Citation Nr: 21029506 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-62 230 DATE: May 13, 2021 ORDER Service connection for hypertension is denied. FINDING OF FACT The Veteran's hypertension is not proximately due to, or the result of, or aggravated by the Veteran's service-connected residuals of fractured of the left tibia and fibula and left foot fracture residuals (left leg disabilities), to include with consideration of obesity as an intermediate step. CONCLUSION OF LAW The criteria for service connection on any basis for hypertension are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from January 1971 to January 1973. This matter is before the Board of Veterans' Appeal (Board) on appeal from an October 2015 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in November 2019. A transcript of the hearing is in the Veteran's file. The Board previously remanded the appeal in April 2020. Specifically, the Board sought an adequate opinion as to various questions regarding the Veteran's hypertension and its possible relationship to his service or to service-connected disabilities. As explained more fully in this decision, the Board finds that an adequate opinion has been obtained. Accordingly, there is substantial compliance with the Board's remand instructions, and the case may move forward. Entitlement to service connection for hypertension. The Veteran is pursuing secondary service connection for hypertension. The Board will limit its analysis accordingly. The Veteran contends that his hypertension is due to weight gain caused by the inability to exercise due to his service-connected residuals of fractured of the left tibia and fibula and left foot fracture residuals (left leg disabilities). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 C.F.R. § 3.310. Further, the Board must also consider whether obesity may serve as an "intermediate step" in the secondary service connection framework. Obesity can be considered "an intermediate step" for service-connection if the evidence shows that a service-connected disability "caused the veteran to become obese" and the obesity caused by the service connected disability "was a substantial factor in causing" the current disability, and that the current disability "would not have occurred but for" the obesity caused by the service-connected disability." VA Off. Gen. Couns. Prec. Op. 1-2017. As to the first element of secondary service connection, current disability, the record indicates that the Veteran has a diagnosis of hypertension. Therefore, this element is met. Review of the record indicates that the Veteran is service connected for left leg disabilities. Therefore, the question for the Board is whether the Veteran's service-connected left leg disabilities were an immediate step to obesity, which he contends caused or aggravated his hypertension. The Veteran was afforded a December 2017 VA examination to determine the nature and etiology of his hypertension. The Board, however, found the December 2017 VA medical opinion to be inadequate in its April 2020 remand. As such, the claim was remanded for another opinion addressing the Veteran's contentions related to his hypertension. The August 2020 VA opinion provides that the Veteran's hypertension is less likely than not proximately due to or the result of the Veteran's service-connected left leg disabilities, to include as an immediate step to his obesity. The VA examiner noted that her review of medical literature that post-service weight gain is age-related due to the decline in serum testosterone in older men that is associated with an increase in fat mass and decrease in muscle mass. The VA examiner highlighted that overeating relative to energy expenditure will uniformly cause obesity and that many factors contribute to the development of obesity over time, such as behavioral, medical, lifestyle, and diet. Sedentary lifestyle combined with a diet high in partially hydrogenated fats, red or processed meats, refined carbohydrates, and sugar. The VA examiner stated that there are many non-weight bearing strength, flexibility, and cardio exercises that allow enough activity to offset weight gain. Moreover, the VA examiner opined that there is no peer reviewed, authoritative orthopedic, and/or medical literature that endorses that the Veteran's service-connected left ankle condition, residuals of left tibia and fibula, and traumatic arthritis of the left foot as causes or significant risk factor for obesity and hypertension. As such, the VA examiner found that the Veteran's hypertension/obesity was less likely than not proximately due to caused or aggravated by the Veteran's service-connected left leg disabilities. In this case, as to the issue of whether the Veteran's hypertension is proximately due to or the result of the Veteran's service-connected left leg disabilities, to include as an immediate step to his obesity, the Board finds that the August 2020 VA medical opinion is the most probative evidence of record as it was definitive, based upon a complete review of the Veteran's entire claims file, in consideration of the Veteran's reported history, prior physical evaluation of the Veteran, and pursuant to the Board's remand instructions, the August 2020 VA examiner provided a complete and thorough rationale in support of her opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, the Board does not disregard the Veteran's contention that his hypertension was caused or aggravated by his service-connected left leg disabilities, to include as an immediate step to his obesity. However, he lacks the medical expertise to offer a competent etiological opinion. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Rather, greater probative value is afforded to the medical evidence of record. (Continued on next page) Thus, the most probative evidence does not support the finding of a causal link between the Veteran's hypertension and his service-connected left leg disabilities (to include obesity), such that the final element of secondary service connection has not been met. The weight of the evidence is against the Veteran's claim, and there is no doubt to resolve. Service connection for hypertension is therefore not warranted. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Higgins, 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.