Citation Nr: 21042817 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-16 398 DATE: July 13, 2021 ORDER Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The probative evidence of record does not show the Veteran's hypertension is related to his active duty service, to include as due to or aggravated by his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for hypertension, to include as secondary to service-connected disabilities, have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.303, 3.304, 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 November 1998 to May 1999, with additional Marine Corps Reserves service. In October 2018, the Veteran was provided a hearing with the undersigned Veterans Law Judge and a transcript of the proceeding is of record. The claim was brought before the Board in June 2019 and November 2020 and was remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Entitlement to Service Connection: Hypertension The Veteran contends that his hypertension is related to his active duty service, to include as secondary to his service-connected disabilities. As an initial matter, the Board recognizes that the Veteran has been diagnosed with hypertension. Thus, the issue turns upon whether there is evidence of an in-service event or injury, and a nexus between the claimed in-service event or injury and his present disability, to include whether his disability is due to or aggravated by his service-connected disabilities. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.310. The Board finds there is not. In January 2020, the Veteran was provided a VA examination. The examiner opined that the Veteran's condition was less likely than not due to or the result of his service-connected psychiatric disorder. After noting an extensive review of the Veteran's medical history, the examiner rationalized that the Veteran's mental health conditions were reported as stable when his blood pressure started to elevate. The examiner found that at the time, the Veteran was on Clonazepam for his condition, which is known to stabilize blood pressure, and is currently on Propranolol for his anxiety, which is known to treat blood pressure. The examiner further explained that the Veteran has multiple factors that are likely contributing to his hypertension, to include family history, severe chronic pain with pain medication use, significant alcohol use, obesity, and hypothyroidism. The examiner explained that given these considerations, it would be difficult to attribute his hypertension to his psychiatric conditions and related medications. The examiner also opined that the Veteran's hypertension was not aggravated beyond the natural progression by his psychiatric condition. The examiner again rationalized that his mental health conditions were noted as stable when his blood pressure began to elevate. The examiner explained that the Veteran's hypertension has not shown a rapid progression or worsening, and medical documentation does not support a rapidly progressing or aggravated condition. Additionally, the January 2020 examiner opined that the Veteran's hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationalized that the Veteran's service treatment records showed normal blood pressure with the Veteran denying any blood pressure problems. The Veteran was also noted as having normal blood pressure in all of 2003 and the Veteran did not start experiencing elevated blood pressure until 2006, after his separation from service. In April 2021, another VA opinion was obtained to consider the Veteran's service-connected cold injury residuals. The examiner opined that it was less likely than not that the Veteran's hypertension was due to his service-connected cold injury residuals, to include his complaints of pain and any medication taken for the pain. The examiner rationalized that the Veteran has reported taking Motrin for his cold injury residual pain and studies have shown Ibuprofen has no significant effect on systolic or diastolic blood pressure. The examiner again noted that the Veteran has multiple factors that are likely contributing to his hypertension, to include family history, severe chronic pain with pain medication use due to his non-service connected back condition, significant alcohol use, obesity, and hypothyroidism. The examiner further explained there were no notes documenting an association between the Veteran's cold injury residuals and blood pressure readings or any peer reviewed literature that supports an association between cold injury residuals and the development of hypertension. The examiner also found that the Veteran's hypertension was not aggravated by his service-connected cold injury residuals beyond natural progression. The examiner again explained there is no documentation that supports any association between cold injury residual of pain and the Veteran's hypertension. The examiner reiterated that documentation supports significant association between the Veteran's hypertension and other causes listed above. The examiner lastly noted that medical documentation does not support a rapidly progressing or aggravated hypertension condition due to the Veteran's cold injury residuals. The Board notes that while the Veteran's records show he has been diagnosed hypertension, the Veteran has provided no records relating his condition to his active duty service, to include as due to or aggravated by his service-connected disabilities. Therefore, the Board finds the January 2020 and April 2021 VA opinions to be of significant probative value in determining that the Veteran's hypertension is not related to his active duty service or his service-connected disabilities. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the reviewing physician's opinions were based on review of the Veteran's lay contentions, his reported medical history, and review of the medical evidence of record. Further, complete and thorough rationales were provided for the opinions rendered and are consistent with the medical evidence of record. The Board acknowledges the Veteran's assertions that his hypertension is related to his active duty service or his service-connected disabilities. The Board also recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any hypertension is related to his service or his service-connected disabilities requires medical expertise that the Veteran has not demonstrated since hypertensive disabilities can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). The Board also considered whether service connection for hypertension is warranted on a presumptive basis or on a basis of continuity of symptomatology. However, the record contains no evidence that the Veteran had hypertension to a compensable degree within one year after discharge from service of that the Veteran continuously experienced hypertension after his discharge from service. In fact, the evidence of record shows the Veteran did not start experiencing elevated blood pressure until 2006, about 7 years after service, or have an official diagnosis of hypertension until February 2012, which is over 10 years after his active duty service. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claim and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Negron, 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.