Citation Nr: 22012195 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 19-04 261 DATE: March 2, 2022 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The approximate balance of the evidence establishes a nexus between an in-service disease or injury and the Veteran's hypertension. CONCLUSION OF LAW The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. § 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from June 2001 to April 2004. This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated June 2017 issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed. The appellant testified at a January 2022 video hearing with the undersigned Veterans Law Judge. This decision is being made under the "one-touch" program as it grants the benefit sought. A transcript of the hearing will be associated with the claims file at a later time. Service Connection Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). If the positive and negative evidence is in approximate balance, the claimant receives the benefit of the doubt. Lynch v. McDonough, __ F.4th __, No. 2020-2067, 2021 U.S. App. LEXIS 37307, at *10 (Fed. Cir. Dec. 17, 2021). Entitlement to service connection for hypertension The Veteran claims entitlement to service connection for hypertension. Following a thorough review of the Veteran's medical records, the Board finds that he is entitled to an award of service connection. The first and most fundamental requirement for any service-connection claim is the existence of a current disability. 38 U.S.C. § 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection: a current disability, diagnosed as hypertension that was diagnosed in 2017. See VA Examination dated May 2017. As to the second element, a disease or injury in service, in a January 2018 Notice of Disagreement (NOD), the Veteran wrote, "Indications of hypertension were found during my service time, however, I believe a formal diagnosis was not made due to the status of my duty assignment as a Navy Diver. I'm currently diagnosed with hypertension and on continuous medication for control of my symptoms." Additionally, in a February 2019 Form 9, the Veteran wrote, Evidence is shown in service records of an elevated BP reading (hypertension) on several occurrences. Many readings of hypertension were not documented while in service due to my job as a Navy EOD Diver. This was due to the fact that hypertensive BP readings would prevent me from being active in my MOS or being able to deploy overseas. The Veteran's service treatment records (STRs) show a June 2001 blood pressure reading of 130/80, and an August 2001 blood pressure reading of 132/79. A November 2001 STR showed a blood pressure reading of 132/72. In July 2002, the Veteran had blood pressure readings of 139/71 and 120/74. In August 2003, the Veteran had blood pressure readings as follows: 151/87, 138/82, 132/88, 137/83, 128/88, 118/86, 122/88, 124/84, 122/86, 128/76, 153/90, 122/80, and 128/82. A January 2004 STR noted that the Veteran had high blood pressure. His blood pressure was 134/71 at the time. An April 2004 STR notation provided that the "patient was told that he had hypertension, however, no evidence in record and blood pressure normal on exam." At the time, he had blood pressure readings of 108/77 and 112/78. In August 2007, the Veteran had a blood pressure reading of 124/62. The Veteran has consistently reported that his hypertension symptoms began while in service. During his hearing, the Veteran reported that he had high blood pressure readings while in service, but looking further into it was discouraged because hypertension would have disqualified him from his MOS as an explosive ordinance disposal (EOD) diver. He also testified that he had high blood pressure readings when he was 19 and 20 years old. However, he did not pay much attention to most of the readings so that he could continue in his MOS. The Board finds no reason to doubt the Veteran's credibility and finds that his statements and testimony are both competent and credible. Furthermore, his STRs contain evidence of high blood pressure readings. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection: evidence of an in-service disease or injury. Finally, with respect to the third requirement, a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the Board finds sufficient credible evidence which establishes this nexus. Medical treatment records following service show that the Veteran had uncontrolled blood pressure since his teens. As noted above, the Veteran served in the military when he was in his teens. See Medical Treatment Record dated October 2009. Furthermore, medical treatment records following separation from service consistently show elevated blood pressure readings. In a May 2017 VA opinion, the examiner found that the Veteran's hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She reasoned, Veteran was seen in service with elevated blood pressure readings on two occasions with readings 153/90 on August 5, 2003 and August 6, 2003 151/87 and 138/84 on seven subsequent visits all within the normal range. There was no evidence in claimant's medical record that he was diagnosed with hypertension during service...Also, please note on separation exam...patient was told he had hypertension have no evidence in record; blood pressure normal on exam...He had been diagnosed with hypertension after service and treated with medications...20 months after discharge from military service. The examiner then cited to several of the Veteran's medical treatment records in support of her conclusion. In a January 2018 letter, the Veteran's primary care physician wrote, Records in the military dating from August 14, 2002 until September 17, 2003 document that he had hypertension, and was never officially diagnosed or treated. Specifically, he had 12 measurements of elevated blood pressures per current standard by the American Cardiology Association. At that time, he had hypertension stage I. Upon initial presentation to my office in March 2014, his blood pressure was 152/98. He is currently being treated with triple therapy for hypertension. Risk factors for cardiovascular disease include a family history in his father and hyperlipidemia currently being addressed with diet and exercise. In a November 2018 opinion, an examiner provided that the Veteran's hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. He provided an extensive list of the Veteran's medical treatment records with relevant blood pressure readings. He also discussed the Veteran's May 2017 VA examination. He then reasoned, It is less likely than not that the Veteran's claimed hypertension is related to the complaints of elevated blood pressure readings during the service. The service treatment records provided one blood pressure reading that was elevated while in the service. That is insufficient to render the diagnosis of hypertension. Sustained elevations of blood pressure readings were not noted until several years later when the diagnosis of hypertension was made and medication treatment was initiated. He continued with elevated blood pressures off and on over the years. It is not possible to make a diagnosis of hypertension, absent hypertensive blood pressure readings. Without such documentation, it would be unfounded to diagnose a condition of hypertension with normal blood pressure readings while in the service. The Board finds that all three opinions are probative, as they provided clear conclusions with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). The record contains an approximate balance of positive and negative evidence for the nexus element of service connection. Based on the foregoing, the Board finds that the competent and credible evidence is approximately balanced as to whether entitlement to service connection for hypertension is warranted. The benefit of the doubt doctrine applies. 38 U.S.C. § 5107(b), Lynch v. McDonough, __ F.4th __, No. 2020-2067, 2021 U.S. App. LEXIS 37312 (Fed. Cir. Dec. 17, 2021). The claim is granted. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Minock 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.