Citation Nr: 21040963 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 15-03 329 DATE: July 7, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) and Barrett's esophagus is denied. FINDINGS OF FACT 1. The Veteran's hypertension did not have its onset during active service or within one-year of discharge from service; the weight of the probative evidence is against finding that the Veteran's hypertension is etiologically related to service. 2. The preponderance of the evidence is against finding that the Veteran's GERD and/or Barrett's esophagus is etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for GERD and Barrett's esophagus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1969 to October 1972. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the claims file. In an April 2020 decision, the Board reopened the claim of service connection for GERD and Barrett's esophagus and remanded the matter as well as the claim of service connection for hypertension for a VA examination and medical opinion. The Board also remanded matters for further development in July 2020 and March 2021. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Hypertension The Veteran seeks service connection for hypertension. He contends that he had elevated blood pressure readings during service and that his hypertension is due to in-service weight gain and/or exposure to jet fuel fumes. Certain chronic diseases, to include hypertension, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). For VA purposes, hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. The term hypertension means the diastolic blood pressure (the bottom number) is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure (the top number) is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. The Board finds that there is no probative evidence supporting the contention that the Veteran's hypertension arose in service or is otherwise etiologically related to service. The Veteran's service treatment records (STRs) do not contain any complaints, symptoms, diagnosis, or treatment for hypertension. Comparing the Veteran's enlistment examination and separation examination, he gained approximately 30 pounds during service. In May 2019, the Veteran submitted a hypertension disability benefits questionnaire (DBQ) that was completed by a private provider. The private provider indicated that the Veteran was diagnosed with hypertension in the 1980s. The Board notes that the Veteran's medical records from the 1980s are not of record and that no etiological opinion was provided. An April 2020 VA examiner opined that the Veteran's hypertension was less likely than not incurred in or etiologically related to service. The examiner indicated that the Veteran's STRs were silent as to any elevated blood pressure readings and there was no in-service injuries, events, diseases, or significant weight gain that put him at risk for developing hypertension. The examiner further indicated that jet fuel exposure is irrelevant with regards to the development of hypertension. An April 2021 VA examiner opined that the Veteran's hypertension was less likely than not incurred in or etiologically related to service. The examiner noted that while the Veteran reported a history of high blood pressure since the 1970s, his STRs documented normal blood pressure on his separation physical and no diagnosis of hypertension was noted. The examiner also noted that on his December 1971 and June 1972 dental patient history, the Veteran indicated that he had not ever been treated for a heart condition or high blood pressure. The examiner indicated that there was no significant weight gain during service that put him at risk of developing hypertension and his STRs were silent as to any evidence that hypertension was ever evaluated, treated, or diagnosed. The examiner stated that while the Veteran reported receiving treatment for his hypertension from 1985, the evidence of record does not reveal any diagnosis until 2001. Specifically, the examiner indicated that the Veteran's private and VA medical treatment records from 1997 to present were reviewed and that the first documentation of hypertension was in July 2001, at which time he was diagnosed with benign hypertension. The examiner indicated that until 2001, the Veteran's blood pressure readings were documented as normal and no medication for hypertension was listed under active medication on any progress notes and his first documented prescription for hypertension was given in 2005 by VA. The Board finds the April 2021 VA examiner's opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, the Board finds that the examiner adequately considered the Veteran's reports that he had elevated blood pressure readings during service and reviewed the medical evidence of record, to include the Veteran's STRs and private and VA medical treatment records, in forming her opinion. Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as to whether the Veteran's hypertension incurred in or is otherwise etiologically related to service. The Board concludes that, while the Veteran has a current diagnosis of hypertension, it was neither chronic in service, nor manifested to a compensable degree in service or within the one-year presumptive period, and continuity of symptomatology is not established. The Veteran's STRs do not contain any complaints, symptoms, diagnosis, or treatment for hypertension. Specifically, the April 2021 VA examiner indicated that the Veteran was not diagnosed with hypertension until 2001, approximately 30 years after separation from service and well outside of the applicable presumptive period. Moreover, the Board finds that the preponderance of the evidence is against finding that the Veteran's hypertension is etiologically related to service. The April 2020 and April 