Citation Nr: 21041222 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 14-26 631 DATE: July 8, 2021 ORDER Entitlement to service connection for hypertension to include as secondary to service connected specific phobia is denied. FINDINGS OF FACT 1. Hypertension was not shown in service or for many years after service. 2. The greater weight of the evidence fails to show a nexus between hypertension and service, or service connected disability. CONCLUSION OF LAW The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from May 1984 to May 1986 and from January 2003 to August 2003. He also had Army Reserve service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In November 2016, the Veteran testified during a hearing before the undersigned. A transcript is of record. This claim was previously before the Board in April 2018 and October 2020 and remanded for additional development. That development having been completed; the claim is once again before the Board. Under the laws administered by VA, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred during service. 38 C.F.R. § 3.303 (d). Generally, the evidence must show: (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. 38 C.F.R. § 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Additionally, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Service connection may be granted on a presumptive basis for certain chronic diseases, including hypertension, if they are shown to be manifest to a degree of 10 percent or more within one year following the Veteran's separation from active military service. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2019). In each case where a Veteran is seeking service connection for any disability, due consideration shall be given to the places, types, and circumstances of such service as shown by the service record, the official history of each organization in which the Veteran served, his or her treatment records, and all pertinent medical and lay evidence. See 38 U.S.C. § 1154 (a). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrent symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A review of the Veteran's service treatment records does not reveal any showing complaints or treatment of high blood pressure. Further, there were no such showings within one year of leaving military service. A review of the Veteran's outpatient treatment records post-service show that he has been diagnosed and treated for hypertension since approximately 2010. A statement dated in February 2010 from the Veteran's private provider revealed the Veteran was currently being treated for hypertension. The physician further indicated that the Veteran had developed hypertension after deployment to Kuwait, without identifying a specific date, and also remarked the Veteran developed medical conditions which more likely than not resulted from the Veteran's military service. However, the specific medical conditions were not identified, and there was no actual reference to in-service or post-service medical records to support the conclusion. The Veteran was provided with a VA examination in November 2018. At this examination the examiner reported the Veteran provided her with a January 2009 statement from the Veteran's private provider which was identical with the February 2010 statement mentioned in the previous paragraph. The examiner considered it was less likely than not that hypertension had its onset in service or was related to a period of service, given the lack of any medical substantiation for a diagnosis in or around 2004. The Veteran provided the results of a private medical opinion dated in November 2018. This person's conclusion was: It is at least as likely as not (a 50%50% probability) that the veteran's current Hypertension Condition is secondary to, related to, and/or aggravated by his service connected Specific Phobia claimed as Anxiety and Depression. An additional VA opinion was obtained in March 2021. Here, the reviewer, a physician whose medical experience began in 1991, who has been doing VA compensation examinations since 2009, and who completed VA curriculum for this examination specialty, opined that it was less likely than not that the Veteran's hypertension was the result of his psychiatric disability. The opinion provider noted the absence of anything in this Veteran's treatment records which support the premise that his hypertension was caused by his service connected psychiatric disability, and at the same time, this Veteran had one of the strongest non-service related risk factors for the developing hypertension, a family history of it. All of the Veteran's living first degree relatives have it. Additionally, the examiner indicated that psychiatric conditions may cause temporary spikes in blood pressure, but not long term high blood pressure. Further, review of this Veteran's file showed no objective evidence supporting the premise that his high blood pressure was aggravated beyond its natural progression by the service connected psychiatric disorder. The Board concludes the greater weight of the evidence is against the claim. First, there is no diagnosis in the treatment records until many years after service. This weighs heavily against the claim. Second, the opinions against the claim, principally, the 2021 opinion, merit considerable weight as that one in particular was given by one shown to possess medical competence generally and trained in the conduct of VA examinations specifically. It further reflected a review of the file had been accomplished, and offered an explanation supporting the adverse conclusion that was rooted in this Veteran's record. In addition, it identified a non-service related cause for the claimed condition. This weighs heavily against the claim. Last, the opinions that suggest a nexus with service are so inexact as in the case of the 2010 private provider's statement, or so loosely expressed, as in the case of the 2018 opinion to be of minimal probative value. In these circumstances, because the greater weight of the evidence is against the claim, a basis upon which to establish service connection has not been presented. The appeal is denied. . M. E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.