Citation Nr: 21014047 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 17-28 093 DATE: March 11, 2021 ORDER Entitlement to service connection for hypertension, including as due to a service-connected lumbosacral spine disability, is denied. FINDING OF FACT The record evidence shows that the Veteran was diagnosed as having and being treated for hypertension during a period of inactive duty training (INACDUTRA) and not during a period of active duty or active duty for training (ACDUTRA). CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension, including as due to a service-connected lumbosacral spine disability, have not been met. 38 U.S.C. §§ 101, 106, 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.1, 3.6, 3.303, 3.304, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Army from October 1969 to September 1971. He also had additional periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA) in the U.S. Army National Guard, including from May 12-26, 2001, on November 30, 2001, and from July 20, 2002, to August 3, 2002. In October 2018, the Board remanded the currently appealed claim to the Agency of Original Jurisdiction (AOJ) for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. The Board directed the AOJ to determine the Veteran’s dates of ACDUTRA and INACDUTRA in the U.S. Army National Guard. The Defense Finance and Accounting Service (DFAS) responded in December 2020 with a detailed listing of the Veteran’s dates of ACDUTRA and INACDUTRA. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). Because the Veteran lives within the jurisdiction of the RO in Winston-Salem, North Carolina, that facility has jurisdiction in this appeal. 1. Entitlement to service connection for hypertension, including as due to a service-connected lumbosacral spine disability The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for hypertension, including as due to a service-connected lumbosacral spine disability. The Veteran contends that he incurred hypertension during active service and experienced continuous post-service disability. The record evidence does not support his assertions that he incurred hypertension during a period of active service (i.e., active duty in the U.S. Army or active duty for training (ACDUTRA) in the U.S. Army National Guard). The Board acknowledges that the Veteran is diagnosed as having and has been treated for hypertension. Unfortunately, the record evidence shows that the Veteran initially was diagnosed as having and treated for hypertension during a period of inactive duty training (INACDUTRA) in the U.S. Army National Guard. The Board notes that, in general, service connection is available for diseases and injuries incurred during a period of active duty or ACDUTRA and for injuries incurred during a period of INACDUTRA. See generally 38 U.S.C. §§ 101(24), 106 (2012); 38 C.F.R. § 3.6 (2019). In other words, service connection is not available for diseases incurred during a period of INACDUTRA. Id. Following the Board’s December 2018 remand, the DFAS provided VA with a detailed listing of the Veteran’s U.S. Army National Guard drill dates, ACDUTRA, and INACDUTRA in December 2020. A review of this information shows that the Veteran received U.S. Army National Guard drill pay for morning and afternoon drills on the following dates in 1996: January 20 21, February 10-11, March 7 and 10, April 20-21, May 18-19, June 16, July 20-21, August 17-18, September 14-15, October 19-20, November 16-17, and December 7-8. The Veteran had active service from June 1 15, 1996. The Veteran also received unit training assembly (UTA) drill pay on July 19, September 13, and October 18, 1996. The record evidence also shows that the Veteran’s hypertension began during a period of INACDUTRA and not active duty or ACDUTRA. For example, in October 2015, a VA clinician opined that, although it was less likely than not that the Veteran’s service-connected lumbosacral spine disability caused or aggravated his hypertension, “The rationale is that it is my professional opinion that [hypertension] should be service connected. Active duty physical from 2000 show that claimant was already on treatment with Adalat for chronic [hypertension] while still on active duty.” The rationale also was based on a review of the claims file. In July 2020, a VA clinician opined that it was at least as likely as not that the Veteran’s hypertension is related to active service. The rationale was that the Veteran was treated for hypertension on May 13, 1996, when he was prescribed medication to treat it. The rationale also was based on a review of the claims file. The Court has held that the Board is free to assess medical evidence and is not compelled to accept a physician's opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). A medical opinion based upon an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A bare conclusion, even one reached by a medical professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). The Court also has held that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). The Board notes that the October 2015 VA clinician and the July 2020 VA clinician related the Veteran’s hypertension directly to active service. Both of these clinicians found persuasive support for their positive medical nexus opinions by relying on treatment records for hypertension dated during time periods when the Veteran was not on active duty or ACDUTRA. In other words, these opinions cannot be used to support granting service connection for hypertension because they rely on treatment for a disease which occurred when the Veteran was on INACDUTRA, and service connection for diseases occurring on INACDUTRA is prohibited. See 38 U.S.C. §§ 101(24), 106; 38 C.F.R. § 3.6. Thus, the Board finds that neither the October 2015 nor July 2020 VA clinician opinions are entitled to probative value on the issue of whether the Veteran’s hypertension is related to active service. The Board recognizes that, in a June 2015 letter, C. L. C., the Veteran’s primary care physician, opined that the Veteran’s chronic low back pain “may be an aggravating [factor] for his hypertension because of the chronic pain.” Current regulations provide that service connection may not be based on a resort to speculation or even remote possibility. See 38 C.F.R. § 3.102; Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); and Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). Accordingly, even if this clinician’s letter is viewed in the light most favorable to the Veteran, this evidence does not establish service connection for hypertension, including as due to a service-connected lumbosacral spine disability. The remaining record evidence shows that the Veteran’s hypertension is not related to active service, including as due to a service-connected lumbosacral spine disability. In October 2015, a VA clinician opined that it is less likely than not that the Veteran’s service-connected lumbosacral spine disability caused or aggravated his hypertension. The rationale for this opinion was based on a review of the claims file. The rationale also was, “there is no evidence of severe chronic debilitating back pain that would lead to chronic elevated [blood pressure].” In May 2017, a VA clinician opined that it was less likely than not that the Veteran’s service-connected lumbosacral spine disability caused or aggravated his hypertension. The rationale for this opinion was based on a review of the claims file. The Veteran contends that he incurred hypertension during a period of active duty or ACDUTRA and experienced continuous post-service disability. The record evidence does not support the Veteran’s lay assertions regarding incurrence of hypertension during a period of active duty or ACDUTRA. It shows instead that the Veteran initially was diagnosed as having and been treated for hypertension during a period of INACDUTRA. As noted above, service connection is not warranted for diseases incurred during a period of INACDUTRA. The Veteran’s claim does not meet the legal prerequisite for service connection for diseases incurred during a period of INACDUTRA. See 38 U.S.C. §§ 101(24), 106; 38 C.F.R. § 3.6. Thus, the Board finds that service connection for hypertension is not warranted. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael T. Osborne, 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.