Citation Nr: 21015977 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 17-39 881 DATE: March 18, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT 1. The preponderance of the evidence is against finding that hypertension began during a period of qualified active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s preexisting hypertension was aggravated by service during Operation Iraqi Freedom from August 2008 to September 2009. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1970 to October 1971; from May 2003 to December 2003; and from August 2008 to September 2009. In August 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is included in the record. Entitlement to service connection for hypertension. The Veteran contends that his diagnosed hypertension was aggravated by the stress he experienced in service during Operation Iraqi Freedom in his last period of active duty service. See August 2020 Board hearing. The question for the Board is whether the appellant has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease; or was aggravated by his active duty service if the disability preexisted service. A veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by active service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). If a preexisting disorder is noted upon entry into service, the Veteran cannot bring a claim for service connection for that disorder, but the Veteran may bring a claim for service-connected aggravation of that disorder. 38 U.S.C. § 1153. A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. The burden falls on the Veteran to establish aggravation. If the Veteran demonstrates a worsening of his condition in service, the burden then shifts to the government to rebut the presumption of aggravation by clear and unmistakable evidence. Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994). The Board concludes that, although the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that his hypertension began during service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 57 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Furthermore, the Board concludes that there is no evidence that the Veteran’s preexisting hypertension was aggravated by his service. See 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a); Jensen, 19 F.3d at 1413. The Veteran’s service treatment records (STRs) reflect that he was first diagnosed with hypertension between periods of active duty. Prior to the Veteran’s initial period of active service, his February 1970 induction examination included a blood pressure reading 130/70. On separation examination in September 1971, blood pressure was measured as 140/80. There was no pertinent defect or diagnosis noted on either examination. There was no finding or diagnosis of hypertension during the Veteran’s initial period of service. The STRs dated in March 2005, between the second and third periods of active duty, showed blood pressure was measured as 154/112 and 140/90. There was no related diagnosis of hypertension. The STRs further demonstrate that in April 2007, between periods of active duty, blood pressure 154/89 and 149/85. The report documents that the Veteran’s blood pressure was being controlled with medication and that he received a provisional diagnosis of hypertension. The April 2007 record is the earliest documented diagnosis of hypertension, which occurred is between his periods of active duty. An April 2013 VA examiner provided a positive opinion regarding direct service connection because “a diagnosis found as part of military records and VA file.” The Board affords that opinion no probative value because it does not address the diagnosis in April 2007, prior to a period of active duty service. In June 2013, a VA examiner reviewed the record and offered a negative opinion as to whether the Veteran’s hypertension was aggravated by his period of active duty service that began in August 2008. The examiner noted that at the beginning of that period, the Veteran’s blood pressure was well-controlled with medication. The examiner also noted that the Veteran’s blood pressure was currently well-controlled with medication. The examiner further noted that the strength of the current antihypertensive medication was an equivalent to slightly less potent regimen than he was on at the beginning of his last period of active duty service. Thus, the Veteran’s hypertension was not aggravated beyond its natural progression by his active duty service from August 2008 to September 2009. At the August 2020 Board hearing, the Veteran described the history of his hypertension and said that in order to be deployed during that last period of active duty, he had to show his blood pressure was under control with medication. The Veteran also testified that he was still having problems with hypertension even though he was taking blood pressure medication. Specifically, he mentions that he had elevated blood pressure levels in his August 2009 separation examination at 146/85. Based on a review of the record, the Board finds that the Veteran’s hypertension existed prior to the period of active duty that began in August 2009 and he has not met the burden of demonstrating a worsening during service. The burden to rebut the presumption of aggravation does not shift to VA. There is no evidence of a diagnosis of hypertension during the first two periods of active duty service. A diagnosis of hypertension was first documented in April 2007. The competent evidence also shows that the preexisting hypertension was not aggravated beyond the natural progression during the last period of service. The June 2013 VA examiner reviewed the record and provided that opinion based on a finding that the Veteran’s hypertension was well-controlled and his current medication regimen was less potent than he was on at the beginning of the period of active service. While Veteran believes his hypertension was aggravated by service, he is not competent to provide an opinion in this case because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. As the preponderance of the evidence is against finding that the preexisting hypertension was aggravated by a period of active service, the claim of service connection is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.