Citation Nr: 21071033 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-51 167 DATE: November 29, 2021 ORDER Entitlement to service connection for hypertension as secondary to service-connected migraine headaches is denied. FINDING OF FACT The Veteran's currently diagnosed hypertension is not proximately due to, or aggravated by, the service-connected migraine headaches. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension as secondary to service-connected migraine headaches have not been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1970 to June 1972. This matter came before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. Preliminary Matters The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service connection for hypertension as secondary to service-connected migraine headaches 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). 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). 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). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a) (2020). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (b) (2020); Allen v. Brown, 8 Vet. App. 374 (1995). The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. As to lay evidence, a layperson is competent to describe symptoms and readily observable disorders but does not have the education, training or expertise to formulate a competent medical opinion linking matters which are of a complex medical nature and beyond the ken laypersons and which cannot diagnosed based on observation or analysis of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372 (2007); see also Davidson v. Shinseki, 581 F.3d 1313, 1316. The Court has held that "generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). Medical treatise evidence may indicate enough of a basis of a generic relationship to establish "a plausible causality based on objective facts." Mattern, 12 Vet. App. at 228 (citing Wallin v. West, 11 Vet. App. 509, 514 (1998)). A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give an appellant the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107(b)). The Veteran in this case asserts that his hypertension is secondary to his service-connected migraine headaches. See VA 21-526b, Supplemental Claim Application, received July 2013; VA 21-4128, Statement in Support of Claim, received March 2014; NOD correspondence, received March 2014. This secondary theory of service connection is the Veteran's sole contention as the Veteran does not contend, and the evidence does not show, that his hypertension began during service or is otherwise etiologically related to it. The Veteran has a current diagnosis of hypertension, with a history dating back to 1995. See, e.g., VA CAPRI, History and Physical Note, dated April 27, 2008. Moreover, service connection for migraine headaches is currently in effect. The issue then becomes whether there is competent evidence of a nexus between the diagnosed hypertension and the service-connected migraine headaches. Evidence in support of the claim includes the Veteran's assertions regarding the etiology of his hypertension. The Veteran also submitted a medical reference that purports to show a relationship between hypertension and headaches. See March 2014 Correspondence. Evidence weighing against the claim includes an August 2017 VA medical opinion which concludes that the Veteran's hypertension is less likely than not related to service-connected migraine headaches. This opinion was based on a review of the Veteran's claims file and treatment records. The examiner explained that the Veteran has had two types of headaches over the years, tension headaches and migraine headaches, and may also have had drug-induced headaches. The examiner noted that the Veteran has also provided conflicting history regarding whether he had chronic headaches since service which suggests that he may not have accurate recall of remote historical information. The examiner reasoned that the Veteran has several risk factors for developing hypertension, which include tobacco use, being overweight and sedentary, and a family history of hypertension. The examiner also stated that medical literature shows that headaches are not a risk factor for the development of hypertension. The examiner also addressed the reference submitted by the Veteran which stated that "high blood pressure can cause headache" and stated that the reference did not report a causative relationship between headaches and the onset of hypertension. The examiner further cited to several medical articles that supported the provided rationale. Additionally, the examiner opined that the Veteran's hypertension was less likely than not worsened beyond its normal progression by his service-connected headaches. The examiner referenced the Veteran's two types of headaches over time and found no significant worsening in the Veteran's blood pressure which was attributable to changes in the headache symptoms and their severity. The examiner noted that the Veteran was on one more medication for control now. However, the examiner found that it was more likely than not that his numerous risk factors, which included increasing age, continued tobacco use, diabetes mellitus, chronic kidney disease, obesity, obstructive sleep apnea, unhealthy diet, and sporadic medication noncompliance, contributed to his problems with blood pressure control. The Board finds the August 2017 VA medical opinion to be competent, credible, and probative. It was authored by a licensed medical profession who has demonstrated her competence through education, training, and experience to offer a medical opinion. The medical professional reviewed the Veteran's claims file and treatment records and was familiar with the Veteran's symptoms, diagnoses and treatment of his hypertension and headaches. Moreover, the opinion contains clear conclusions with supporting data connected by a reasoned medical explanation. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, the Board finds the VA medical opinion highly probative, competent, and persuasive medical evidence in this case. Notably, there are no medical opinions of record that contradict the August 2017 opinion. Additionally, the medical reference from the National Headache Foundation cited by the Veteran does not suggest that headaches cause hypertension; rather, the reference suggests that hypertension or medication taken for hypertension can cause headaches. At any rate, the medical reference is of little probative value here because no medical expert has related this Veteran's hypertension to his headaches. A general medical reference citing relationships between disorders is of much less probative value than the specific examination findings and diagnostic assessments of record in this case that show no evidence of the claimed nexus. The Veteran reports daily headaches and he is competent to do so. He is also competent to report what his blood pressure monitor reads when he tests his blood pressure. Nonetheless, his statements relating his hypertension to his service-connected headaches, are not deemed competent because he, as a lay person is not been shown to possess the requisite medical training to provide a medical opinion, such as determining the etiology of hypertension. Jandreau v. Nicholson, 492 F.3d at 1376, 1377, n. 4 (Fed. Cir. 2007). The Board finds that the VA examiner's probative medical opinion outweighs the lay assertions in this case. The Board acknowledges the Veteran's hearing testimony that a medical doctor said his hypertension is elevated when he experiences a headache. In this regard, lay evidence can be competent and sufficient to establish a diagnosis where the layperson is competent to identify the medical condition, is reporting a contemporaneous medical diagnosis, or describes symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, this does not mean that in adjudicating a claim that a layperson's statements of what he or she was told by medical personnel must be blindly accepted as true. While the holding in Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) that "the connection between what a physician said and the layman's account of what he purportedly said, filtered as it [is] through a layman's sensibilities, is simply too attenuated and inherently unreliable to constitute 'medical' evidence" is no longer binding in light of the holding in Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) and Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), the reasoning in Washington, Id. at 368, is persuasive particularly in circumstances in which the layperson is reciting matters of a complex medical nature which was reportedly told to him or her many years earlier. See also Smith v. Derwinski, 2 Vet. App. 137, 140 (1992) (VA "is not required to accept every bald assertion [] as to service connection or aggravation of a disability."). The Board also notes the many logs submitted by the Veteran showing his blood pressure readings during the appeal. However, blood pressure readings alone are not sufficient to relate his hypertension to his headaches. Moreover, as to the question of aggravation, the Board reiterates that while the Veteran now takes more anti-hypertensive medication, the August 2017 VA examiner attributed the increase in medication to the Veteran's many risk factors as cited above, including sporadic noncompliance of medication, and not to his headaches. In sum, the weight of the competent and credible evidence of record demonstrates no etiological relationship between the current hypertension and a service-connected disability. For these reasons, the Board finds that a preponderance of the evidence is against the claim and the appeal must be denied. Because the preponderance of the evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107, 38 C.F.R. § 3.102. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beach, Julia M. 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.