture and tinnitus and not the other way around. The examiner acknowledged the medication, such as Sudafed, used to treat sinus congestion related to his service-connected allergic rhinitis can raise blood pressure, the Veteran reported he rarely took these medications. The examiner also reasoned that concerning his service-connected tension headaches, the Veteran's elevated blood pressure started before the onset of his tension headaches. She noted that the hypertension associated with headaches he experienced in 2006 and beyond were located on the superior of the head and different that his service-connected tension headaches. See May 2021 Medical Opinion. Additionally, the examiner reasoned that the Veteran's remaining service-connected disabilities did not cause his diagnosed hypertension. She reasoned that the literature suggests that hypertension can cause tinnitus but not vice versa. The examiner also reasoned that hypertension could cause esophageal stricture but not the other way around. The VA examiner acknowledged the Veteran's service-connected scars but noted that none of the pain was causative of hypertension. See May 2021 Medical Opinion DBQ. Finally, the May 2021 examiner reasoned that the Veteran's service-connected back condition was independent of the Veteran's blood pressure in service. She reasoned that it is unlikely that the Veteran's pain caused his blood pressure to worsen beyond its normal progression to require full treatment finally in 2006. The onset of the Veteran's back strain was 1987. The Veteran had elevated blood pressure prior to this and some normal readings around the onset, showing it was an independent issue. She added, the Veteran does "live in pain" but reasoned that the Veteran's blood pressure was independent of any pain in service as he had visits involving pain but normal blood pressure. She further reasoned that the Veteran's blood pressure was seen as enough of an issue to treat headaches in the superior head in 2006, when he was 41 years old. Anything at or under the age of 55 is considered early onset hypertension. She stated, over half of adults over the age of 20 have elevated or high blood pressure, making it a common problem. She reasoned that when someone has early onset hypertension, secondary hypertension is ruled out. The examiner stated that causes of secondary hypertension vary but one of them is excessive alcohol intake. The Veteran had no other possible causes such as diabetes, hyperthyroidism or renovascular disease. According to the file, the Veteran stopped drinking in 2011. She reasoned that a possible explanation that the Veteran is still has stage 2 hypertension is that he has high cholesterol and has been treated with prescription medication since 2014. She concluded that it is less likely than not that the Veteran's service-connected conditions aggravated the Veteran's hypertension beyond its natural progression. In addition, the examiner noted limited limitations are present but opined that they did not cause the Veteran's hypertension. She reasoned, the Veteran has some mobility limitations due to past musculoskeletal injuries and while these may have caused him to gain weight over the years, he has another causative risk factor for hypertension that include past excessive drinking and aggravating risk factors of hyperlipidemia, or high cholesterol. Id. The Board acknowledges that the Veteran's service treatment records show the Veteran had elevated blood pressure readings of 120/82 (December 1986), 110/60 (January 1988), 110/70 (March 1989), 132/82 (November 1989), 130/50 (December 1989), 120/ 80 March 1991), 104/82 (June 1991), 128/60 (October 1992) and 137/62 (March 1995). Moreover, during the course of his appeal the Veteran stated that he was told by medical staff in service that his blood pressure readings were high and was asked on multiple occasions if he had high blood pressure to which he responded no because he had not been diagnosed at that time. The Veteran was diagnosed with hypertension in November 2006. The Board observes that the medical evidence does not suggest that the Veteran's hypertension is related to his period of active service or the result of a service-connected condition. The preponderance of the evidence shows that the Veteran's hypertension began after his period of service and was not caused by any incident of service. Service treatment records are negative for complaints, treatment or diagnosis of hypertension. The Veteran's hypertension was neither incurred in nor aggravated by service or a service-connected disability. The Board finds that as a lay person, the Veteran lacks the requisite education, training, and experience needed to self-diagnose hypertension or render an opinion as to its etiology. The Veteran, however, is competent to speak on matters such as symptoms for which he was able to discern through his five senses, as well as report what he was told in service about hypertension as well as whether he was diagnosed as having hypertension or having seen or been told about elevated blood pressure readings. See Davidson v. Shinseki, 581 F.3d 1313 (2009); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Further, his reports of irregularity in his blood pressure after service were not sufficient to render an opinion etiologically linking the condition to service. Accordingly, the most probative evidence of record addressing whether the Veteran's hypertension is related to or had its onset in service or was caused or aggravated by his service-connected disabilities, is the May 2021 VA examiner's opinion. That examiner took into consideration the Veteran's history and his report of a weight gain due to his service-connected disabilities. As a finder of fact, the Board concludes that after a careful review of the lay and medical evidence of record, the preponderance of the evidence is against the claim for service connection for hypertension; there is no doubt to be resolved and service connection for hypertension is denied. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jacquelynn M. Jordan, 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.