Citation Nr: 21030086 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 16-35 468 DATE: May 17, 2021 ORDER Service connection for hypertension is denied. FINDING OF FACT Hypertension is not attributable to service, was not manifest within one year of separation from any period of active duty, and while it preexisted the Veteran's period of service beginning in 2010, it was not aggravated by such service. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1999 to January 2003, and September 2010 to October 2011 in the United States Army. He also served on active duty for training from May 1994 to June 1995, with additional service in the National Guard, including from June 2004 to November 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Board remanded the claim for further development. 1. Service connection for hypertension is denied. VA provides disability compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to show a service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Active military, naval, or air service includes any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in or aggravated in the line of duty, or any period of inactive duty for training (INACDUTRA) during which the individual concerned was disabled from an injury, but not also disease, incurred in or aggravated in the line of duty, or when a cardiac arrest or cerebrovascular accident occurs during such training. 38 U.S.C. §§ 101(21), (24), 106; 38 C.F.R. § 3.6(a), (d). Reserve and National Guard service generally means ACDUTRA and INACDUTRA. ACDUTRA is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). Basically, this refers to the two weeks of annual training, sometimes referred to as "summer camp," which each Reservist or National Guardsman must perform each year. It can also refer to the Reservist's or Guardsman's initial period of training. INACDUTRA includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). Basically, this refers to the twelve four-hour weekend drills that each Reservist or National Guardsman must perform each year and is often referred to as "weekend warrior" training. These drills are deemed to be part-time training. Additionally, for certain chronic diseases, including hypertension, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). For those listed chronic diseases, a showing of continuity of symptoms affords an alternative route to service connection when the requirements for application of the presumption are not met. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). The presumption pertaining to chronic diseases under 38 U.S.C. § 1112 does not apply to ACDUTRA or INACDUTRA service. See Smith v. Shinseki, 24 Vet. App. 40 (2010); Acciola v. Peake, 22 Vet. App. 320 (2008); Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Under VA regulations, hypertension must be confirmed by readings taken two or more times on at least three different days. The regulation also clarifies that the term "hypertension" means that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104 , Diagnostic Code (DC) 7101, Note (1). Additionally, in order for hypertension to be considered compensably disabling, the evidence must show that diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or there is a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. 38 C.F.R. § 4.104, DC 7101. The Veteran has current hypertension, documented on VA examination in December 2019. As determined by VA examiners in March 2013 and May 2016, and as found by the Board in the January 2019 remand, he was diagnosed with hypertension in November 2008. His private physician at the time prescribed Hydrochlorothiazide 25 mg and Lisinopril 20 mg, and his next and final period of military service began in September 2010. As hypertension preexisted the period of service beginning in September 2010, the legal analysis applicable to this period of service is different from that applicable to his earlier periods of service, and will be discussed separately. Service prior to the period beginning in September 2010 The Veteran's service treatment records, including entrance and separation examination reports, for the periods of service prior to that beginning in September 2010 are silent for any indication of hypertension. Blood pressure measurements documented in service treatment records for this time period include the following: 110/80 (March 1992), 122/68 (April 1994), 134/72 (January 1995), 120/78 (January 1996), 120/86 (February 1997), 118/84 (June 1997), 128/66 (February 1999), 114/78 (June 1999), 132/72 (September 1999), 112/78 (December 1999), 132/76 (November 2000), 134/78 (February 2000), 134/86 (May 2000), 127/78 (July 2000), 116/68 (December 2000), 136/63 (March 2001), 128/60 (December 2001), 136/80 (January 2006). As noted, the Veteran was diagnosed with hypertension in November 2008. However, he was not serving on active duty in November 2008. As hypertension is a disease, not an injury, it cannot be service-connected based on a period of INACDUTRA. Additionally, the record does not reflect an onset of hypertension during any period of ACDUTRA. His personnel records have been obtained, and do not indicate any periods of ACDUTRA in November 2008. His service treatment records have been obtained, and there are none dated from November 2008 documenting complaints, treatment, or diagnoses pertaining to hypertension. Rather, service treatment records show that an annual flying duty health screening examination was conducted in November 2008, and the Veteran's blood pressure measurement was 130/88. Hypertension was not documented on an accompanying clinical examination report and no abnormalities of the heart or vascular system were found. The only abnormalities found pertained to elevated cholesterol levels, and he was sent a letter notifying him of such. The service treatment records dated from November 2008 are otherwise silent for any documentation of hypertension; rather, it appears that hypertension was discovered by a private physician in November 2008 who prescribed medication. Records dated subsequent to November 2008 indeed indicate treatment for hypertension. Thus, while hypertension arose in November 2008, it was not during any period of ACDUTRA. On the matter of the etiology of the disability, the record contains VA examination reports of May 2016 and December 2019. While a VA examination was also conducted in in March 2013, the examiner did not address the etiology of the disability. On VA examination in May 2016, the examiner reviewed the claims file and examined the Veteran. He opined that the Veteran's hypertension was less likely than not incurred in or caused by military service, noting that the Veteran underwent yearly physicals during periods of active duty service, as well as during service in the National Guard, with no indication of hypertension until 2008. He noted that the Veteran was not serving on active duty when his hypertension arose, and there was no evidence that training caused high blood pressure. On VA examination in December 2019, the 2016 VA examiner noted that there was no documentation of hypertension in the service treatment records, and the November 2008 high blood pressure measurement was not of record. He found that the file contained no evidence of unusual circumstances in any training periods in 2008, and there is no indication that hypertension was caused or aggravated by military service. Rather, the Veteran has been diagnosed with essential hypertension, and the disability has followed a typical course of development. