Citation Nr: 21032775 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-11 175 DATE: May 27, 2021 ORDER Entitlement to service connection for hypertension, to include as due to exposure to asbestos and/or photographic chemicals is denied. FINDING OF FACT The most probative evidence of record does not support the finding that the Veteran's hypertension had its onset in service, manifested within one year following service discharge, and/or that it is otherwise related to service. CONCLUSION OF LAW The criteria to establish service connection for hypertension, to include as due to exposure to asbestos and/or photographic chemicals, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1978 to February 1985. This matter comes before the Board of Veteran's Appeals (Board) from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in January 2019 when the claim was remanded for development. The Board finds the January 2019 remand directives have been substantially complied with, and the matter is again before the Board. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran's pending appeal pertaining to the effective date of the award of service connection for tension headaches and sinusitis will be addressed in a separate Board decision. Entitlement to service connection for hypertension, to include as due to exposure to asbestos and/or photographic chemicals The Veteran seeks service connection for hypertension. In favor of his claim, the Veteran asserts that his hypertension is related to his service, to include his in-service exposure to asbestos and/or photographic chemicals. See NOD; correspondence pertaining to photographic chemicals dated April 2014 and associated with the claims file in May 2014; see also Correspondence of July 2018 containing an article on association between asbestos exposure and cardiovascular diseases. Generally, service connection may be established for a disability resulting from disease or injury in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). To establish service connection for a disability, there must be (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 be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as hypertension, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Alternatively, even if a chronic disease is not shown within one year of discharge, service connection may be established by showing continuity of symptomatology. Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); see also Davidson v. Shinseki, 581 F.3d 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). However, the Federal Circuit held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In the present case, the Board finds that the preponderance of the evidence is against the finding that the Veteran's hypertension had its onset in service, manifested within one year following service discharge, or is otherwise related to service. The Veteran's service treatment records (STRs) and post-service medical records have been associated with the claims file. The Veteran has a current diagnosis of hypertension. See Hypertension Disability Benefits Questionnaire (Hypertension DBQ) dated October 2019, associated with the claims file in November 2019. As such, his claim surpasses the first prong of the Shedden service-connection test, a current disability. The Veteran's STRs show various blood pressure readings throughout his service; most of which were within normal limits. See STRs generally. Notwithstanding, the Board notes that in August 1982, his blood pressure was recorded as 150/86 and in February 1984, his blood pressure was noted as 140/90. See STRs for August 1982 and February 1984. Additionally, the Veteran's military personnel records show that his military occupational specialty (MOS) was as a photographer. This MOS has a minimal risk of exposure to asbestos. M21-1.IV.ii.1.I.3.c. Additionally, as the Veteran has asserted in his various statements in favor of his claim, he was exposed to photograph developing chemicals during his service. In light of these circumstances, the Board concedes that the Veteran had at least minimal exposure to asbestos and had exposure to photograph developing chemicals during service. Accordingly, the Veteran's claim surpasses the second prong of the Shedden service connection test, the in-service incurrence, as his STRs reveal at least 1 abnormal blood pressure reading during service and his exposure to asbestos and photograph developing chemicals have been conceded. Now, the questions that remain before the Board are whether the Veteran's hypertension had its onset in service or is otherwise related to his service, to include his conceded exposures; the nexus requirement of the Shedden service connection test. In February 2016, a VA medical opinion was associated with the claims file. The examiner, after reviewing the evidence of record, to include the Veteran's STRs and other records; opined that the Veteran's hypertension is less likely than not related to his in-service exposures. In favor of this opinion, the examiner noted that no expert medical literature had been found causally linking exposure to potassium dichromate, or other photographic chemicals, to the development of hypertension. See VA medical opinion, associated with the claims file in February 2016. The Board finds this medical opinion adequate for adjudication purposes and assigns it high probative value. In March 2018, a second VA medical opinion was associated with the claims file. In this opinion, the examiner opined that the Veteran's hypertension less likely than not had its onset during service and is less likely than not causally or etiologically related to his service, to include any symptomatology, event, or incident therein. In favor of this opinion, the examiner noted that the blood pressure readings noted in the Veteran's STRs were not sufficient to show a chronic condition of hypertension during service. She noted that the STRs were silent for evidence diastolic blood pressure predominantly 90mmHg or greater, or for systolic blood pressure predominantly 160mmHg or greater. She also noted that the STRs were silent for evidence of a diagnosis of or treatment for a chronic hypertension condition. The examiner addressed the Veteran's abnormal blood pressure readings as shown in the STRs for August 1982, and February 1984, and noted that although they meet the minimum values for elevated diastolic blood pressure (90mmHg), subsequent blood pressure recordings during service were