Citation Nr: 21015063 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-21 560 DATE: March 16, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The Veteran’s hypertension is not secondary to service-connected renal condition 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 the Veteran’s service-connected renal condition 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 on active duty in the United States Army from September 1967 to October 1969. This appeal comes before the Board of Veterans’ Appeals (Board) from a June 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2018, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is available in the record. This matter was previously remanded in September 2020 for further development, to include requesting the Agency of Original Jurisdiction (AOJ) to obtain an addendum VA opinion. The addendum VA opinion was obtained; and therefore, the Board finds that its remand instructions were substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for hypertension is denied. The Veteran seeks entitlement to service connection for his hypertension. He contends that his hypertension first manifested during his period of active service. In the alternative, he asserts that his hypertension is secondary to his service-connected disability. Direct Service Connection Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). Generally, service connection requires: (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease; and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). Certain chronic diseases will be presumed related to service (to include cardiovascular disease, hypertension, and malignant tumors), absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of hypertension. See October 2020 VA Treatment Record. Therefore, the first Hickson element is met. As to the second element of Hickson, for direct service connection the Veteran must show an in-service incurrence or aggravation of a disease or injury. Here, the Board notes that the Veteran’s service treatment records (STR) do not show any documented complaints of, or treatment for hypertension or high blood pressure. In his separation examination, the Veteran denied a history of high blood pressure. See June 1969 Separation Examination. All identifiable blood pressure readings taken during the Veteran’s period of service indicate normal readings (as informed by Note (1) of 38 C.F.R. § 4.104, Diagnostic Code 7101, defining hypertension as diastolic pressure predominantly 90mm or greater, and isolated systolic hypertension as systolic blood pressure predominantly 160mm or greater with a diastolic blood pressure of less than 90mm). During service, the Veteran had systolic blood pressure readings of 120mm and 132mm, as well as diastolic blood pressure readings of 75mm and 92mm. See May 1970 STR. An August 1969 STR noted the Veteran’s blood pressure to be 110mm over 65mm. The record does not show that hypertension had its onset in service, that it was manifest within a year of service or has been continuous since service. A VA treatment record from August 1980 noted the Veteran was diagnosed with Hypertension in 1979, which is 10 years post-service. Additionally, on the issue of nexus, there are no medical opinions of record that directly link the Veteran’s currently diagnosed hypertension condition to service. Thus, based upon the most probative evidence of record, the Board finds that Veteran’s claim does not meet the requisite elements for direct service connection. Secondary Service Connection Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). The Veteran has a current diagnosis of hypertension. See October 2020 VA Treatment Record. Thus, the first Allen element is met. The second Allen element requires the evidence to show that the Veteran’s hypertension was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. A VA medical opinion was obtained in November 2020. The VA examiner stated that there is no medical literature that supports any mechanism by which obstructive uropathy (the cause of the Veteran’s renal transplant) or subsequent kidney transplant would cause or aggravate the Veteran’s hypertension. As the VA examiner indicated he reviewed the Veteran’s records and remand instructions before explaining his opinion, the Board finds this opinion highly probative. There are no other opinions of record. After a review of the evidence, the Board finds the preponderance of the evidence is against finding the Veteran’s hypertension was caused or aggravated by his service-connected disabilities. The Board has considered the lay statements by the Veteran that his hypertension was caused or aggravated by his service-connected disabilities. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Jandreau, 492F.3d at 1377, n.4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159 (a)(2). As the preponderance of the evidence is against finding the Veteran’s hypertension was caused or aggravated by his service-connected disabilities, the benefit-of-the-doubt does not apply. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Holcombe, 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.