Citation Nr: 21013296 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 15-16 399 DATE: March 9, 2021 ORDER Service connection for hypertension is denied. FINDING OF FACT The Veteran’s hypertension is not secondary to service-connected lumbar spine degenerative disc disease and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for hypertension due to service or service-connected lumbar spine degenerative disc disease are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the United States Army from March 1976 to August 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Board remanded this matter for further development. The Veteran attended a videoconference hearing before the undersigned in January 2019. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection for a disability, a Veteran must show: (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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be granted for a disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. During the pendency of the Veteran’s claim, VA’s Office of General Counsel (OGC) issued an opinion which, in part, stated that obesity may serve as an “intermediate step” between a service-connected disability and a current disability. See VAOPGCPREC 1-2017. The test for making that determination is 1) whether a service-connected disability caused a veteran to become obese; 2) if so, whether the resulting obesity was a substantial factor in causing the current disability being claimed; and 3) whether the current disability would not have occurred but for the obesity caused by the service-connected disability. The second prong, stated differently, asks whether there is a medical theory causally connecting the obesity to the current disability. The third prong, stated differently, asks whether the current disability would have developed the same way if obesity was absent. See Shyface v. Sec’y of Health and Human Svs., 165 F.3d 1344 (Fed. Cir. 1999) (discussing “substantial factor” and “but for” causation). The Veteran contends that his hypertension is due to his service-connected lumbar spine degenerative disc disease. For the following reasons, the Board disagrees and finds that service connection is not warranted. The Veteran has a current diagnosis of hypertension, and thus satisfies the first element of service connection. There is no evidence of in-service incurrence of hypertension or an in-service disease or injury that would cause hypertension. In a February 2012 statement, the Veteran stated that he was treated for hypertension in-service and that his diastolic rate was at or near 100. A review of the Veteran’s service treatment records does not support this statement. There is no evidence of treatment for hypertension and the Veteran’s diastolic rate never reached 100, with its highest being at 80. As such, the Board finds that the second element for direct service-connection is not met. However, this does not foreclose service-connection for the Veteran. He also is contending that his hypertension is due to a back disability. The Veteran is service connected for lumbar spine degenerative disc disease. As such, secondary service connection may be considered. In February 2019, the Veteran submitted a private medical opinion in support of his claim. The physician found that it was as likely as not that the Veteran’s hypertension was caused by one or more conditions which resulted from military service. The physician explained their rationale being based on the Veteran reporting hypertension earlier than in the records available for the physician, and the Veteran having primary hypertension with risk factors including being overweight and having chronic pain treated with pain medication including nonsteroidal anti-inflammatory drugs. The physician found these risk factors had an impact on the Veteran’s blood pressure. However, the physician did not explain what medications affected blood pressure and why. As such, the Board affords the private opinion less probative weight. The private physician also found that the Veteran’s chronic pain conditions in his shoulder and back have limited the Veteran’s efforts to increase physical activity and lose weight, which would result in better blood pressure control. The private physician though did not address the criteria provided in the OGC opinion. Specifically, the private physician did not find whether it was the Veteran’s back disability, which he is service-connected for, or his shoulder disability, which he is not service-connected for, caused the Veteran to be obese. The physician also did not opine whether the Veteran’s resulting obesity was a substantial factor in causing his hypertension and whether the Veteran’s hypertension would not have occurred but for his obesity. As such, the Board finds the opinion to be inadequate and affords it little probative weight. In November 2019, after remand, VA obtained a medical opinion from a VA examiner. The VA examiner opined that it was less likely than not that the Veteran’s service-connected lumbar spine degenerative disc disease caused or aggravated the Veteran’s hypertension beyond its natural progression. The examiner noted that studies of nonsteroidal anti-inflammatory drugs may show an increase in hypertension, but the statistics for this are misleading. The examiner explained this with how if a medication increases a risk for cardiac condition from 3 to 1000 individuals to 4 to 1000 individuals, medical literature would list this as being a significant risk for taking a given medication, but it is still an extremely tiny contributor to cardiac disease or hypertension from an overall perspective. The examiner also addressed whether the Veteran’s hypertension was due to obesity caused by his service-connected lumbar spine degenerative disc disease. The examiner found that the Veteran’s service-connected lumbar spine degenerative disc disease did not cause him to be obese. The examiner’s rationale for this was based on physicians encouraging patients with low back pain to remain physically active with many short walks, but the Veteran is unable to engage in this activity due to right hemiparesis secondary to a cerebrovascular accident (CVA) which is not service-connected. The VA examiner is competent to provide this opinion, the Board finds him to be credible, and affords the opinion great probative weight. The Board acknowledges the contentions from the Veteran and his fellow servicemember that the Veteran’s current hypertension was caused by stress from the pain of his service-connected lumbar spine degenerative disc disease. The Veteran and his fellow servicemember have not shown that they have the requisite medical knowledge to provide a medical nexus opinion for the Veteran’s current disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board affords the Veteran and his fellow servicemember’s lay statements less probative weight and affords more probative weight to the November 2019 VA opinion. Accordingly, the preponderance of the evidence is against a finding that the Veteran’s hypertension is secondary to his service-connected lumbar spine degenerative disc disease or related to an in-service injury or disease. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for hypertension. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Chandeck, 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.