Citation Nr: 21028945 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 14-42 921 DATE: May 12, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II, is denied. FINDING OF FACT Hypertension was not incurred in service, is not otherwise caused by service, and was not caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the United States Air Force from August 1971 to August 1975. This matter comes before the Board of Veterans' Appeals (Board) from an August 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge by videoconference in July 2017; a transcript is associated with the claims file. The Board remanded the above claim in May 2018. In addition, the Board remanded the issues of entitlement to service connection for right and left upper and lower extremity peripheral neuropathy. In a September 2019 rating decision, the VA Appeals Management Center (AMC) granted entitlement to service connection for right and left upper and lower extremity radiculopathy and assigned separate ratings and effective dates for the disabilities. The foregoing constituted complete grants of benefits as to the foregoing disabilities and they are no longer in appellate status. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 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." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection also is warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends that his current hypertension was incurred in service, was otherwise caused by service, or was caused or aggravated by his service-connected diabetes mellitus. Blood pressure measurements are expressed as systolic divided by diastolic pressure in millimeters of mercury (mmHg). The Veteran's service treatment records include a blood pressure reading of 114/70 in his August 1971 Report of Medical Examination at entrance into service. In January 1972, the Veteran had a blood pressure of 130/100 during a period when he was experiencing stomach pain, dizziness, and vomiting. The Veteran had a blood pressure reading of 134/70 at the time of his December 1974 Report of Medical Examination. In a contemporaneous Report of Medical History, the Veteran denied a history of high or low blood pressure. A December 1974 Report of Medical History also included the Veteran's denial of a history of high or low blood pressure. A December 1974 Report of Medical Examination also included a blood pressure finding of 134/70. In his July 2010 claim, the Veteran claimed that his hypertension was secondary to his diabetes mellitus. The Veteran testified at a July 2017 Board hearing. At that time, he appears to have suggested that he had hypertension problems from service and that he started having problems with and was diagnosed with diabetes mellitus in the 1980s or 1990s. The Veteran underwent a June 2019 VA diabetes mellitus examination wherein the examiner indicated that the Veteran's complications of diabetes mellitus, type II, were diabetic peripheral neuropathy and erectile dysfunction. The examiner did not indicate that hypertension was a complication of the diabetes mellitus. The Veteran also was afforded a VA examination for hypertension in June 2019. The examiner noted a diagnosis of hypertension. The Veteran reported he was diagnosed with hypertension in the late 1980s or early 1990s by his private primary care provider. He had been on medication since that time. Following examination, the examiner concluded that it was less likely than not that the Veteran's hypertension is causally or etiologically related to service. In addition, it was less likely than not that the Veteran's hypertension was caused or aggravated by his service-connected diabetes mellitus. The rationale noted that the Veteran's service treatment records did not show a diagnosis of hypertension during service. There was a single elevated diastolic reading, but that did not establish hypertension. The examiner noted that it was unclear from a review of the records when the hypertension was formally diagnosed. The Veteran reported that his hypertension had been treated from the 1990s, but review of the private medical records showed a diagnosis in 2001 or 2002. The Veteran had been diagnosed with diabetes mellitus was around the same time. The examiner found it significant that current labs revealed normal serum creatinine and urinalysis. There was no evidence of renal disease associated with his diabetes currently. The examiner found it significant that the Veteran was obese with a body mass index of 36.9. "Review of the medical literature in UpToDate reveals that hypertension is common in patients with type II diabetes and is strongly correlated with presence of obesity. Obesity is a known risk factor for development of both hypertension and diabetes type II. Therefore it is more likely that the veteran's hypertension is related to his known risk factor of obesity than related to his diabetes which is not complicated by renal disease." Thus, the Veteran has a current diagnosis of hypertension. The crucial question, therefore, is whether the Veteran's hypertension was incurred in service, otherwise caused by service, or was caused or aggravated by a service-connected disability, specifically his diabetes mellitus, type II. The Board concludes it was not. As to granting the claim on a direct basis, the Veteran has not specifically alleged in-service onset or that the hypertension otherwise was caused by service. The Board acknowledges the single notation of a diastolic blood pressure of 130/100; however, the June 2019 examiner concluded that the single blood pressure reading was insufficient to demonstrate hypertension. Given the foregoing and the normal blood pressure reading at separation and the Veteran's denial of a history of high or low blood pressure prior to separation, the Board finds no basis for granting the Veteran's claim on a direct basis. As to granting the claim on a secondary basis, the Board finds the conclusions of the June 2019 VA examiner of significant probative weight. The examiner concluded that while diabetes mellitus is a risk factor for hypertension, the Veteran's obesity was the most likely cause of his hypertension. The reason for this conclusion was that hypertension was associated with diabetes, but that obesity was "strongly correlated" with the development of hypertension. As the examiner provided a thorough rationale for the opinion provided that was based on a review of the claims file, interview of the Veteran, and physical examination, the Board finds this opinion the most probative evidence of record. The sole evidence in support of his claim are the Veteran's lay contentions. Given the medical complexity of linking hypertension to the Veteran's service-connected diabetes mellitus and the greater level of education, training, and experience of the June 2019 VA examiner, the Board affords the examiner's opinion far greater probative weight. Cf. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim for entitlement to service connection must be denied. See 38 U.S.C. § 5107(b); see generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.