Citation Nr: 21011918 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 12-06 914 DATE: March 3, 2021 ORDER Service connection for hypertension, to include as secondary to service-connected diabetes, is denied. FINDING OF FACT The evidence fails to establish that the Veteran had hypertension that was caused or aggravated by his service-connected diabetes. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1966 to February 1968. He died in January 2015. The appellant is his surviving spouse and has been substituted as the appellant in this appeal. This appeal before the Board of Veterans’ Appeals (Board) arose from a July 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The procedural history of this case has been detailed in the prior actions in the appeal. Accordingly, the procedural history will only be repeated herein as necessary to explain the state of the issue currently before the Board. Most recently, in April 2020, the Board remanded the current matter for further development, to specially include obtaining an addendum medical opinion. Upon completion of the requested development, the agency of original jurisdiction (AOJ) issued a supplemental statement of the case (SSOC) in which it continued to deny the claim for service connection for hypertension, secondary to service-connected diabetes. The matter was thereafter returned to the Board for further appellate adjudication. Service Connection In the instance case, the Veteran was seeking service connection for hypertension. At the outset, the Board notes that the Veteran did not claim this disability as directly related to his military service. See 38 C.F.R. §§ 3.303, 3.304. Rather, it was the Veteran’s contention that hypertension was related to his diabetes. Indeed, in his March 2010 application for compensation, the Veteran stated that he was seeking service connection for “diabetes with secondary s/c for hypertension.” Accordingly, because the Veteran did not assert that his claimed hypertension is directly related to service and because the record similarly does not reasonably raise the theory of direct service connection, the Board will address only whether the Veteran was entitled to service connection for hypertension on a secondary basis. See Robinson v. Mansfield, 21 Vet. App. 545, 552-56 (2008)), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed.Cir.2009). A disability may be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. Regarding whether service connection is warranted as secondary to service-connected diabetes, the Veteran was afforded a VA diabetes examination in June 2010. A review of the examination report indicates that diabetes was diagnosed in March 2010 and that hypertension was diagnosed six to ten years prior. Regarding potential complications of diabetes, the examiner stated specifically that hypertension was not a complication of the Veteran’s diabetes, noting that the onset of hypertension pre-dated the Veteran’s diabetes diagnosis. The examiner also stated that the Veteran’s hypertension had not been worsened by his diabetes, but provided no supportive reasoning. The Veteran was then provided a VA hypertension examination in January 2012. A review of the examination report reveals that the Veteran’s hypertension, indicated to have been diagnosed in 2000, was controlled with continuous use of medication. Regarding a relationship between the Veteran’s hypertension and his diabetes, the examiner similarly noted that the hypertension diagnosis preceded the diagnosis of diabetes. The examiner further stated that diabetes does not cause hypertension in the absence of renal disease. (Parenthetically, the Board notes that renal dysfunction caused by diabetes was not indicated at the time of a VA diabetes examination, also conducted in January 2012.) The examiner did not, however, address whether the Veteran’s hypertension had worsened due to his diabetes. In May 2020, in response to the Board’s April 2020 remand directives, the AOJ obtained an addendum medical opinion specifically addressing the likelihood that the Veteran’s hypertension had been aggravated by his service-connected diabetes. Upon review of the record, the VA clinician opined that it is less likely than not that the Veteran’s service-connected diabetes had aggravated his hypertension. As rationale for that opinion, the VA clinician noted that at the time the Veteran was last examiner, his systolic blood pressure readings ranged from 110s to 130s and his diastolic blood pressure readings were in the 80s. The clinician further pointed out that the Veteran was on only a single antihypertensive medication. The clinician stated that these blood pressure readings and prescribed course of medication falls withing the projected national history of the condition and does not represent aggravation beyond the natural progression of the disease. Given the negative VA opinions regarding causation and aggravation, which opinions are uncontradicted by other medical opinion evidence of record, the Board finds that service connection for a hypertension on a secondary basis must be denied. Reviewing the June 2010, January 2012, and May 2020 VA medical opinions, the Board does not find that the opining clinicians failed to consider any of relevant evidence before providing the requested opinions regarding causation and aggravation. Further, the Board finds that the opinions are supported by adequate rationale, in that the June and January 2012 clinicians discussed that the Veteran’s hypertension pre-dated his diabetes diagnosis; the January 2012 clinician also explained that diabetes does not cause hypertension in the absence of renal disease, which the Veteran is not noted to have. Additionally, the May 2020 VA clinician explained why the medical evidence does not support a finding that hypertension was aggravated by the Veteran’s service-connected diabetes. As such, the Board accepts the June 2010, January 2012, and May 2020 VA medical opinions as probative of the medical nexus questions regarding secondary service connection (causation and aggravation). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Board also points out that other than simply advancing simply his belief that his hypertension was secondary to his diabetes, the Veteran submitted no evidence, to include any lay evidence/argument, in support of his claim. As such, there is no evidence to weigh against the VA clinicians’ opinions. (Continued on the next page)   Accordingly, in light of the VA clinicians’ opinions, there is no basis upon which to establish service connection for hypertension as secondary to service-connected diabetes, as the evidence of record simply does not support a finding that the Veteran’s hypertension was caused or aggravated by his service-connected diabetes. See Allen, supra; 38 C.F.R. § 3.310. In finding that service connection for the above disability is not warranted, the Board has considered the benefit-of-the-doubt doctrine, but finds that the record does not provide an approximate balance of negative and positive evidence on the merits. The Board is unable to identify a basis for granting service connection under the theory advanced by the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). Timothy Berryman Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Neilson, 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.