Citation Nr: 21031221 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 17-32 052 DATE: May 20, 2021 ORDER Entitlement to service connection for hypertension is denied. FINDING OF FACT The Veteran's hypertension is not related to service, to include as secondary to conditions of aortic stenosis or varicose veins. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 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 Marine Corps from June 1976 to June 1979, from June 1980 to April 1985 and from April 1985 to June 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in November 2020. The hearing transcript is of record. In January 2021, the Board remanded the claim to obtain a new medical opinion. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also 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). In the alternative, secondary service connection may be established for a disability that is proximately due to, or the result of, or aggravated by a service-connected disease or injury. Establishing secondary service connection requires evidence of: (1) A current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the current disability was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Entitlement to service connection for hypertension. The Veteran contends that his hypertension is related to service, to include as secondary to service-connected conditions of aortic stenosis or varicose veins. The Veteran's October 1995 service treatment records (STRs) show blood pressure reading of 130/82. September 1993 STRs show blood pressure reading of 123/79. March 1992 STRs show blood pressure reading of 110/70. July 1990 STRs show blood pressure reading of 102/80. February 1994 STRs show blood pressure reading of 110/70. June 1990 STRs show blood pressure reading of 114/70. July 1989 STRs show blood pressure reading of 110/70. November 1988 STRs show blood pressure reading of 92/70. December 1995 STRs show blood pressure of 129/84. March 1983 STRs show blood pressure of 136/83. August 2014 VA treatment records note history of treatment for benign hypertension. In August 2014, a private physician stated that the Veteran has a diagnosis of hypertension. In the associated August 2014 nexus statement, the physician stated that hypertension and aortic stenosis can contribute to left ventricular hypertrophy. Upon remand, an examiner was asked to address whether the opposite is true, that is, whether hypertension is secondary to the Veteran's now service-connected aortic stenosis or varicose veins disabilities, or otherwise related to service. In a January 2021 addendum medical opinion, a VA examiner opined that the Veteran had blood pressure taken multiple times during his service. The examiner stated that on June 1980, November 1984, January 1983, December 1995 and July 1997 medical reports, the Veteran checked no for high or low blood pressure. The examiner stated that although the Veteran had a few isolated incidences of high blood pressure in June 1980 (130/84), July 1985 (140/100) October 1995 (130/82), he was not diagnosed with hypertension in the military. Thus, the examiner stated, it is less likely as not that his hypertension is a continuation of hypertension from the military or secondary to being in the military. The examiner stated that, in August 2014, Dr. D. stated that hypertension and aortic stenosis can contribute to left ventricular hypertrophy; the Veteran underwent aortic valve replacement surgery in October 2014. The examiner then pointed to a November 2020 statement from Dr. P. that the Veteran's significant degeneration of the aortic valve is most likely secondary to his history of recurrent streptococcal pharyngitis and pneumonia infections during his time in the service. The examiner cited to a July 2020 article from the journal of hypertension, which notes that in patients with aortic stenosis, the presence of hypertension negatively affects the hemodynamic severity of the stenosis and worsens left ventricular remodeling. Thus, the examiner concluded, hypertension worsens aortic stenosis, but the examiner did not see any relationship of the reverse that aortic stenosis causes or worsens hypertension. Regarding varicose veins, the examiner explained, varicose veins come about because of venous hypertension; they do not cause hypertension. Thus, the examiner opined, it is less likely as not that his hypertension was caused by or worsened by his service-connected aortic stenosis or varicose veins. After careful review of the claim, the Board concludes that the evidence of record weighs against finding that the Veteran's hypertension is related to service, to include as caused by or aggravated by service-connected aortic stenosis or varicose veins. The examiner considered whether there evidence of record and the Veteran's medical history, and explained that although service-connected aortic stenosis or varicose veins may be caused by hypertension, the reverse is not true and hypertension was also not aggravated by either service-connected disability. Additionally, the examiner explained that the Veteran's hypertension was not related to service on a direct basis because although there were isolated elevated pressure readings, there was no continuation of a service-connected disability. Therefore, no medical link was established. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data based on the evidentiary record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran maintains that his hypertension is related to service. Although the Veteran is credible as to his testimony regarding symptoms, there is no indication that he has the training or expertise to competently opine on the cause of his hypertension. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for hypertension as a chronic disability under 38 C.F.R. § 3.307 (a), as the competent medical evidence of record does not demonstrate that the Veteran's hypertension was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. See 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wilson, 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.