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the preponderance of the evidence is against the claim. The probative evidence does not show that the current hypertension is related to the Veteran's active military service, or that a chronic disability was incurred during active duty. No pertinent disability was found within one year of separation from the Veteran's period of active duty from January 1999 to January 2003; rather hypertension was not shown until 2008. The medical opinion evidence is also persuasive. The May 2016 and December 2019 VA examiner addressed the contentions of direct service connection, but opined that the Veteran's current hypertension is not related to military service. He explained that the Veteran has essential hypertension. Essential is defined as "idiopathic, said of a disease." Dorland's Illustrated Medical Dictionary at 649 (32nd ed. 2012). Idiopathic is defined as "of unknown cause or spontaneous origin." Id. at 912. Essential hypertension is defined as "hypertension occurring without discoverable organic cause." Id. at 896. The examiner based his conclusions on an examination of the claims file, including service treatment records, post-service treatment records, and diagnostic reports, and provided a rationale for the conclusions reached. The only evidence to the contrary of the VA examiner's opinions is the lay evidence. The Veteran, however, does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of such a medically complex disability as hypertension. See, e.g., Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). In reaching this decision the Board considered the doctrine of reasonable doubt, however, the doctrine is not for application. Period of Service dated from September 2010-October 2011 Veterans are presumed to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that the injury or disease in question existed prior to service and was not aggravated by such service. 38 U.S.C. §§ 1111, 1137. Only such conditions as are recorded in entrance examination reports are to be considered as "noted." 38 C.F.R. § 3.304 (b); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). If a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but he/she may bring a claim for service-connected aggravation of that disorder. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air 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. Under 38 U.S.C. § 1153, the burden falls on the veteran to establish aggravation of the preexisting disorder. Id.; Horn v. Shinseki, 25 Vet. App. 231, 235 (2012). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. 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 C.F.R. § 3.306 (b). On the Veteran's September 2010 entrance examination, the examiner noted that the Veteran had hypertension that was controlled with Hydrochlorothiazide and Lisinopril. Thus, it is clear that the Veteran entered this period of service with preexisting hypertension. At issue is whether the hypertension was aggravated by military service. During this period of service, a health screening was conducted in December 2010, and the Veteran denied having any chronic health problems. His hypertension medications were listed but no further mention of hypertension was made by the Veteran or provider. In a separate Report of Medical Examination, no abnormalities of the heart or vascular system were found. In September 2011, a post-deployment health assessment was conducted. The Veteran reported having no health problems impacting his work or daily activities; the only problem he was having was with muscle aches. In a separate examination report, several conditions were identified that had worsened or developed during deployment, including a cyst, strained calf, and a toenail problem. His hypertension was not included in the list. Shortly following his October 2011 discharge, a January 2012 service examination documented that the hypertension had been under good control. The Veteran's blood pressure was measured to be 130/85. Additionally, as described above, on VA examination in December 2019, the examiner found no indication that hypertension was caused or aggravated by military service. He explained that the Veteran has been diagnosed with essential hypertension, and that the disability has followed a typical course of development. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the Veteran's preexisting hypertension was not aggravated by his period of active duty dated from September 2010 to October 2011. As noted, 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 C.F.R. § 3.306 (b). The Board finds no competent or persuasive evidence that the disability increased during this period of military service. To the contrary, while his hypertension medication was noted on several occasions, no complaints or treatment were rendered for the disability. The Veteran made no mention of any pertinent symptomatology on health assessments, and no examining provider during this time period rendered any findings regarding hypertension itself. In January 2012, shortly after discharge, his hypertension was found to be under good control and his blood pressure measurement was 130/85. This measurement is consistent with those taken years prior to the diagnosis. Accordingly, service aggravation of hypertension must be denied. 38 U.S.C. § 1153; 38 C.F.R. § 3.306; Horn, 25 Vet. App. 231; Wagner, 370 F.3d 1089. (Continued on the next page) In reaching this decision the Board considered the doctrine of reasonable doubt, however, the doctrine is not for application. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.