Citation Nr: 21015702 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 16-12 053 DATE: March 18, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The competent evidence shows that the Veteran does not have a definitive diagnosis of hypertension. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2000 to March 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before a Veterans Law Judge (VLJ) in November 2019. In January 2021, he was notified that the VLJ who conducted his hearing was no longer employed by the Board, and was offered another hearing. The Veteran did not reply within 30 days or request another hearing. Therefore, the case will be decided on the transcript of record. This case was remanded to the AOJ in April 2020 for additional development. The Board finds that the AOJ substantially complied with all remand directives, and the case is ready for adjudication. 1. Entitlement to service connection for hypertension Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For VA purposes, hypertension means that the diastolic pressure is predominantly 90 mm mercury, or greater. Isolated systolic hypertension means that the systolic pressure is predominantly 160 mm mercury or greater with a diastolic pressure of less than 90 mm. For diagnosis, hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Service connection may only be awarded to an applicant who has a disability existing on the date of application or at any time during the appellate period, not for past disability. Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328, 1332 (1997)); Romanowsky v. Shinseki, 26 Vet. App. at 294. The Board must assess the credibility and weight of all of the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert, 1 Vet App. at 49. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran contends that he has a diagnosis of hypertension that was incurred in service or diagnosed within a year of separation. As explained in more detail below, the Board concludes that the Veteran does not meet the criteria for a diagnosis of hypertension or isolated systolic hypertension for VA purposes. Therefore, the claim must be denied. The Veteran’s service treatment records (STRs) do not reveal a diagnosis of hypertension. Having reviewed the blood pressure readings contained in the Veteran’s STRs, the Board notes that the highest recorded systolic blood pressure was 156 mm in May 2003, and the highest recorded diastolic blood pressure was 83 mm in February 2008. A VA treatment note dated in October 2009 shows that the Veteran’s home blood pressure averages were in the 120s/70s. The home readings were reportedly “well within normal limits.” The Veteran’s VA treatment records show that the highest recorded systolic blood pressure was 154 mm in June 2009. The highest recorded diastolic pressure was 97 mm in June 2009. A VA staff physician, Dr. C. L., diagnosed the Veteran with hypertension and started him on antihypertensive medication in March 2014. Prior to that, the Veteran’s diastolic pressure was also as follows: 79, 85, and 97 in June 2009; 92 and 81 in September 2009; 90 and 85 in October 2009; 87 in July 2010; and 91 in March 2014. The Veteran submitted a Disability Benefits Questionnaire (DBQ) dated in June 2014. Dr. L. diagnosed hypertension, not isolated systolic hypertension. She explained that the Veteran had several readings showing elevated blood pressure between 2009 and 2014, including 146/85 in June 2009, 137/92 in September 2009, and 147/91 in March 2014. An April 2014 VA treatment record indicates that the Veteran had elevated blood pressure without a diagnosis of hypertension. In a March 2016 Form 9, the Veteran argued that he had elevated blood pressure readings on active duty, which were not consistently documented because of deployment, meaning an official diagnosis was not able to be made. A Board hearing was held in November 2018. The Veteran argued that he had hypertension during service, and that his hypertension was diagnosed within a year of separation. The AOJ obtained a medical opinion in June 2020. The VA examiner reviewed the Veteran’s records and indicated that the Veteran did not have a diagnosis of hypertension or isolated systolic hypertension. The Veteran had not taken antihypertensive medication since October 2016, and since then, he had no readings documented in his VA treatment records showing systolic pressure over 160 mm, and he only had one diastolic pressure reading over 90 mm in December 2019. The VA examiner spoke to the Veteran by phone, and the Veteran reported taking no medication for hypertension. The examiner reviewed the blood pressure readings Dr. L. used to diagnosis hypertension and indicated that the readings may be due to excitement and are less accurate since there were no other readings meeting VA criteria of 2 different readings on 3 or more days. Therefore, it is less likely than not that the Veteran has a diagnosis of hypertension that was incurred in or caused by service. Based on a review of the competent medical evidence, the Board concludes that service connection for hypertension is not warranted. Specifically, the Board finds that the Veteran does not have a definitive diagnosis of hypertension as per the VA medical examiner. As outlined above, the pertinent legal criteria require that the evidence establish a current disability. This criterion is not met in this case regarding the claimed hypertension. