Citation Nr: 21014509 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-15 941 DATE: March 12, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that hypertension began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that GERD began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for gastroesophageal reflux disease (GERD) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1964 through December 1966. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a January 28, 2013, rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO). The Board previously remanded the claims for hypertension and GERD in October 2020 to afford the Veteran an adequate VA examination for his current hypertension as well as to afford the Veteran an initial VA examination for GERD. A review of the claims file now shows that there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scottv. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinsonv. Peake, 21 Vet. App. 545, 552 (2008). Service Connection A veteran is entitled to service connection for a disability resulting from a disease or injury incurred or aggravated during active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163(Fed. Cir. 2004). A disease diagnosed after discharge may still be service connected if all the evidence establishes that it was incurred in service. 38 C.F.R. § 3.303 (d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Certain chronic diseases, including hypertension, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303 (b). The theory of continuity of symptomatology under 38 C.F.R. § 3.303 (b) does not apply to any condition that has not been recognized as chronic under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 1. Entitlement to service connection for hypertension is denied. The Veteran contends that his hypertension began during service and was therefore, caused by service. Service treatment records (STRs) show beginning in 1964, the Veteran began to have abnormal blood pressure readings. Specifically, in January 1964 his blood pressure reading was 122/66, 134/80 in April 1964; 115/70 in June 1975, 150/80 in August 1966, and 110/90 in December 1966. However, the Veteran was never diagnosed with hypertension nor was any recurring health problem noted on his separation examination. The Veteran also reported that he began to experience headaches in service as the result of his blood pressure. After service, the Veteran’s medical records indicate he was first diagnosed with hypertension sometime in January 1997. Prior to this date, complaints and treatment for symptoms of hypertension are not found. The Veteran was afforded a VA examination in September 2012 wherein the Veteran reported that he was first diagnosed with hypertension roughly fifteen years earlier. After examination, it was opined that the Veteran’s hypertension was less likely than not a manifestation of his military service. The examiner reasoned that a diagnosis of hypertension is based upon three separate blood pressure readings over three different days in which the systolic blood pressure is at least 140 and/or the diastolic is at least 90. This examination was later deemed inadequate for the examiner relied upon a single blood pressure reading in the Veteran’s STRs in providing a negative nexus opinion. As a result, the Board found the September 2012 examination to be inadequate for adjudicative purposes and ordered a remand in October 2020. After the Board’s October 2020 remand, the Veteran was afforded another VA examination for his hypertension later that same month. The examiner confirmed and noted the Veteran’s diagnosis of hypertension with a date of first diagnosis in January 1997. It was noted that the Veteran takes continuous medication as treatment for his condition. The examiner further noted several blood pressure readings located in the Veteran’s STRs. Ultimately, the examiner opined “it is my medical opinion that the Veteran’s hypertension is not incurred in or caused by military service”. The examiner explained, that even though the Veteran’s STRs document abnormal readings over various times throughout service, “these measurements do not meet [the] criteria of hypertension”. He further explained that “headaches, as known in medical literature, [are] non-diagnostic of hypertension”. It was noted that the Veteran could not recall when he was first diagnosed with hypertension and that his post-service medical records were silent as to hypertension until a formal diagnosis “some 30 years after service” in January 1997. The Board acknowledges that the specific blood pressure reading from August 9, 1966 referred to in the Board’s prior remand directive was not specifically noted by the October 2020 examiner’s opinion. It is further noted that the examiner did not use the appropriate legal standard of “as likely as not” in offering his medical opinion. However, the examiner did consider the whole record and reviewed all pertinent medical evidence as referenced in his rationale. The examiner noted several other blood pressure readings contained in the Veteran’s STRs concluding “these measurements do not meet criteria diagnostic of hypertension”. Furthermore, the examiner’s opinion was not ambiguous, clearly denying a nexus between service, hypertension and GERD. See Dyment v. West, 13 Vet. App. 141 (1999) (holding medical examiner’s word choice is not error where opinion is unambiguous). See also Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012) (“There is no requirement that a medical examiner comment on every favorable piece of evidence in a claims file.”). Therefore, the Board finds the October 2020 VA examination to be in substantial compliance with the Board’s remand directives. Stegall, 11 Vet. App. 268 (1998). Further, the Board finds the October 2020 VA examiner’s opinion persuasive. The examiner considered the Veteran’s medical history to include several abnormal blood pressure readings noted in STRs, the Veteran’s lay statements of onset in service, experiencing headaches claimed to be caused by high blood pressure as well as supporting his opinion with reference to medical literature. