Citation Nr: 21010377 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 13-09 096A DATE: February 24, 2021 ORDER Service connection for hypertension is denied.   FINDING OF FACT The Veteran’s hypertension did not have its onset during service and is not otherwise related, to include his exposure to Camp Lejeune contaminated water (CLCW) and his in-service use of prescription propoxyphene. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1984 to November 1988 and from February 1991 to March 1991, including service at Camp Lejeune. The case is on appeal from a July 2010 rating decision. In January 2017, the Board remanded the case for further development. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran, his representative 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). Service connection for hypertension. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). For veterans who are presumed to have been exposed to contaminants in the water supply while serving at Camp Lejeune for no less than 30 days from August 1, 1953, to December 31, 1987, VA has established a presumption of service connection for certain diseases. 38 C.F.R. § 3.307(a)(7), 3.309(f). Hypertension is not a listed disease encompassed by this regulation. However, where a presumption does not exist, VA is to consider whether service connection is warranted on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). Analysis The Veteran contends his hypertension is related to service, including his confirmed exposure to CLCW. Additionally, he asserts his hypertension is associated with the prescription medication propoxyphene he took during service for his migraines. The Veteran’s service treatment records (STRs) show that he had elevated blood pressure during service. His in-service blood pressure readings include a June 1985 record which shows blood pressure of 140/90; an August 1985 record which shows blood pressure of 140/90; a September 1985 record which shows blood pressure of 146/76; an August 1986 record which shows blood pressure of 122/88; a January 1987 record which shows blood pressure of 120/88; a December 1987 record which shows blood pressure of 110/60; a January 1988 record which shows blood pressure of 110/72; and the September 1988 separation examination which shows blood pressure of 122/76. Service personnel records (SPRs) show service at Camp Lejeune to presume the Veteran’s in-service exposure to CLCW. The Board finds the Veteran has a current diagnosis of hypertension. As early as August 2003, medical records show the Veteran was diagnosed with hypertension. Following his June 2010 claim, the Veteran submitted an April 2013 substantive appeal in which he indicated he was exposed to CLCW and that such exposure led to his hypertension. A November 2016 appellate brief was submitted by the Veteran’s representative which reported according to the Mayo Clinic, systolic pressure from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure from 80 to 89 mm HG is classified as prehypertension. He noted systolic pressure from 140 to 159 mm Hg or diastolic 90 to 99 mm Hg is classified as hypertension. The representative indicated the Veteran’s service treatment records demonstrated numerous prehypertensive and hypertensive blood pressure readings which suggests his hypertension had its onset during service. He further asserted remand was required by VA to provide a medical opinion to address the etiology of the Veteran’s hypertension. As noted, the claim was remanded by the Board in January 2017 for further development, including a VA examination to determine if the Veteran’s hypertension was causally related to service. A May 2020 VA opinion was provided in which the examiner opined the Veteran’s hypertension was not caused by or a result of his service, to include CLCW. The examiner noted the Veteran’s blood pressure readings in service were above normal; however, he stated there is no evidence to suggest an acute or temporal effect of CLCW on the Veteran’s blood pressure. He further stated there is no body of medical literature to support an association between CLCW and hypertension. The May 2020 VA physician indicated cardiovascular disease and valvular heart disease have not been demonstrated to be associated with organic solvents, such as those that were found in CLCW. He stated while medical literature does not support an association between cardiovascular disease and CLCW solvent exposure, there are other stronger factors which may have led to the Veteran’s hypertension. The examiner noted the Veteran’s strong family history of hypertensive cardiovascular disease, the vasoconstrictive effects of nicotine, hyperlipidemia and his history of heavy alcohol consumption are more likely causes for his hypertension. The examiner indicated nicotine is known to cause a reduction in the pliability of the peripheral arterial walls and multiple studies have demonstrated mechanisms by which excessive alcohol results in systolic hypertension. Moreover, he stated studies show a reduction in alcohol intake is effective in lowering blood pressure, both in hypertensives and normotensives and may help to prevent the development of hypertension. Therefore, he reported it is less likely than not that the Veteran’s CLCW exposure is the cause of his hypertensive cardiovascular disease. An additional VA examination report was submitted in October 2020 in which the examiner opined the Veteran’s hypertension is not related to service. He took note of the Veteran’s elevated blood pressure readings throughout his service treatment records, as well as his use of prescription propoxyphene. He indicated in the Veteran’s reported history during the examination, the Veteran reported his high blood pressure had its onset in 1998, seven years following his discharge from service. With regard to the Veteran’s in-service use of propoxyphene, the examiner reported he took this medication to treat his headaches and migraines. He stated review of Micromedex shows the side effects of propoxyphene include hypotension and decreased blood pressure, and not hypertension or increased blood pressure. As such, the examiner concluded the Veteran’s hypertension is not causally related to service, to include his use of propoxyphene during service. The Board determines the Veteran’s hypertension did not have its onset during service and is not causally related to service, to include his in-service exposure to CLCW and use of prescription propoxyphene. After review of the evidence, the Board finds the May 2020 and October 2020 medical opinions to be the most persuasive evidence of record. The VA examiners thoroughly reviewed the Veteran’s record, including his service treatment records, and based on this review and the relevant medical literature, they opined the Veteran’s hypertension is not etiologically related to service. The two examiners provided well-reasoned explanations with consideration of the relevant facts. They offered clear conclusions with supporting data, as well as well-reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (“[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). The Board notes there are no medical opinions of record linking the Veteran’s hypertension to service. The Board acknowledges the Veteran’s and his representative’s contentions, as well as the elevated blood pressure readings during service. However, as a layperson, the Veteran is not competent to provide an opinion pertaining to the complex medical issues present in this case. In this regard, the etiology of hypertension involves a medical subject concerning an internal process extending beyond an immediately observable cause-and-effect relationship and the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). As such, the lay evidence of record is afforded less probative weight than the May 2020 and October 2020 VA medical opinions. In sum, the Board determines the Veteran’s hypertension did not have its onset during service and is not otherwise related to service. The preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, service connection for hypertension is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.