Citation Nr: 21021077 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 13-25 340A DATE: April 9, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The Veteran’s hypertension was not caused or aggravated by his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to April 1970. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. This matter was before the Board three times prior, including in April 2018, in January 2020 and in April 2020 – when the matter was remanded for further development. The Veteran testified before the undersigned during a hearing of January 2018. The transcript of said hearing is of record. 1. Entitlement to service connection for hypertension as secondary to PTSD The Veteran contends that his hypertension disability was caused or aggravated beyond natural progression by his service-connected posttraumatic stress disorder. The Veteran concedes that his hypertension did not originate during active duty service. See January 2018 hearing transcript and May 2019 VA examination. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current hypertension disability that is proximately due to or the result of, or was aggravated beyond its natural progress by, his service-connected PTSD. The Board concludes that, while the Veteran has a current hypertension disability, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by, his service-connected PTSD. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran was afforded VA examinations in May 2019, in February 2020, and in June 2020. The May 2019 VA examiner opined that the Veteran’s hypertension is less likely than not proximately due to or the result of the Veteran’s PTSD, reasoning that the two conditions are not medically related. The examiner explained that the Veteran had a history of tobacco use and obesity, which are risk factors for hypertension. The examiner concluded on this basis, referencing medical research from the Mayo Clinic, that the objective medical evidence shows hypertension is a separate entity entirely from PTSD and is unrelated to it. The examiner also opined that the Veteran’s hypertension is less likely than not aggravated by PTSD, citing lack of evidence that the Veteran’s hypertension is beyond normal progression. This matter was remanded by the Board in January 2020 for further development on the basis that the May 2019 examiner’s opinion on aggravation was inadequate for adjudication purposes. The Veteran was thus afforded another VA examination in February 2020. The examiner again opined that the Veteran’s hypertension is less likely than not related to PTSD. The examiner reasoned that review of the Veteran’s claims file shows he has a family history of hypertension as well as a significant history of smoking, which are risk factors for the development of hypertension. The examiner also opined that the hypertension was less likely than not aggravated beyond natural progression by PTSD , noting that initial records of the Veteran’s blood pressure are unavailable to establish a baseline which would indicate aggravation, and further, that the Veteran is only taking one blood pressure medication – which is inconsistent with hypertension beyond natural progression. The Board again remanded the matter in April 2020, finding the February 2020 VA examination inadequate for adjudication purposes. The Veteran was afforded his most recent VA examination in June 2020. The examiner opined that the Veteran’s hypertension is less likely than not related to PTSD. The examiner reasoned that current medical literature and research shows no physiologic or biomechanical causal relationship between a mental health condition such as PTSD and a physiologic condition of hypertension. The examiner explained that while anxiety may cause a temporary elevation in blood pressure, it cannot cause or permanently aggravate primary or secondary hypertension. The VA examiner who provided the June 2020 opinion reviewed the record, examined the Veteran, and conducted medical research. The examiner’s opinions were based on the specific facts of this case as presented in the record and by the Veteran at an in-person examination. The examiner provided appropriate rationales that are factually accurate, fully articulated, and soundly reasoned. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Accordingly, the Board accepts the VA examiner’s opinions as the most probative evidence as to whether it is less likely than not that the Veteran’s hypertension is caused or aggravated by his PTSD. The Board acknowledges the Veteran’s lay statements indicating that his hypertension is related to his PTSD, including the credible sworn testimony of the Veteran before the undersigned during the hearing of January 2018. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms either in service or after service). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, a layperson without the appropriate medical training and expertise is simply not competent to provide a probative opinion on a complex medical matter, such as an etiological relationship between any current disability and military service or another disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA medical evidence of record, including the June 2020 VA examination. Although grateful for the Veteran’s honorable service, the Board concludes that the preponderance of the evidence is against the claim for service connection and the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Comninos, Georgio 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.