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Ardison v. Brown, 6 Vet. App. 405, 407 (1994). The Board acknowledges the Veteran’s belief that there is such a causal connection, but finds the Veteran lacks the competency to render such a medically complex opinion. See Layno v. Brown, 6 Vet. App. 465, 469(1994). It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a)(1). It is not shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical opinion as to the etiology of hypertension. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Thus, with respect to a nexus between the Veteran’s current hypertension and in-service occurrence, the Board assigns more probative weight to the October 2020 VA examiner’s opinion which denied service connection after thorough review of the Veteran’s file, extensive medical history and consideration of abnormal blood pressure readings in service as well as complaints of headaches. As such, the Board finds no causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board has also considered whether the Veteran is entitled to service connection for hypertension as a "chronic disease." See 38 C.F.R. § 3.303 (b). Hypertension is included in the list of "chronic" diseases under 38 C.F.R. § 3.309 (a). The Board notes that the Veteran’s medical records contain no reports of hypertension or treatment until 1997, over 30 years after his separation from service. Furthermore, the Veteran has not argued, and the record does not show, that he was diagnosed with hypertension or any other "chronic" disease listed under 38 C.F.R. § 3.309 (a) during service or within one year of separation from service. Therefore, service connection is not warranted on a presumptive basis under the provisions of 38 C.F.R. §§ 3.303 (b), 3.307, and 3.309. In light of the above, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not for application. The claim therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 2. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. The Veteran contends that he has suffered from GERD, claimed as acid reflux, beginning in and since service. Service treatment records (STRs) are silent for complaints, treatment or diagnosis of GERD. The Veteran’s separation examination in December 1966 also did not note any symptoms of GERD. The Veteran’s post service treatment records first document a formal diagnosis of GERD sometime in January 1997. In correspondence dated July 2014, the Veteran stated that he has suffered from GERD symptoms since 1967 including the use of treatment as well as being awoken at night due to his symptoms. The Veteran was afforded a VA examination in October 2020 in which the examiner opined that the Veteran’s GERD was not incurred in or caused by his military service. The examiner noted that the Veteran was first diagnosed with GERD in January 1997. He further noted that the Veteran currently has symptoms including pyrosis, reflux, sleep disturbances caused by reflux that occur four or times a year with an average duration of less than a day. The examiner explained that the Veteran could not remember when he was first diagnosed with GERD, earlier reports indicated at least 15 years before his prior VA examination in 2012. Lastly, the examiner noted that the Veteran’s post service medical treatment records were silent for almost 30 years for reports, treatment or diagnosis of GERD until January 1997. Ultimately, the examiner opined that there was no nexus between the Veteran’s current GERD and military service for there was a lack of objective medical evidence of GERD until 1997, some 30 years after separation of service. The Board once more finds the October 2020 VA examiner’s opinion persuasive. The examiner considered the Veteran’s medical history to include reports of onset in service, continuous medication needed to treat the symptoms, as well as reported symptoms. It is noted that the examiner’s supporting rationale was complex in nature and more concise language could have been used. However, the examiner’s rationale and underlying meaning is understood by the Board, thus a remand is not required for clarification purposes. See McClaim v. Nicholson, 21 Vet. App. 321 (2007) (noting that although clarity is preferred, it “is not and cannot be demanded in every instance or finality would forever be delayed pending perfection in draftsmanship”). See also Parrish v. Shinseki, 24 Vet. App. 391, 401 (2011) (recognizing that a poorly drafted medical opinion is not necessarily inadequate if it can otherwise be understood). The Board acknowledges the Veteran’s belief that there is such a causal connection, but finds the Veteran lacks the competency to render such a medically complex opinion. See Layno v. Brown, 6 Vet. App. 465, 469(1994). It is well established that a layperson without medical training is not qualified to render a medical opinion regarding the diagnosis or etiology of certain disorders and disabilities. See 38 C.F.R. § 3.159 (a)(1). It is not shown that the Veteran is otherwise qualified through specialized education, training, or experience to offer a medical opinion as to the etiology of GERD. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Thus, with respect to a nexus between the Veteran’s current GERD and in-service occurrence, the Board assigns more probative weight to the October 2020 VA examiner’s opinion which denied service connection after thorough review of the Veteran’s file, extensive medical history and consideration of symptoms and reported treatment. As such, the Board finds no causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In light of the above, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not for application. The claim therefore must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.