normal. Additionally, the examiner noted that although the Veteran's post-service medical records showed that in 2007 he reported a history of "some high blood pressure over the years"; that the record is silent for objective evidence to support a diagnosis of hypertension before 2012. She also noted that although the Veteran was started on Metoprolol prior to 2012, a medication commonly used to treat hypertension, that the indication for the medication was the Veteran's coronary syndrome and recent angioplasty at the time; as the records noted metoprolol was to be tapered and discontinued after three months of post-surgical therapy. The examiner further noted that the first objective evidence to support a diagnosis of chronic hypertension was in January 2012, when the Veteran was treated with lisinopril for hypertension. She further opined that there is no evidence of record to show any relationship between the Veteran's exposures or conditions in service and his current condition of hypertension. Additionally, she expressed agreement with the February 2016 medical opinion as the available evidence-based medical literature is silent for chronic hypertension resulting from a period of chemical exposures. See medical opinion, associated with the claims file in March 2018. The Board finds this medical opinion adequate for adjudication purposes and assigns it high probative value. Additionally, following the October 2019 Hypertension DBQ, the examiner who examined the Veteran opined that it is less likely than not that the Veteran's exposure to asbestos or photographic chemicals, contributed significantly to his hypertension. In favor of this opinion, the examiner noted the evidence the Veteran submitted pertaining to the various chemicals he was exposed to and their carcinogenic nature, as well as studies showing an increased risk of cardiovascular related diseases in persons exposed to asbestos. However, the examiner pointed out that he had been unable to find any information linking the chemical potassium dichromate to an increased risk of heart disease or hypertension. Further he pointed out that although some studies did find an increased risk of cardiovascular related diseases to asbestos exposure, there is no specific mention of an association between asbestos and hypertension. He also noted that the term "cardiovascular diseases" typically implies coronary artery disease (narrowed coronary arteries) and associated sequela (like myocardial infarction) but does not typically imply systemic hypertension. See medical opinion, dated October 2019, associated with the claims file in November 2019. The Board finds this medical opinion adequate for adjudication purposes and assigns it high probative value. Based on the above, the Board finds that Veteran's claim fails to surpass the third prong of the Shedden service connection test, the nexus requirement; as the most probative evidence of record does not support the finding that the Veteran's hypertension is related to his service, to include his conceded exposures. In the present case, various medical professionals have addressed the Veteran's assertions of his hypertension either originating in service or being related to his in-service exposures of asbestos and/or photograph developing chemicals. The March 2018 medical opinion explains that although the Veteran's STRs show 2 abnormal blood pressure readings during service; that these readings are not sufficient to establish a diagnosis of hypertension during service and that the condition was officially diagnosed in 2012; many years after the Veteran's separation from service. Further, the February 2016 and October 2019 medical opinions addressed the Veteran's assertions that his exposure to asbestos and photograph developing chemicals could have caused his hypertension. The examiners reviewed the existing medical literature and opined that although some literature does suggest an increased risk for cardiovascular related diseases for asbestos-exposed workers, that such findings do not specifically apply to hypertension. Additionally, these opinions also noted that the medical literature does not support a link between hypertension and exposure to photograph-developing chemicals. The Board is sympathetic to the Veteran's sincere belief that his hypertension is related to his service. However, the most probative evidence of record does not support that conclusion. Additionally, although the Veteran is competent to report symptomatology, he is not competent to provide a medical opinion as to the etiology of his hypertension or to diagnose himself with the condition during service, which requires specialized knowledge or training. See Layno v. Brown, 6 Vet. App. 465, 470 (1994); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Accordingly, for the reasons explained above, the Board finds that the preponderance of the evidence is against the finding that the Veteran's hypertension originated in service or is etiologically related to his service; to include his conceded exposures. As the preponderance of the evidence is against the claim, the claim must be denied, and the benefit of the doubt is not for application. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinksi, 1 Vet. App. 49 (1990). (Continued on the next page) In reaching this conclusion the Board has also considered whether the evidence supports a finding of continuous symptomatology. However, the medical records available do not support the finding of continuous symptomatology, as the evidence does not support a diagnosis of hypertension until 2012 and prior to that the record does not contain sufficient evidence to show a continuity of symptomatology to include abnormal blood pressure readings since service or within the applicable presumptive period. Thus, the most probative evidence of record does not support the finding that the Veteran's hypertension had its onset in service or that it manifested to a compensable degree within the applicable presumptive period with continuity of symptomatology, to warrant service connection on a presumptive basis. Therefore, as the preponderance of the evidence is against the finding of in-service onset or continuous symptomatology, entitlement to service connection for hypertension to include as due to exposure to asbestos and/or photographic chemicals is not warranted on a presumptive basis. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Gonzalez-Maldonado 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.