Citation Nr: 21007125 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 17-43 312 DATE: February 8, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s hypertension began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1947 to December 1967. This matter is on appeal to the Board of Veterans’ Appeals (Board) from an April 2015 rating decision. A hearing was held by the undersigned Veterans Law Judge in June 2018. The claim was subsequently remanded in October 2018, February 2020, and December 2020. The Board finds the most recent December 2020 remand directives have been substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran has a current diagnosis of hypertension. He has consistently contended that he learned of his hypertension during his separation examination and was officially diagnosed and treated for his hypertension a few years later in 1972. In his NOD, he stated he was told his blood pressure was too high at his service retirement; he believed his reading to be at least 170/80. He began taking blood pressure medication shortly after leaving the military. In his June 2018 hearing, he explained that at his exit examination, he was told he had potential high blood pressure, and was told he could file a claim, which he did later that year. In June 2018 correspondence, the Veteran explained that he mailed a VA form in January 1968 informing VA that he had elevated blood pressure. In 1972, he received treatment at the Pensacola Naval Hospital for high blood pressure and has been on medication since that time. In June 2019 correspondence, the Veteran repeated these contentions and asserted it is unlikely his hypertension had its onset and became so severe in the short years between discharge in 1968 and 1972. The Veteran’s service treatment records (STRs) do not reflect any hypertensive blood pressure readings. In his May 1967 separation examination, his blood pressure was 124/74. There was no notation of hypertension, and the Veteran indicated “no” for high or low blood pressure. In a March 2015 VA examination, the examiner concluded it was less likely than not that the Veteran’s hypertension was related to service. The STRs did not support an onset in service, and the examiner remarked that isolated mildly elevated blood pressure is not the same as hypertension. She continued that essential hypertension has no clear cause and is thought to be linked to genetics or family history, poor diet, lack of exercise, etc. It does not have an apparent cause and most people have it. In an October 2017 letter, the Veteran’s treating physician, Dr. T, stated he had treated the Veteran for over 2 years. Dr. T reviewed the Veteran’s medical records and the Veteran provided him with a detailed history of his duties in the military. Dr. T stated the Veteran’s blood pressure started to become elevated during the end of his military career in the late 1960’s. By 1972 he was officially diagnosed with hypertension and he has been on medication since that time. Dr. T concluded that in his opinion, it is very likely that the Veteran’s time in the military caused, or at least contributed to many of his medical problems, including hypertension. The claim was remanded in October 2018 to obtain an addendum opinion regarding the conflicting etiology opinions between Dr. T and the March 2015 VA examiner, as well as to obtain treatment records post-service. In a September 2019 VA examination, the examiner stated “in consideration of presumption of soundness at time of Separation and Re-enlistment exam, no pertinent STR, normal pertinent Separation exam, no evidence that Veteran sought medical attention for his condition within a year after separation from active duty in 1967, and temporal relationships regarding onset of treatment for HTN in 1972, in my opinion, a nexus cannot be demonstrated.” As the above rationale did not address Dr. T’s opinion, the claim was again remanded for an addendum opinion in February 2020. In a July 2020 VA examination, the examiner concluded it was less likely than not that the Veteran’s hypertension was related to service. The examiner noted there was a normal separation examination, no STR documentation of the condition, and no evidence of diagnosis within a year of separation, but otherwise failed to provide a rationale for his conclusion. Thus, the claim was again remanded in December 2020. In a December 2020 addendum opinion, the July 2020 examiner expanded on his conclusion. Regarding Dr. T’s letter, the examiner stated it was reviewed and appreciated. However, while full of patient advocacy, it is devoid of any scientific grounds. There is no medical literature that supports Dr. T’s statement; thus, his personal opinion is relegated to speculation. The examiner further noted that while the Veteran is credible to report symptomatology, he is not qualified to make a medical diagnosis or medical nexus. Hypertension is a diagnosis with a known, though multifactorial, etiology, and is commonly of adult onset in the general population. As stated in medical literature, “the pathogenesis of [hypertension] is poorly understood but is most likely the result of numerous genetic and environmental factors that have multiple compounding effects on cardiovascular and renal structure and function.” The Board finds that the weight of the evidence is against the Veteran’s claim. The December 2020 opinion is particularly probative, as it contains a thorough review of the Veteran’s medical history and provides a clear rationale based on medical literature. Further, the examiner aptly opines that Dr. T’s opinion was not based on objective medical evidence or literature, but rather, speculation. For these reasons, the Board affords the December 2020 opinion more probative weight. See Willis v. Derwinski, 1 Vet. App. 66 (1991) (While the conclusions of a physician are medical conclusions that the Board cannot ignore or disregard, the Board is free to assess medical evidence and is not compelled to accept a physician’s opinion). The Board acknowledges that the Veteran is competent to testify as to his beliefs that his disabilities are related to service. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). In order for lay evidence to be competent, the individual must have personal knowledge, derived from his/her own senses, of what is being attested; “[c]ompetent testimony is thus limited to that which the witness has actually observed, and is within the realm of his personal knowledge.” Layno v. Brown, 6 Vet. App. 465, 471 (1994). Here, the Veteran is competent to attest to the timeline of his hypertension diagnosis based on his memory. The Board has considered his contentions that he was told he was hypertensive at his separation examination. However, the objective evidence is in direct contradiction to his contention. There was no notation of hypertension on the examination report; in fact, a normal blood pressure reading was notated, and it was expressly indicated there was no high blood pressure. Thus, the Board does not find this contention credible. Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996) (In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal consistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the Veteran). Regarding his contention that he filed an application for compensation for hypertension for VA in 1968, an application is indeed in the claims file. However, it did not specify what disability was being claimed. A letter was sent to the Veteran in January 1968 requesting clarification, and no response was received. Thus, while the Board acknowledges the Veteran’s contention that the claim was for hypertension, the lack of objective evidence supporting this contention coupled with the lack of indication of hypertension on his separation examination leads the Board to conclude that the Veteran’s testimony in this regard is not credible. Finally, the Board has considered the Veteran’s testimony that he believes his hypertension had its onset in service as it manifested only a few years after service. However, there is nothing in the record to suggest that the Veteran has the appropriate training, experience, or expertise to render a medical opinion regarding etiology of his hypertension. See 38 C.F.R. § 3.159 (a)(1) (setting forth that competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). While the Veteran is competent to report what he has experienced, he is not competent to ascertain the etiology of any current condition, as the causative factors for such are not readily subject to lay observation. See Layno, 6 Vet. App. 465; see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, his testimony is not afforded any weight in this regard. In conclusion, as the weight of the evidence is against his claim, the Veteran’s claim for service connection for hypertension must be denied. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Carroll, 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.