Citation Nr: 21041807 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 17-09 458 DATE: July 10, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, mood disorders, and depression, is denied. FINDINGS OF FACT 1. The Veteran's hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The preponderance of the evidence is against a finding that the Veteran has a psychiatric disorder that is attributtable his service. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for acquired psychiatric disorder, to include anxiety, mood disorders, and depression, 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 November 1971 to September 1972. This matter comes before the Board of Veterans' Appeals (Board) from a February 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing before the undersigned in August 2019. A transcript of the hearing is made part of the record. The Veteran testified that the migraine headaches in service was an early indicator of hypertension. This claim was remanded by the Board in December 2019 for further development, to include obtaining service treatment and military personnel records and providing VA examinations. The Board again remanded the matter in September 2020 for outstanding and relevant Social Security Administration records to allow VA to request these records. In a March 24, 2021 correspondence, the Social Security Administration indicated there were no responsive records. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38U.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). 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). 1. Entitlement to service connection for hypertension. The Veteran contends that his hypertension is related to service. The Veteran has not asserted a specific injury or in-service event which caused his hypertension and has not indicated when his hypertension symptoms began. The Veteran testified that the migraine headaches in service was an early indicator of hypertension. The Veteran has a current diagnosis of hypertension as evidenced by November 2010 VA treatment records. Hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. STRs are negative for any symptoms, findings or diagnosis of hypertension. April 1971 entrance exam report of medical history reports frequent/severe headaches, and depression or excessive worry. December 15, 1971 Dorfman/mental health evaluation. The consultation request is dated December 3, 1971. The consultation request states "phobia about rifles cannot hit targets. Having headaches. Headaches last occurred at time of mother's death". January 1972 STR reports migraines since 1968 upon death of mom. Migraines stopped with treatment but started again after he became nervous and angry. November 1997 letter from Dr. R., states Veteran has severe hypertension and common migraine who on September 16, 1997 had sudden onset of headache and right-sided weakness. The cited letter dated December 5, 2000 from Dr. M., received October 22, 2018, noted worsening of migraines with anxiety. The Veteran has had a long history of hypertension. In 1997 he had a cerebral bleed. Dr. M provided additional statements regarding the increase of headaches during service. January 2020 VA DBQ the examiner stated the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran has asserted that his migraines in service were an early sign of hypertension. Hypertension or high blood pressure can be a direct cause of headaches. However, headaches from high blood pressure have a different mechanism from migraine headaches and two are not directly related. Blood pressure headache is usually associated with a hypertensive crisis such as hypertensive emergency or urgency which is inconsistent with the veteran symptoms. The examiner noted that nexus had not been established. Although this examination report makes additional statements regarding secondary service connection, the contention is that headaches as a symptom in service were an early manifestation of the current hypertension disability. Service connection is not in effect for headaches and secondary service connection need not be further addressed. The Board notes, that private medical treatment records show the Veteran was not diagnosed with hypertension until November 1997, decades after his separation from service and decades outside of the applicable presumptive period. Prior to November 1997, the Veteran had not been seen at the VA medical center until 2000, at which time his blood pressure was high and he had a diagnosis of hypertension. While the Veteran is competent to report experiencing symptoms of high blood pressure for many years, the Veteran has not contended that he has experienced those symptoms at discharge from service or during the presumptive period. Further, contemporaneous treatment records show the onset of high blood pressure as November 1997, decades outside of the presumptive period See Buchanan, 451 F.3d at 1336-37. Service connection may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's hypertension and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. While the Veteran believes his hypertension is related to service, he is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377, 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. In sum, the Board finds that the preponderance of the evidence is against this service connection claim, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, mood disorders, and depression. The Veteran contends that his psychiatric disorder was caused by his active duty service. The Veteran's service treatment records have some complaints, symptoms or diagnosis of mental conditions. April 1971 entrance exam report of medical history reports frequent/severe headaches, and depression or excessive worry. December 1971 STR reported Veteran had phobia about rifle. January 1972 STR reports migraines since 1968 upon death of mom. Migraines stopped with treatment but started again after he became nervous and angry. January 2016 VA mental disorders DBQ examiner noted the Veteran had a stroke in 1997. He suffered right sided paralysis and feels depressed and anxious since then. He was diagnosed with mood disorder and anxiety disorder secondary to stroke. The Veteran is not service connected for stroke. January 2020 VA DBQ the examiner stated the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The diagnosis is related to a reported cerebrovascular accident that his wife indicates occurred in 1997. The diagnosis is unrelated to military service. Symptoms of this disorder began after having the cerebrovascular accident in 1997. The examiner provided adequate additional rationale for this opinion. Review of this report with opinion and rationale indicates that the examiner had detailed knowledge of the facts of this case and provide thorough and comprehensive reasons for the opinion weighing against service connection. The Board finds this significant probative evidence against service connection. Consideration has been given to the Veteran's assertion that his acquired psychiatric disorder, to include anxiety, mood disorders, and depression are the result of his military service. He is noted to be competent to report his own symptoms, to include anxiety, depression and irritability or matters within his personal knowledge. However, he has not been shown to have the medical knowledge to attribute an acquired psychiatric disability to service. Accordingly, the criteria for service connection have not been met for an acquired psychiatric disorder, to include anxiety, mood disorders, and depression. That is, the evidence does not show that mental disability was diagnosed in service and the weight of the evidence is against a finding that a mental disability has existed continuously since service or otherwise attributable to service. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, that doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the claim for service connection for acquired psychiatric disorder is denied. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Ottley III 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.