Citation Nr: 21013607 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 13-32 067 DATE: March 10, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart disability is denied. FINDINGS OF FACT 1. Hypertension did not have its onset during the Veteran’s active service and is not otherwise etiologically related to such service; and was not present to a compensable degree within one year of the Veteran’s separation from active service. 2. A heart disability did not have its onset during the Veteran’s active service and is not otherwise etiologically related to such service; and was not caused or chronically worsened by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for a heart disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active air service from July 1954 to January 1958. This matter come before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2018. A transcript of that hearing has been associated with the claims file. This case was previously before the Board, most recently in November 2020, at which time the issues currently before the Board were remand for additional development. The case has now been returned to the Board for further appellate action. Service Connection – Hypertension and a Heart Disability The Veteran asserts that his hypertension is related to active service. Specifically, the Veteran testified that the stress of his job as a code interceptor caused his elevated blood pressure. He has reported that a long history of elevated blood pressure ultimately led to his development of a heart disability. Service treatment records (STRs) are silent for complaints of, treatment for, or a diagnosis of hypertension while the Veteran was in active service. Of record is a June 1955 treatment note showing the Veteran’s blood pressure to be 110/65. In January 1958, the Veteran was afforded a separation examination. There is no indication from the record that the Veteran reported elevation in blood pressure due to stress, or any other factor at that time. At that time, the Veteran’s blood pressure was noted to be 122/74. There is no other indication from the examination report that there was any concern regarding the Veteran’s blood pressure at the time of his separation from service. In May 1958, the Veteran was afforded a VA examination in connection with other claims for VA compensation. At that time, the Veteran had three blood pressure readings. His blood pressure was noted to be 134/90 when sitting, 132/88 after exercise, and 130/90 two minutes after exercise. At that time, the Veteran’s heart was within normal limits, although slight tachycardia was noted. The examiner noted that the increased blood pressure and tachycardia was likely due to youth and a reaction to the examination. A chest X-ray conducted at that time was negative for any abnormality of the heart. A diagnosis of hypertension or any other heart disability was not made at that time. In February 2010, the Veteran filed a claim of entitlement to service connection for a heart disability. At that time, the Veteran reported that his heart disability started in May 2007. A review of the medical evidence of record shows that the Veteran was seen at a private medical facility in May 2007 for complaints of a six month history of exertional substernal chest discomfort. At that time, he was noted to have a history of hypertension, however the date of diagnosis of such was unknown. At that time, the Veteran was diagnosed with coronary artery disease, hypertension, and hyperlipidemia. It was noted that the Veteran would require an immediate coronary artery bypass graft (CABG) surgical procedure. There is no indication from the treatment notes that the Veteran’s hypertension had its onset during the Veteran’s active service, or within one year of his separation from such service. In February 2011, the Veteran was afforded a VA examination. At that time, the Veteran reported that he had experienced high blood pressure since service, and that he had been placed on blood pressure regulation medication as early as 1959. The examiner confirmed the diagnosis of hypertension by history; however, the examiner did not provide an opinion regarding the nature and etiology of the Veteran’s hypertension. In February 2020, the Veteran was afforded VA hypertension and heart examinations. At that time, the VA examiner noted the diagnosis of hypertension and coronary artery disease. The examiner opined that the Veteran’s hypertension and coronary artery disease were less likely as not incurred on or caused by the claimed in-service injury, event, or illness. In so finding, the examiner noted that the Veteran did not have documented high blood pressure until nearly 40-50 years following his separation from active service. Further, the examiner noted that the Veteran began having chest pain around 2007, and had a CABG surgical procedure shortly thereafter, and the current literature did not support a finding that an incident during the Veteran’s active service would cause coronary artery disease to occur 40-50 years later. Based on some inadequacies in the February 2020 VA medical opinion, and addendum opinion as obtained in November 2020. At that time, the VA examiner opined that it was less likely as not that the Veteran’s diagnosed hypertension had its onset during the Veteran’s active service, or was otherwise etiologically related to such service. In so finding, the VA examiner noted the findings of elevated blood pressure and tachycardia noted in the May 1958 VA examination report and found that those findings were transient in nature, and were followed by over 40 years of normal readings nad heart rate. As such, the VA examiner found that it was less likely as not that the findings noted in the May 1958 VA examination report had any effect on, or relationship to, the Veteran’s current hypertension and heart disability. Further, the