Citation Nr: 21024698 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 12-12 701 DATE: April 23, 2021 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The Veteran’s blood pressure was pre-hypertensive prior to entry on active service and was categorized as hypertension at separation. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1968 to July 1970 to include service in the Republic of Vietnam. 1. Entitlement to service connection for hypertension The Veteran contends that he developed hypertension as a result of exposure to Agent Orange in active service or as secondary to his service-connected PTSD. After a thorough review of the available evidence, the Board finds that entitlement to service connection is warranted for hypertension. The Veteran submitted a claim for entitlement to service connection for hypertension in March 2009. In an August 2010 rating decision, the RO denied entitlement to service connection for hypertension. The Veteran perfected a timely appeal. The Board has remanded this claim before and now arrives at this current decision. Entitlement to service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for a disease diagnosed after service discharge when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service,” the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Every veteran shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment, and was not aggravated by such service. 38 U.S.C. § 1111. VA regulation provides that the term “noted” denotes “[o]nly such conditions as are recorded in examination reports,” 38 C.F.R. § 3.304(b), and that “[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions.” 38 C.F.R. § 3.304(b)(1). To rebut the presumption of sound condition for conditions not noted at entrance into service, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. VAOPGCPREC 3-03 (July 16, 2003), 70 Fed. Reg. 23027 (May 4, 2005); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). A pre-existing injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Green v. Derwinski, 1 Vet. App. 320 (1991). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. A lack of aggravation during service can be shown by establishing by clear and unmistakable evidence either that there was no increase in disability, or that any increase in disability was due to the natural progression of the pre-existing condition. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Wagner, 370 F.3d at 1096; Horn v. Shinseki, 25 Vet. App. 231, 235. The Veteran “need not produce any evidence of aggravation in order to prevail”; instead, the burden is on the VA to identify affirmative evidence demonstrating that there was no aggravation. Horn, 25 Vet. App. at 235. The burden is not met by finding that the record contains insufficient evidence of aggravation. Id. Notably, for hypertension, regulations provide that hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more. Hypertension must be confirmed by readings taken two or more times on three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). At the June 2019 VA examination, the examiner confirmed a diagnosis of hypertension. The Veteran has met the first element of service connection during the period of appeal. A January 2020 VA medical opinion explains that the Veteran’s service treatment records (STRs) show a blood pressure reading of 136/82 upon entry into active service at the medical examination in August 1968. The examiner referred to this as evidence that the Veteran was pre-hypertensive prior to entry on duty but did not reach the conclusion that the Veteran’s records showed he had been diagnosed with hypertension or that the examiner himself would diagnose the Veteran with hypertension prior to service. The Board confirms that the Veteran’s STRs document this blood pressure reading. The Board also finds that the Veteran’s entrance examination does not “note” a high blood pressure or hypertension condition upon entry into active service within the meaning of 38 C.F.R. §3.304(b). On the associated medical history form on entry into service, the Veteran marked “no” to a history of high or low blood pressure. Accordingly, the Veteran is presumed sound upon entry with regard to hypertension as there is no clear and unmistakable evidence to warrant a finding that the disease of hypertension existed before acceptance and enrollment. The Veteran’s STRs document a periodic medical examination in April 1969. The blood pressure reading there was either 128/70 or 128/90 as the handwritten results are difficult to discern. At this appointment, the Veteran had additional consultation for a stomach condition. The blood pressure is written on another page with the same date in April 1969 and is noted as 130/90, although the handwriting is again unclear as to the diastolic pressure. On the October 1969 medical history for dental work, the Veteran marked “no” to a history of abnormal blood pressure. At the separation medical examination, the Veteran’s blood pressure was marked as 144/82. The January 2020 VA medical examiner stated that such a blood pressure reading was “definitely hypertension.” Post-service, there is a May 24, 1973 medical record documenting a blood pressure reading of 130/80. The Veteran wrote on his May 2012 VA Form 9 that he has had problems with hypertension since his time in military service. The October 2016 VA examination confirms that the Veteran is taking medication to control hypertension. Here, the Veteran’s STRs appear to show that he had blood pressure readings consistent with the definition of hypertension during active service. The January 2020 VA examiner wrote that the Veteran’s blood pressure reading at the separation medical examination was “definitely hypertension,” whereas he opined that prior to service, the Veteran was “pre-hypertensive” but did not conclude that the Veteran had a formal diagnosis of hypertension prior to service, nor is there evidence documenting such. The record does not show hypertension was officially diagnosed during service, but blood pressure readings were consistent with hypertension per the VA medical examiner. Accordingly, resolving reasonable doubt in favor of the Veteran, hypertension manifested during active service and the Board grants entitlement to service connection for hypertension. 38 U.S.C. §§ 1110, 1111; 38 C.F.R. §§ 3.303(d). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Miller, 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.