Citation Nr: 21024794 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 14-03 186 DATE: April 26, 2021 ORDER Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for right wrist carpal tunnel syndrome, to include as secondary to service-connected right elbow disability, is remanded. Entitlement to service connection for a left wrist carpal tunnel syndrome, to include as secondary to service-connected right elbow disability, is remanded. FINDING OF FACT The preponderance of the evidence weighs against a finding that the Veteran’s hypertension was incurred in or is otherwise related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty from August 1989 to November 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2011 and January 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony before the undersigned Veterans Law Judge in January 2017. The Board of Veterans’ Appeals (Board) issued a decision denying the claims listed above as well as increased rating claims for a right elbow disability in October 2017. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (CAVC). In August 2018, the Court issued an Order, granting a joint motion for partial remand (JMPR), remanding the claims to the Board for action consistent with the JMPR. The Board remanded the matters for development, consistent with the JMPR, in April 2019 and rendered a decision regarding the right elbow increased rating claim in November 2020. As such, the only issues before the Board are the service connection claims noted above. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for hypertension, to include as due to service in Southwest Asia. The Veteran asserts that his hypertension is related to his military service. The record indicates that the Veteran has a diagnosis of hypertension. As such, a current disability has been shown. Regarding the second element of service connection, the Veteran’s STRs contain occasional elevated blood pressure readings during his active duty service. However, STRs do not show the Veteran was ever treated for or diagnosed with hypertension during his active duty service. The earliest post-service medical record that mentions hypertension is from October 2000, two years after the Veteran’s discharge from duty, which shows an assessment of “obesity and [hypertension]” in the context of notes regarding health maintenance and patient education. A July 2002 record also indicates a diagnostic impression of hypertension. An August 2002 medical record shows the Veteran denied having hypertension and stated his blood pressure is “normally [] down” and “has been up sometimes.” In March 2003, an impression of hypertension was noted again, and the Veteran was again described as being “obese.” The Veteran was afforded a VA examination for hypertension in December 2013. The examiner noted the scattered and inconsistent elevated blood pressure readings reflected in the Veteran’s STRs and explained that these reading were accompanied by complaints of pain or acute illness, which are specifically noted in the examination report and shown in the record. The examiner also noted that the Veteran’s discharge examination report noted a blood pressure reading of 122/74 and that it did not contain any indication of any complaints of or treatment for hypertension. The examiner further explained that a transient elevated blood pressure is not uncommon and does not carry the same implications, medically, as essential hypertension. However, as the examiner did not address the headaches the Veteran claims he had during service and whether these were manifestations of his hypertension, the Board remanded the issue in November 2020 in order to address this deficiency. In the November 2020 VA medical opinion, the examiner stated that the Veteran’s hypertension was less likely than not due to his military service or exposure to toxins while service in Southwest Asia. The examiner explained that hypertension is a very common condition in obese males, such as the Veteran, and that his modest hypertension condition does not result in headaches, and headaches occur with “end organ damage in a hypertensive emergency.” As such, the headaches in service were less likely than not manifestations of the Veteran’s hypertension. The examiner further explained that the Veteran also has a diagnosis of metabolic syndrome (in addition to hypertension), which includes increased blood pressure readings as a symptom, and the Veteran’s high body mass index (BMI) and elevated blood sugar levels are risk factors and additional symptoms of metabolic syndrome. While there is evidence of the Veteran having elevated blood pressure readings while on active duty service, there is no evidence of any diagnosis of hypertension or any other related condition while the Veteran was in service. Nor is there any diagnosis of hypertension or a related condition within one year of the Veteran’s discharge. While the Veteran claims that his hypertension was incurred during his service and could be related to his in-service headaches, the medical records do not support that contention, and the VA examinations and opinions of record explicitly refute that contention. In addition, the Board notes that hypertension is a cardiovascular disorder that can only be diagnosed pursuant to testing procedures laid out in 38 C.F.R. § 4.104, Diagnostic Code 7101, and the Veteran is not competent to provide evidence as to hypertension absent the training or credentials needed to administer such testing. In sum, the Board finds that the Veteran’s lay statements of record are outweighed by the persuasive rationale provided in the VA opinions of record. To the extent that the Veteran has been shown to be competent to opine on symptoms and matters of personal observation, respectively, the Board finds that the opinion of the VA medical examiners are of greater probative weight than the lay statements of record, and the Veteran is not shown to have the training or credentials to provide a competent medical opinion on the etiology of his hypertension, as that requires medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The VA examiners have training, knowledge, and expertise upon which was relied upon to reach the above determinations, and the opinions reflect a comprehensive, accurate, and reasoned review of the entire evidentiary record. Thus, the VA medical opinions outweigh the lay statements of record. Ultimately, the preponderance of evidence is against a finding that the Veteran’s hypertension is related to his active service. The Board finds that the November 2020 VA opinions is the most probative evidence with respect to the claim, given the examiner’s training and credentials, and the review of the claims file. As such, the benefit-of-the-doubt doctrine does not apply in this case, and service connection for hypertension must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Entitlement to service connection for bilateral wrist carpal tunnel syndrome is remanded. Pursuant to the November 2020 Board remand, the Veteran was provided a VA examination in November 2020. The examiner reviewed, cited, and considered the evidence in the claims file. The VA opinion addressed and provided a rationale regarding why the Veteran’s bilateral wrist carpal tunnel syndrome was not causally related to his service-connected right elbow disability; however, there is no opinion of record that addresses aggravation. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). Thus, the Board finds that a remand is necessary to obtain an addendum opinion with a complete rationale as to whether the Veteran’s bilateral wrist carpal tunnel syndrome, particularly the right wrist, is aggravated by his service-connected right elbow disability. The matters are REMANDED for the following action: Arrange for an addendum opinion (examination if necessary) from the November 2020 examiner or another appropriate medical examiner that addresses whether the Veteran’s bilateral wrist carpal tunnel syndrome was caused by or aggravated beyond its natural progression by his service-connected right elbow disability. In providing a response, the examiner should review the entire claims file and provide a rationale with supporting evidence. The VA examiner is cautioned that the term “aggravated,” as used in 38 C.F.R. § 3.310 (b), does not require that there be “permanent worsening” of the nonservice-connected disability. Instead, secondary service connection is warranted for “any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.” See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ariasaif, 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.