Citation Nr: 21005343 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 14-42 750 DATE: February 1, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT Hypertension did not have its initial onset in service or within a year of service discharge; and, the preponderance of the evidence fails to establish that the Veteran’s diagnosed hypertension is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 501 (a), 1111, 1112; 38 C.F.R. § 3.303, 3.307, 3.309.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1979 to June 1982 and from January 1991 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural history, this matter was previously before the Board in May 2018 and August 2020, at which time the Board remanded the claim for additional development. In August 2020, the Board remanded for an addendum opinion by the VA examiner who provided the January 2019 VAX (VA examination) and medical opinion. There has been substantial compliance with the Board remand and this matter is ripe for adjudication. Entitlement to service connection for hypertension is denied. The Veteran asserts that his hypertension had its initial onset during his active military service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of 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). 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. See 38 C.F.R. § 3.303 (d). Elements of service connection may also be established by showing continuity of symptomatology under 38 C.F.R. § 3.303 (b). Continuity of symptomatology may be shown by demonstrating “(1) that a condition was ‘noted’ during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology.” Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson v. Shinseki, 581 F.3d 1316 ; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). However, the Federal Circuit held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309 (a), such as hypertension. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. See 38 C.F.R. § 3.303 (b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases (such as hypertension) become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. See 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Pertinent here, VA regulations provide that hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more. Hypertension must be confirmed by readings taken two or more times on three different days. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran was diagnosed with hypertension in October 2006. See October 2020 addendum opinion. The first element of Shedden is met. Regarding the second element of Shedden, in-service incurrence, service treatment records are negative for diagnosis or treatment of hypertension. The Veteran argues the contrary. He contends that February 27, 1981 was the onset of his hypertension, which corresponds with the date of a service treatment record (STR) that show the Veteran complained of chest pain and was assessed for possible cardiac involvement. As there is a record of this event, the Board finds that element two of Shedden has also been met. As to the third prong of Shedden, the Veteran has not provided a competent medical opinion to support his claim and the VA medical examiner provided a negative nexus opinion. A VA addendum opinion was provided in October 2020. The VA medical examiner found the Veteran’s hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA medical examiner provided the following supportive rationale: There was a cardiology evaluation while in service that made the diagnosis of atypical chest, which means there is no cardiovascular condition. There is no evidence of hypertension blood pressure readings while in service or evidence of treatment for hypertension. The Board finds this opinion to be highly probative, as it was based on a thorough review of the Veteran’s claim file and an adequate rationale was provided to support the conclusion. See Bloom v. West, 12 Vet. App. 185, 187 (1999). The medical opinion is afforded substantial probative weight. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 304 (2008). The treatment records support the VA examiner’s rationale. Blood pressure readings were the following: On February 5, 1979 was 142/68, on August 7, 1979 was 116/70, on August 9, 1979 was 134/80, on October 2, 1979 was 104/70 and 110/80, on October 3, 1979 was 140/86 and 126/66, on October 29, 1979 was 122/78, on October 30, 1979 was 110/90, on October 31, 1979 was 132/72 and 120/70, February 27, 1981 was 122/78, on March 10, 1984 was 108/70, on September 20, 1986 was 130/80, on September 29, 1990 was 118/80, on May 8, 1991 was 120/78, on August 17, 1991 was 120/70, and on February 26, 1994 was 125/80. Further, the February 27, 1981 consultation report that the Veteran references as the date of onset for his disability showed no cardiovascular condition. The examiner found that the pain was very probably musculoskeletal in origin, since the rest of the evaluation did not indicate cardiac origin. The EKG pattern was normal. His blood pressure was 122/78. The Board acknowledges that the Veteran himself has claimed that he suffers from hypertension either as directly related to his active service. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., high blood pressure readings; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Veteran's lay assertions of medical diagnosis or etiology cannot constitute evidence upon which to grant the claim for service connection, and the Board affords these statements little probative value. See Latham v. Brown, 7 Vet. App. 359, 365 (1995). Turning to another theory of entitlement. The hypertension diagnosis is outside the applicable 1-year presumptive period under 38 C.F.R. § 3.307 (a)(3). As to the second and third element of Shedden under 38 C.F.R. § 3.303 (b) continuity of symptomatology, the Veteran reported that he has been suffering from hypertension since active military service. See January 2019 VAX. This assertion is inconsistent with the evidence of record. The VA examiner reviewed and considered the blood pressure readings recorded in the STRs and determined that they do not support a diagnosis of hypertension. The Veteran has not demonstrated continuous treatment for hypertension. In fact, his initial treatment for hypertension was not until many years after service. Thus, continuity of symptomology has not been demonstrated. In sum, there is simply no evidence of a diagnosis of hypertension during service or one year after service. Continuity of symptomology has not been demonstrated. There is likewise insufficient medical evidence to establish an etiological link between the Veteran’s current hypertension and his period of active service. The Board is mindful that all reasonable doubt is to be resolved in the Veteran’s favor. However, the preponderance of the evidence is against the claim, and the claim must be denied. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Smith, 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.