examiner opined that it was less likely as not that the Veteran’s heart disability was caused or chronically worsened by his hypertension. In so finding, the examiner noted that the Veteran’s coronary artery disease and subsequent CABG surgical procedure were more likely than not related to a number of other factors such as the Veteran’s age, diet, exercise, and genetics. In a December 2020 addendum VA medical opinion, the examiner again opined that it was less likely than not that any heart disability had its onset during active service, or was otherwise caused by such service. In so finding, the examiner again noted the May 1958 VA examination report which noted findings of elevated blood pressure and tachycardia. The examiner noted the 1958 VA examiner’s notation that such findings were likely due to youth, exercise, and some reaction to the examination, and noted that “white coat hypertension” was a well-established phenomenon where someone’s blood pressure and pulse could be elevated only during a medical examination. The examiner noted that as there were no subsequent notations of elevated blood pressure for approximately 50 years, it was likely not a chronic illness at that time. The examiner noted that “white coat hypertension” did not merit treatment and was not a known cardiac risk factor. The Board finds that the VA medical opinions are adequate when read in conjunction with one another. In this regard, the examiners thoroughly reviewed and discussed the relevant evidence, considered the contentions of the Veteran, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, there is no medical opinion of record to the contrary. As such, the VA medical opinions are the most probative evidence of record. The Board notes that the Veteran is generally competent to report when he first experienced symptoms of hypertension. However, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. Competency is a legal concept determining whether testimony may be heard and considered, and credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465 (1994). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board may weigh the absence of contemporaneous medical evidence against the lay evidence in determining credibility, but the Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 133 (Fed. Cir. 2006). The Board may not ignore a Veteran’s testimony simply because he is an interested party and stands to gain monetary benefits. However, personal interest may affect the credibility of the evidence. Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991). In this case, the Board finds that the Veteran’s statements that he experienced hypertension in-service and implied continuous treatment for such after service are not credible. In this regard, the Veteran’s statements are inconsistent with the other evidence of record. The service treatment records (STRs) are silent for complaints of, treatment for, or a diagnosis of hypertension while the Veteran was in active service. The Veteran’s in-service complaints consisted of colds, coughs, nose bleeds, sore throat, and stomach pains. While the Veteran has now reported that he experienced dizzy spells while in active service during periods of elevated blood pressure, those instances are not documented in the record. Further, the Veteran’s blood pressure readings in service were within normal limits, and there is no indication of hypertension concerns at any time during the Veteran’s active service, to include at his January 1958 separation examination. Further, while the Veteran has reported a 1959 diagnosis of hypertension and the beginning of medication management at that time, that is completely inconsistent with the objective evidence of record. In this regard, the Veteran specifically noted on his February 2010 claim for a “heart” disability that his disability had its onset in May 2007. Further, there is no indication from the private medical records from May 2007 when the Veteran was seen for substernal chest discomfort on exertion for a period of approximately six months that he reported a longstanding, approximately 50 year history of hypertension. The Board finds that the statements the Veteran made when seen for his substernal chest discomfort that ultimately led to an immediate CABG surgery to be especially credible as they were provided for purposes of seeking treatment and not compensation. Additionally, during the February 2020 VA examination, the Veteran stated that the onset of hypertension was in 2010. Additionally, while the Veteran was noted to have elevated blood pressure readings and tachycardia at the time of a May 1958 VA examination for other disabilities, there is no indication from the record that the Veteran was diagnosed with hypertension or a heart disability at that time. In fact, in the December 2020 VA medical opinion, it was noted that those findings were consistent with a “white coat” phenomenon where blood pressure and pulse could read as elevated during a medical examination. As the Veteran’s reports of hypertension since service are inconsistent with the other evidence of record, the Board finds that those statements are simply not credible. While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current hypertension to his active service as that would require medical knowledge, training, and expertise and is simply outside the realm of common knowledge of a lay person. Further, the Veteran is not competent to provide an opinion regarding the nature and etiology of his heart disability, as that would also require medical knowledge, training, and expertise that is outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claims, and entitlement to service connection for hypertension and a heart disability is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ivan Franklin 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.