2021 VA examiners opined that the Veteran's hypertension is not due to weight gain during service or exposure to jet fuel fumes therein. The Board notes that neither the Veteran nor his representative have presented or identified any contrary medical opinion or treatment that supports his claim. While the Veteran believes that his hypertension began in service or is etiologically related to service, he is not competent to provide a nexus opinion in this case. The Veteran, as a layperson, is not competent to speak to such medically complex matters, such as the etiology of the claimed disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record, the Board ultimately affords the objective medical evidence of record, to include the April 2020 and April 2021 VA medical opinions, which weigh against finding such a connection, with greater probative weight than the lay opinion. Nieves-Rodriguez, 22 Vet. App. at 304. In sum, the Board finds that the competent and credible evidence of record does not demonstrate that the Veteran's hypertension arose in service, within one-year of service, or is otherwise etiologically related to service. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). GERD and Barrett's Esophagus The Veteran seeks service connection for GERD and Barrett's esophagus. He contends he began to have symptoms of GERD while in service that he self-treated with Tums and Rolaids. Additionally, he contends that his condition is due to in-service exposure to jet fuel fumes. The Board finds that there is no probative evidence supporting the contention that the Veteran's GERD and/or Barrett's esophagus are etiologically related to service. The Veteran's STRs contain emergency room (ER) records from November 5th and 6th, 1971 for stomach pains; he was diagnosed with a gastrointestinal infection. No further gastrointestinal complaints, treatment, or diagnosis are of record. The Veteran's 1998 private medical treatment records note diagnosis of GERD and Barrett's esophagus. A July 2011 VA examiner opined that the Veteran's condition was less likely than not incurred in or caused by service. The examiner reasoned that it was unlikely that exposure to fumes would cause GERD and/or Barrett's esophagus. The examiner further noted that while exposure may have caused symptoms during active exposure there is no nexus between that exposure and the development of the Veteran's current GERD and Barrett's esophagus. In May 2019, the Veteran submitted an esophageal conditions DBQ that was completed by a private provider. The private provider indicated that the Veteran was diagnosed with GERD in 1985 and Barrett's esophagus in 2004. No etiological opinion was provided. The Board once again notes that the Veteran's medical records from the 1980s are not of record. An April 2021 VA examiner opined that the Veteran's GERD and/or Barrett's esophagus was less likely than not incurred in or etiologically related to service. The examiner noted that while the Veteran reported having symptoms of vomiting, burning in throat, and significant stomach irritation during service which required him to take medication such as Tums or Rolaids, his STRs do not contain to any treatment, evaluation, or diagnosis of GERD. She indicated that review of the Veteran's documented symptoms during the ER visit in November 1971 are not consistent with GERD or the symptoms he reported as his history. She indicated that he was diagnosed with acute gastroenteritis, which is an inflammation of the lining of the intestines caused by a virus which is not related to GERD or Barrett's esophagus, which resolved as there was no further ER visits noted in his STRs. She indicated that there is no documentation or diagnosis of GERD or Barrett's esophagus until 1998, years after separation from service. She also indicated that the most recent July 2019 EGD revealed no evidence of Barrett's esophagus. The Board finds the April 2021 VA examiner's opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Additionally, the Board finds that the examiner adequately considered the Veteran's reports that his GERD began during service and reviewed the medical evidence of record, to include the Veteran's STRs and private and VA medical treatment records, in forming her opinion. Accordingly, the Board accepts the VA examiner's opinion as the most probative evidence as to whether the Veteran's GERD and/or Barrett's esophagus is etiologically related to service. The Board finds that the evidence weighs against a finding that his GERD and/or Barrett's esophagus is etiologically related to service. The only evidence of any relationship between GERD and/or Barrett's esophagus are the Veteran's statements. However, beyond the Veteran's conclusory statements, there is no evidence in the record of any such relationship. He has not provided any evidence beyond his statements that his GERD and Barrett's esophagus is related to service. Additionally, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of a medically complex disorder such as GERD and/or Barrett's esophagus. Jandreau, 492 F.3d at 1377. Thus, although the Board has carefully considered the lay contentions of record, the Board ultimately affords the objective medical evidence of record, which weighs against finding such a connection, with greater probative weight than the Veteran's lay statements. Accordingly, the Board affords more probative weight to the May 2019 and April 2021 VA medical opinions. In sum, the Board finds that the evidence weighs against a finding that the Veteran's GERD and/or Barrett's esophagus is related to service. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply, and the claim for service connection must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert,1 Vet. App. at 55. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.