Citation Nr: 22010481 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 17-48 984 DATE: February 23, 2022 ORDER Service connection for hypertension is denied. REMANDED Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. FINDING OF FACT Hypertension is not shown to be causally or etiologically related to any disease, injury, or incident during service, and did not manifest to a compensable degree within one year of separation from active duty. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 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 in the United States Army from February 1966 to October 1968. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in February and December 2017 by a Department of Veterans Affairs (VA) Regional Office. The Veteran testified at a Board hearing before the undersigned in January 2022. A transcript of that hearing has been associated with the record. Service Connection Hypertension Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as cardiovascular-renal disease, to include hypertension, are presumed to have been incurred in service if manifested to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that his currently diagnosed hypertension had its onset during his military service. However, the Board finds that the preponderance of the evidence is against his claim for service connection for such disorder. In this regard, the Veteran's service treatment records are negative for complaints, treatment, or diagnoses referable to hypertension. Additionally, his October 1968 separation examination reveals a blood pressure reading of 124/72 and he denied currently or previously having high blood pressure in his contemporaneous report of medical history. Importantly, the Veteran's VA treatment records on file reveal that he was not diagnosed with hypertension until approximately 2016, which is over 40 years after discharge from service. Finally, there is no competent evidence relating his complaints of high blood pressure to a diagnosis of hypertension within his first post-service year. In this regard, the Board notes that the Veteran has not been afforded a VA examination and/or opinion in regard to his claim. However, VA is not required to provide a medical examination or opinion when there is no credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Additionally, a mere conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Consequently, as there is no indication that the Veteran's currently diagnosed hypertension is related to any instance of his military service, a VA examination or opinion is not necessary to decide such claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Therefore, based on the foregoing, the Board finds that his currently diagnosed hypertension did not have its onset during his military service or within a year after separation, and is not otherwise shown to be causally or etiologically related to any disease, injury, or incident during service. Thus, service connection for such disorder is not warranted. In reaching its decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim for service connection for hypertension and, as such, that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. The claim is denied. REASONS FOR REMAND The Veteran asserts that he developed sleeping problems, to include sleep apnea, as a result of service, to include service-connected PTSD. Specifically, he testified in January 2022 that due to enemy bombings and attack in service he did not sleep properly and developed a sleep disorder. He also described an inability to wear a CPAP mask because of PTSD symptomology. He further contends that his service-connected PTSD causes symptoms which disrupt his sleep. He testified that doctors told him that his sleep apnea was aggravated by his PTSD. In December 2017, the Veteran underwent a VA examination in relation to his PTSD. At that time, the examiner concluded that the "sleep problems" experienced by the Veteran were secondary to PTSD and not a separate condition. The Veteran's difficulty with falling and staying asleep were part and parcel of his PTSD symptomology. However, the Veteran's representative submitted multiple medical articles following the January 2022 hearing. One acknowledges the sleep problems experienced by those with PTSD but describes a link between PTSD and sleep apnea. Another asserts that PTSD symptoms cause sleep apnea. The Veteran has not been provided with a VA examination regarding the etiology of a sleep disorder. Given his testimony and the medical evidence, the Board finds that VA's duty to obtain a VA medical opinion has been triggered. See McLendon, supra. The matters are REMANDED for the following action: Schedule the Veteran for an examination to determine the etiology of his sleep disorders, to include sleep apnea. The examiner is asked to diagnose all sleep disorders present during the appeal period. Then, with regard to each, he or she should opine whether such disorder had its onset in, or is otherwise related to, service. The examiner should also offer an opinion as to whether each disorder is caused or aggravated by the Veteran's service-connected PTSD. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should consider any pertinent medical literature suggesting a relationship between sleep apnea and PTSD. The examiner is also asked to specifically address the Veteran's reports of an inability to wear a CPAP mask due to PTSD symptomology. (Continued on the next page) A rationale for any opinion offered should be provided. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeremy J. Olsen, 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.