Citation Nr: A21020159 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 200527-88608 DATE: December 17, 2021 ORDER Entitlement to service connection for hypertension, claimed as high blood pressure, is denied. FINDINGS OF FACT 1. A preponderance of the evidence of record does not show that the Veteran had a diagnosis of hypertension in service or at service separation. 2. A preponderance of the evidence of record is against a finding that the Veteran's hypertension manifested to a compensable degree within one year of separation from active-duty service or is otherwise etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, claimed as high blood pressure, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Navy from November 1988 to November 1991. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In his May 2020 substantive appeal, the Veteran indicated, "Direct Review by a Veterans Law Judge: I do not want a Board hearing and will not submit any additional evidence in support of my appeal." See May 2020 VA Form 10182, Notice of Disagreement. The matter is now before the Board for consideration. In general, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish entitlement to service connection, there must be: (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. See generally 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. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Presumptive service connection can satisfy the requirements of an in-service event and a nexus to military service. Chronic diseases listed under 38 C.F.R. § 3.309(a)-(f) that manifest either during active service or subject to the requirements of 38 C.F.R. § 3.307 after discharge or release from military service are sufficient to establish in-service incurrence or aggravation. If a chronic disease enumerated in 38 C.F.R. § 3.309 does not manifest in-service or within the applicable time limits, the second and third elements of service connection may be granted based on continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The United States Court of Appeals for the Federal Circuit (Fed Circuit) clarified that the law providing for awards of service connection on the basis of continuity of symptomatology is limited to those "chronic" diseases listed under 38 C.F.R. § 3.309(a). See Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. The Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). While the Veteran is competent to provide a diagnosis of an observable condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of mental health or musculoskeletal diseases. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Although the credibility of lay evidence may not be refuted solely by the absence of corroborating medical evidence, it is a factor. See Buchanan, supra (lay evidence concerning continuity of symptoms after service, if credible, may be competent, regardless of the lack of contemporaneous medical evidence). Other factors are the lapse of time in recollecting events attested to, prior conflicting statements as opposed to consistency with other statements and evidence, internal consistency, facial plausibility, bias, interest, the length of time between alleged incurrence of disability and the earliest or first corroborating medical or lay evidence thereof, and statements given during treatment (which are usually given greater probative weight, particularly if close in time to the onset thereof). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). A Veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the Veteran). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See Gilbert, supra.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Board has thoroughly reviewed the record in conjunction with this case. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that "absent specific evidence indicating otherwise," VA is presumed to have reviewed all evidence in the record when making a determination.). Although the Board has an obligation to provide adequate reasons and bases for its decisions, there is no need to discuss, in detail, the entire body of evidence. See Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (holding that the Board is not required to discuss all of the evidence of record but rather it must address the relevant evidence.); see also Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). To that end, the Board's analysis will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). Any failure by the Board to mention evidence in its decision does not trigger a presumption that it was not considered. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007). The Veteran contends that his hypertension is the result of his military service. See January 2020 VA Form 21-526EZ, Application for Disability Compensation and May 2020 VA Form 10182, Notice of Disagreement. The Veteran has a diagnosis of hypertension. See February 2020 VA Hypertension examination report. The first element of service connection is satisfied. Unfortunately, a preponderance of the evidence is against a finding of elements two and three, an in-service event and a nexus to service. Service treatment records do not show that the Veteran had a diagnosis of hypertension in service. Meaning, these records do not reflect clinical findings of diastolic blood pressure readings manifested as predominantly 90 mm or greater, systolic blood pressure readings manifested as predominantly 160 mm or greater, or diastolic pressure predominantly 100 mm or more, requiring continuous medication for control while in service. Specifically, the documented history of the Veteran's blood pressure readings taken during service include 130/74mm at the October 1988 Report of Medical Examination report; 110/70mm in the April 1989 Chronological Record of Medical Care record; 100 / 68 in the July 1989 Chronological Record of Medical Care record; 110 / 70 in the September 