Citation Nr: 21069077 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 15-11 822 DATE: November 17, 2021 ORDER Entitlement for service connection for hypertension is granted. FINDING OF FACT The Veteran's hypertension was incurred during his period of ACDUTRA from July 1994 to September 1998. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for hypertension are met.38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1987 to November 1990 and from October 2004 to May 2009. The Veteran also served on active duty special work (ADSW), which is a form of active duty for training (ACDUTRA), from July 1994 to September 1998. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In July 2018, the Veteran testified at a Travel Board hearing before the undersigned. A transcript of the hearing is of record. Entitlement for service connection for hypertension The Veteran has asserted that his hypertension arose during his period of ADSW. During his 2018 Board hearing, the Veteran stated that it first was found while he was serving in California in 1997 or 1998. See Hearing Transcript, p.3. The Veteran stated that he was referred to a primary care doctor and that he was started on medication for hypertension at that time. 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 nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c)(1). ACDUTRA is not defined as "active" service unless the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). A claimant whose claim is based on a period of ACDUTRA or inactive duty for training (INACDUTRA) cannot be entitled to the presumption of service connection for various diseases. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010); see also 38 U.S.C. §§ 101 (24)(B), 1112, 1137; 38 C.F.R. §§ 3.6 (a), 3.307(a). Accordingly, the Board notes that to the extent that the Veteran would argue that presumptive service connection for hypertension is warranted due to onset of a chronic condition during service, presumptive service connection is not available when the chronic condition had onset during a period of ACDUTRA. If the Veteran is shown to have had a disability due to an injury (or disease) that was incurred during his period of ACDUTRA, then service connection can still be granted for the disability on a direct basis. See 38 C.F.R. § 3.6 (a); Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). The Veteran's service treatment records (STR) document that the Veteran was reported to have blood pressure readings of 128/88 in March 3, 1995, 140/92 on September 5, 1996, and 140/92 on September 13, 1996. In September 2002, the Veteran was documented to have a history of hypertension and was taking medication for this condition. In May 2012, he was given a VA examination regarding his claim for service connection for hypertension. The VA examiner noted that the Veteran's hypertension was diagnosed in service but did not provide an opinion regarding the etiology of the Veteran's condition. In January 2013, the Veteran provided statements indicating that his hypertension was originally diagnosed while he was serving in California between 1995 and 1996. He stated that he was treating with a private physician at that time and that the records have been destroyed. In April 2013, the May 2012 examiner opined, after review of the record and the Veteran's verbal history, that the Veteran's hypertension was at least as likely as not incurred in or caused by service. In February 2020, a VA examiner provided an opinion that the Veteran's hypertension began during a period of active service or ACDUTRA and has continued to the present. The examiner noted that there is a pattern of chronicity of the problem beginning in the service, persisting to the present. The examiner explained that there was a pattern of evaluation and treatment in the service and noted the Veteran's reports that he did not have hypertension prior to the service (and that there were no records that indicate that he did.) Further, the examiner noted that there were multiple blood pressure readings during active duty indicating hypertension. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. After review of the evidence of record, the Board finds that the evidence is at least in equipoise regarding whether the Veteran's hypertension had onset during his period of ACDUTRA from July 1994 to September 1998. The Board finds probative the Veteran's statements that his hypertension had onset between 1995 and 1998. See January 2013 C&P Examination and 2018 Hearing Testimony. The Board also finds probative the opinions of the April 2013 and February 2020 VA examiners that the Veteran's hypertension had onset during service. Particularly, the February 2020 examiner opined that that the Veteran's hypertension at least as likely as not was incurred during a period of active duty, ACDUTRA, or INACDUTRA and has continued to the present. The examiner provided a thorough rationale that is supported by the evidence of record, including consideration of the lay statements provided by the Veteran, available medical records, and a physical examination of the Veteran. The examiner noted that there is no medical documentation of hypertension prior to the ACDUTRA period reported by the Veteran and that he has been prescribed medication since at least 2002. Further, the examiner noted several instances during this period of elevated blood pressure readings. See blood pressure readings from March 1995 and September 1996. As such, the Board finds the March 2020 medical opinion to be highly probative evidence weighing in support of a connection between the Veteran's current hypertension and its incurrence during his period of ACDUTRA from July 1994 to September 1998. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As the medical evidence of record supporting an etiological relationship between the Veteran's hypertension and his period of ACDUTRA from July 1994 to September 1998 is not contradicted by any competent medical evidence of record, the Board finds that the Veteran's hypertension was incurred during this period and has persisted since that time. Accordingly, the Board finds that the evidence is at least in equipoise regarding whether the Veteran's current hypertension was incurred during his period of ACDUTRA from July 1994 to September 1998, and service connection for hypertension is warranted on a direct basis. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.M. Johnson, 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.