Citation Nr: 21030794 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-27 134 DATE: May 19, 2021 ORDER Entitlement to service connection for hypertension as secondary to service-connected degenerative disc disease is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's hypertension began during active service, is related to an in-service injury or disease, is secondary to service-connected back disability or was aggravated beyond its natural progression by his service-connected back disability. CONCLUSION OF LAW The criteria for service connection for hypertension due to service or service-connected back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran has active service from June 1984 to June 1986; August 1990 to April 1991; and January 2005 to February 2005. This case is before the Board of Veterans' Appeals (Board) from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans' Law Judge at a January 2019 hearing. In November 2020, the Board remanded this matter to the RO for additional development. Finding there has been substantial compliance with the Board's remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998), the Board may proceed with appellate review. Also remanded in November 2020 were claims for bilateral plantar fasciitis, and sleep apnea. Because the claims were granted by a March 2021 rating decision, they are no longer in appellate status. (3/02/2021 Rating Decision Narrative). Hypertension. The Veteran has claimed service connection for hypertension as secondary to service-connected degenerative disc disease with thoracolumbar strain status post laminectomy and spinal fusion (10/18/2011 VA 21-4138 Statement In Support of Claim; 1/07/2019 VA 646 Statement of Accredited Representative in Appealed Case). The Veteran contends that his June 2010 back surgery did not work out as well as anticipated, resulting in life and employment changes. At that time, he was diagnosed with high blood pressure, and he believes that it is related to the stress of all these changes. (1/31/2019 Hearing Transcript, pg.16). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Secondary service connection may be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310 (b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). In addition, where a veteran asserts entitlement to a chronic disease but there is insufficient evidence of a diagnosis in service, service connection may be established under 38 C.F.R. § 3.303(b) by demonstrating a continuity of symptomatology since service, but only if the chronic disease is listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When a chronic disease manifests to a degree of 10 percent or more within 1 year from the date of separation from service, that disease is presumptively service connected. 38 C.F.R. §§ 3.303 (b), 3.307(a)(3). Hypertension is contemplated as a chronic disease under 38 C.F.R. § 3.309(a). The section provides for cardiovascular-renal disease, including hypertension since hypertension is an early symptom long preceding the development of those diseases in their more obvious forms, a disabling hypertension within one year period will be given the same benefit of service connection as any of the chronic diseases listed. 38 C.F.R. § 3.309(a). Here, the Veteran has a current diagnosis of hypertension (7/17/2013 VA Examination, pg. 3), and is service connected for degenerative disc disease with thoracolumbar strain status post laminectomy and spinal fusion (10/05/2020 Rating Decision-Codesheet). Of record is an August 2011 letter from a treating physician confirming the Veteran's one-year history of hypertension. The Veteran's July 2013 VA examination for hypertension also confirms a 2010 diagnosis with hypertension (10/18/2011 Medical Treatment Record - Non-Government Facility, pg. 3; 7/17/2013 VA Examination). The Veteran's service treatment records, to include physical examinations and post deployment surveys, do not reflect complaints or diagnosis of hypertension. While not dispositive, this weighs against a finding of in-service onset. Additionally, the Veteran in this case has not contended his currently diagnosed hypertension began during service or, as a chronic disease, manifested to a compensable degree during the presumptive period. The medical evidence of record does not suggest continuity of symptomatology since service. In a 2008 chiropractic note, the Veteran denied hypertension, which is consistent with his hearing testimony that onset of his hypertension was in 2010, years after his active service (05/27/2010 Medical Treatment Record - Non-Government Facility, pg. 71; 01/31/2019 Hearing Transcript, pg. 17). The evidence does not suggest the Veteran's hypertension began during service or, as a chronic disease, manifest to a compensable degree during the presumptive period. Accordingly, service connection on a direct or presumptive basis is not warranted in this case. The Board turns to the whether the Veteran's hypertension is proximately due to or the result of or was aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current disability, the preponderance of the evidence is against finding that the Veteran's hypertension is proximately due to, the result of, or was aggravated beyond its natural progression by his service-connected back or mental health disabilities. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran was afforded a July 2013 VA examination for hypertension. After an in-person examination and review of the Veteran's file, the examiner opined it is less likely as not that the Veteran's hypertension is proximately due to or the result of degenerative disc disease of the thoracolumbar spine, with right lower extremity radiculopathy, status post laminectomy and fusion. The examiner noted that the Veteran has become rather anxious about his lower back problems, as was manifested at that time by his high level of anxiety. However, the examiner explained that this should only cause transient rises in his blood pressure. The examiner noted that the Veteran is not obese and does not have any other metabolic diseases, such as diabetes or thyroid problems currently (7/17/2013 VA Examination, pg. 5). The Veteran was afforded a January 2021 VA examination for hypertension. The examiner opined the Veteran's hypertension was not aggravated beyond its natural progression secondary to Veterans degenerative disc disease with thoracolumbar strain status post laminectomy and spinal fusion. The examiner explained the Veteran's pain may cause transient elevation of blood pressure but would not result in continued elevated blood pressure. The examiner also addressed other risk factors for hypertension that the Veteran possessed. The examiner also explained that arterial stiffness, as opposed to a back disability, is the major cause of elevated systolic blood pressure and pulse pressure, as well as lower diastolic blood pressure in older adults (2/02/2021 C&P Exam; 02/01/2021 C&P Exam). Taken together, the Board finds the July 2013 and January 2021 medical opinions to be the most probative evidence of record and weigh against the Veteran's claim. The opinions are based on a comprehensive review of the Veteran's case and history, to include an in-person examination, claims file and medical records, as well as lay statements of record. The January 2021 also provided a link to medical literature regarding hypertension management and changes in blood pressure during the aging process in support of the opinion. The negative nexus opinions are found to be highly probative and assigned significant weight against the Veteran's claim. The Veteran believes his hypertension is related to his service connected back disability and associates the onset of the hypertension as being with his disappointment with the outcome of his back surgery. The Veteran in this case is not competent to provide a diagnosis or nexus opinion regarding this issue. The issue is medically complex, requiring specialized knowledge of the interaction between multiple organ systems and anatomical relationships. The record does not show that the Veteran possesses the medical training, credentials, or specialized experience to make medical determinations. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board assigns more probative weight to the above described medical evidence of record. As discussed, the record does not suggest, nor does the Veteran contend in-service onset, or that his hypertension manifest to a compensable degree within the presumptive period. Likewise, the most probative evidence weighs against a finding that the Veteran's hypertension is secondary to service-connected back disability or was aggravated beyond its natural progression by his service-connected back disability The Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that it began during active service or is otherwise related to or aggravated by an in-service injury, event, or disease. Accordingly, the Veteran's claim of entitlement to service connection for hypertension as secondary to service-connected degenerative disc disease is denied. Finally, the opinions of record are deemed sufficiently expansive to include consideration of the Veteran's service-connected depressive disorder, as his anxiety over the spine disability was expressly considered. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. A. Myers 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.