Citation Nr: 21029440 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-38 561 DATE: May 13, 2021 ORDER Service connection for hypertension, including as secondary to the service-connected low back disability, is denied. FINDINGS OF FACT 1. The Veteran has a current diagnosis of hypertension. 2. Symptoms of hypertension were not chronic in service, were not continuous since service separation, and were not shown to a compensable degree within one year of service separation. 3. Hypertension was not incurred in service and is not etiologically related to service. 4. The hypertension is not caused or worsened in severity by the service-connected low back disability. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the Appellant, served on active duty from August 1979 to September 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision from the Regional Office (RO), which, in pertinent part, denied service connection for hypertension. This matter was previously before the Board in November 2018 and April 2020. In April 2020, the Board remanded the issue on appeal for additional development to obtain an addendum VA medical opinion. The Board finds that the Agency of Original Jurisdiction (AOJ) substantially complied with the April 2020 Board Remand directives. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). The Board finds that the duties to notify and assist in this case have been fulfilled. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. Service Connection for Hypertension is Denied. The Veteran contends that service connection for hypertension is warranted as secondary to the service-connected low back disability. The Veteran has not advanced any other theory of service connection for hypertension. See May 2014 Statement in Support of the Claim. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires evidence of: (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 in or aggravated by service. The Veteran is currently diagnosed with hypertension, which is considered a "cardiovascular disease" recognized as a "chronic diseases" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309 apply to the claim for service connection for hypertension. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(c). Establishing service connection on a secondary basis essentially 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. 38 C.F.R. § 3.310(c). The evidence shows a current disability of hypertension. See September 2014, December 2019 VA examination reports. After reviewing all the lay and medical evidence of record, the Board finds that the weight of the lay and medical evidence demonstrates that hypertension, which began after service, is not related to active service or the service-connected low back disability. Regarding presumptive service connection, the Board finds that the weight of the evidence shows that symptoms of hypertension were not chronic in service, were not continuous since service, and did not manifest to a compensable degree within one year of service. The weight of the evidence is against finding that symptoms of hypertension were "chronic" in service. The service treatment records do not reflect any history, complaints, symptoms, diagnosis, or treatment of a hypertension during service. Service treatment records show that blood pressure readings were consistently within normal limits, as systolic reading raged between 108 to 120 and diastolic blood pressure readings ranged between 64 to 80. See July 1979, July 1980, July 1981, April 1982, May 19825, March 1983 service treatment records. The Board next finds that the weight of the evidence is against finding that symptoms of hypertension were "continuous" since service separation. Post-service treatment notes are silent for complaints or symptoms of hypertension for many years after service separation. The record is silent for any clinical signs or symptoms hypertension until 2014, 31 years after service separation, when an elevated blood pressure reading of 180/100 was noted. See April 2014 private treatment record. Additionally, during the September 2014 VA examination, the Veteran reported that he has never been diagnosed with hypertension, but that he was taking medication for high blood pressure. In July 2019, the Veteran reported that he was first diagnosed with hypertension 15 years earlier, that is approximately 2004, though he could not recall the date. See September 2014, July 2019 VA examination reports. Post-service treatment records only show that the current hypertension is managed with medication but does not reflect lay reports of symptoms of hypertension during service or continuous symptoms since service separation. This same evidence also shows that symptoms of hypertension did not manifest to a compensable degree within one year of service separation. As to the theories of direct and secondary service connection, the Veteran has not provided a medical nexus opinion that indicates a relationship between hypertension and active service or the service-connected low back disability. A May 2020 VA treatment record shows that the Veteran reported that he believes his hypertension may be related to low back pain; however, the Veteran also reported that he likely consumes too much sodium, as he only drinks Pepsi throughout the day and he owns a food truck and serves a lot of smoke and heavily seasoned foods. The record also shows that the Veteran has a history of obesity. The record shows that the Veteran has been counseled about his sodium intake and obesity; however, no treating or examining physician of record has opined that the current hypertension was caused by or incurred in active service or is the proximate result of or aggravated by the service-connected low back disability. See May 2020, July 2016 VA treatment records. As for the Veteran's assertion that his hypertension may be related to the service-connected low back disability, as a lay person, the Veteran is competent to report any hypertension symptoms he experienced at any given time; however, under the specific facts of the case that show no in-service hypertension symptoms, no hypertension symptoms until almost 31 years after service, and lay reports of other risk factors for the development of hypertension such as sodium intake and obesity, the Veteran does not have the requisite medical training or credentials to be able to render a competent medical opinion regarding the cause of the Veteran's hypertension. The etiology of hypertension requires medical expertise and falls outside the realm of common knowledge of a lay person. The etiology of the Veteran's hypertension is a complex medical etiological question dealing with the origin and progression of the hypertension disease and is diagnosed primarily on clinical findings and physiological testing rather than observation by the five senses. For these reasons, the Veteran's unsupported lay opinion under the specific facts of this case that include no in-service injury, diagnosis, or symptoms of hypertension; no hypertension symptoms until years after service; no medical nexus indicating and correlation between hypertension and the service-connected low back disability; and the presence of other, post-service risk factors, is of no probative value. A VA addendum medical opinion was provided in May 2020. The VA examiner opined that it is less likely than not that hypertension was incurred in or caused by active service. The VA examiner explained that there is no evidence of hypertension while in service or proximate to service as the Veteran's blood pressure was 110/64 in January 1982, 120/80 in April 1982 and was 124/72 in March 1983. The examiner noted that although no onset date is noted on the earlier disability benefits questionnaire, the veteran was on medication as of 2014. Therefore, it is less likely than not that the veteran's hypertension arose in service or is due to events in service. See May 2020 VA examination report As to the theory of secondary service connection, the VA examiner in May 2020 opined that it is less likely than not that the current hypertension was caused by or aggravated by the service-connected low back disability, to include as due to medications used to the treat the service-connected disability. The examiner explained that orthopedic conditions, including degenerative changes of the spine, do not cause hypertension, and there is no physiologic or anatomic mechanism by which an orthopedic condition of the spine would cause hypertension. This applies to the medications used to treat the back conditions. The examiner noted that this is accepted medical knowledge and practice. Further, the Veteran has been diagnosed with essential hypertension, which implies no secondary cause. Age, heredity, salt intake and metabolism, weight and BMI, along with other factors, contribute to hypertension. Moreover, there is also no anatomic or physiologic mechanism by which the veteran's hypertension would be aggravated by an orthopedic condition of the spine, to include degenerative changes. The examiner noted that the blood pressures readings on the two VA exam reports are similar, 139/75 in 2019 and 134/85 in 2014. The veteran was on equivalent doses of medication at both exams. Additionally, there is no end-organ damage attributed to hypertension. Therefore, there is no objective evidence of aggravation. Considered in light of the records as a whole, the Board finds the May 2020 VA opinion to be of highly probative value, as it is based on an accurate history of the Veteran's medical condition, considers other risk factors for the development of hypertension, and is supported by a rationale which does not support a probable causal relationship between the Veteran's hypertension and active service or the service-connected low back disability. There is no medical nexus opinion of record that supports an etiological relationship between the Veteran's hypertension and service, to include as secondary to the service-connected low back disability. Based on foregoing, the weight of the competent and credible evidence demonstrates no relationship between the current hypertension that began years after service or the service-connected low back disability. As the preponderance of the evidence is against service connection on all theories of service connection; therefore, the claim for service connection for hypertension must be denied. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Moore, Shanna 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.