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The examiner observed that the Veteran’s blood pressure readings did not meet VA criteria, either before or after he stopped taking antihypertensive medication. Therefore, the Board finds that service connection for hypertension is not warranted. Although the Board acknowledges that the Veteran believes he has hypertension, there is no evidence to suggest that the Veteran is competent to diagnose this disability. The issue is medically complex, as it requires the interpretation of symptoms and medical findings by a trained medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, although the diagnosis of hypertension appears in the Veteran’s records, the Board affords the June 2020 VA opinion significant weight, and more weight than Dr. C. L.’s DBQ and the annotations of hypertension in the records. The Board also affords the actual blood pressure readings in the Veteran’s file significant weight, and more weight than Dr. C. L.’s DBQ and the annotations of hypertension in the records. First, the Board finds the June 2020 VA opinion adequate for deciding the claim because it is based on an interview with the Veteran, a review of the relevant records, and an application of the VA criteria for diagnosing hypertension. The VA examiner’s opinion is supported by a rationale explaining why the Veteran does not meet the criteria, and noted that the diastolic readings of 90 mm or greater were caused by excitement, inaccurate, and not consistently shown, whereas Dr. C. L.’s DBQ does not include a rationale. Moreover, while the diagnosis of hypertension appears in the records, the objective readings in the Veteran’s VA treatment records do not support a diagnosis meeting VA criterion. The readings are significant because they are an objective measurement of the Veteran’s blood pressure and an indication of whether or not the criteria are met. Given that the VA examiner provided a fully reasoned and adequate explanation why the Veteran does not have a hypertension diagnosis, and the objective readings do not show that the VA criteria for a diagnosis are met, the Board must rely on the competent medical evidence before it in concluding that the criterion of a current disability is not met. The Board also finds that, while the Veteran had diastolic readings of 90 mm or greater, the records do not show that the readings were “predominantly” that high. Nine readings appear in the Veteran’s VA treatment records before Dr. L. diagnosed hypertension in the March 2014 visit. Of the nine readings, only four are 90 mm or greater. Here, the Board interprets “predominant” to mean more than half. Additionally, the Board notes that the Veteran had readings of 90 mm or greater on the same week or even same day that he had other readings below 90 mm. For example, on June 1, 2009, the Veteran had a diastolic reading of 97 mm; the next day, his diastolic readings were 85 and 79. On September 3, 2009, the Veteran had a diastolic reading of 92 mm, and one of 81 mm on the same day. On October 6, 2009, the Veteran’s first diastolic reading was 90 mm, but the second was 85 mm. At the March 2014 appointment where Dr. L. made the diagnosis of hypertension, the Veteran’s diastolic reading was 91 mm, but a second blood pressure was not taken. Given that on 3 of the 4 days that the Veteran’s diastolic readings that were 90 mm or greater, he also had readings below 90 mm the same or next day, the Veteran’s diastolic blood pressure cannot be said to be “predominantly” 90 mm or greater. Here, the Board also interprets “predominantly” to mean “consistently.” Although the Veteran argues that he had a hypertension diagnosis in service, or within a year of separation, the Board finds that the objective records do not reflect such a diagnosis. First, the STRs do not show any diastolic readings of 90 mm or greater. The Board acknowledges the Veteran’s argument that his blood pressure was not consistently measured during deployment; however, the readings that are available do not meet VA criteria, and the Board must rely on the objective numbers. Second, the available records from March 2008 to April 2009 do not show any diastolic readings of 90 mm or greater or systolic readings of 160 mm or greater, nor a diagnosis of hypertension. In fact, the earliest that the Veteran had a diastolic reading of 90 mm or greater was in June 2009, more than a year after separation, and an October 2009 note shows that the Veteran’s home readings were “well” within normal limits. The Board also notes that the Veteran does not have a diagnosis of isolated systolic hypertension. First, Dr. C. L., the Veteran’s physician, did not diagnose isolated systolic hypertension, which the Board notes is significant. Second, the Board notes that the Veteran has not had systolic readings of 160 mm or greater during the appeal period or during service. In sum, with a negative VA opinion and the objective blood pressure readings having significant weight and outweighing Dr. L.’s DBQ, the Board finds the preponderance of the evidence weighs against a finding that the Veteran has a diagnosis of hypertension. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, 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.