1989 Chronological Record of Medical Care record; 100 / 60 in the 1989 Chronological Record of Medical Care record; 110 / 78 in the December 1989 Chronological Record of Medical Care record; 110 / 82 in the May 1991 Chronological Record of Medical Care record; 100 / 70 in the July 1991 Chronological Record of Medical Care; 98 / 60 in October 1991 Chronological Record of Medical Care record; and 110 / 80 in the December 1991 Chronological Record of Medical Care record. The Veteran also denied having high blood pressure on five occasions during service. See November 1988 Dental Health Questionnaire, September 1990 Chronological Record of Medical Care, January 1991 Dental Health Questionnaire, December 1991 Report of Medical History, and December 1991 Dental Health Questionnaire. The Veteran was provided with a VA medical examination in February 2020. The examining physician reviewed the claims file and evidence of record in preparation for his report. The Veteran was examined in person, and his statements were considered, including a report by the Veteran that he was diagnosed with high blood pressure in 2017, which continues to be treated with Losartan. A history of blood pressure readings taken for the Veteran did not include diastolic measurements predominantly 100 or more. Blood pressure readings taken at the VA examination were as follows: 130 / 90, 134 / 88, and 136 / 90. The Veteran reported no functional impact on his ability to work due to high blood pressure. See February 2020 VA Hypertension examination report. Regarding direct service connection, the examining physician concluded: "The claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." In formulating his opinion, the examining physician stated: "According to the history taken and he entry examination performed, he had no history of hypertension, and his pressure was normal on entry examination. No elevated blood pressure readings were found during his military service." See February 2020 VA Hypertension examination report. The Board acknowledges the Veteran's lay assertions that he believes his current hypertension condition is the result of active-duty service. The Veteran is not shown to have medical education or experience. He is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition, as these are medically complex issues. A conclusory, generalized lay statement that military service caused his current hypertension condition is insufficient to prove service connection. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. The February 2020 report from the VA examiner is the most probative evidence of record on the question of entitlement to service connection. The opinion was based on an extensive review of all the evidence, including lay statements from the Veteran, was supported by a detailed rationale, provided data to support any conclusions, and provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodrigues v. Peake, 22 Vet. App. 295 (2008). The February 2020 VA examiner opinion is consistent with the evidence of record, including service treatment records, VA and private treatment records, and the Veteran's lay statement of a 2017 hypertension diagnosis, more than 15 years after service separation. The VA examiner opinion provides compelling evidence against the Veteran's claim for service connection. There is no competent, credible evidence to refute the February 2020 VA examiner opinion. Finally, the Veteran's diagnosis of hypertension is not included on the list of chronic diseases enumerated in 38 C.F.R. § 3.309(a). Continuity of symptomatology is required under 38 C.F.R. § 3.303(b), "where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned." The only evidence of continuity of symptomatology in the record comes from the Veteran. See January 2020 VA Form 21-526EZ, Application for Disability Compensation and May 2020 VA Form 10182, Notice of Disagreement. The first recorded diagnosis of hypertension is a February 2020 report from the Veteran, nearly 30 years after service. See February 2020 VA Hypertension examination report. The Veteran does not meet the requirements for presumptive service connection, either by diagnosis in-service, evidenced by a lack of the required, predominant blood pressure readings, within the prescribed time limits after service, also evidenced by the lack of the required, predominant blood pressure readings, or through continuity of symptomatology, evidenced by a lack of medical documentation in the record for a diagnosis of hypertension until at least 2017, raising a legitimate question of chronicity. Therefore, he is not entitled to the presumption of an in-service incurrence, aggravation in-service, or nexus to service. See 38 C.F.R. §§ 3.303, 3.307, and 3.309. In summary, a clear preponderance of the evidence of record indicates the Veteran does not meet the relevant diagnostic criteria under 38 C.F.R. § 4.104, DC 7101, for service connection of hypertension. The Board has considered the statements of the Veteran. However, the Board assigns more probative weight to the contemporaneous medical evidence, including service treatment records, private and VA treatment records, and the VA medical examination. In addition to the lack of in-service complaints, medical examinations and self-reports were negative for vascular conditions while in-service. Treatment records document the onset of hypertension in 2017, as reported by the Veteran, more than 25 years after service. As such, the weight of the probative evidence of record is against a finding that the Veteran is entitled to service connection for hypertension, and the requirements for presumptive service connection are not met. Consequently, service connection for hypertension is not warranted, and the claim for service connection must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Small, Attorney Advisor 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.