Citation Nr: 22014015 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 17-01 198 DATE: March 11, 2022 ORDER Service connection for hypertension is denied. FINDING OF FACT The evidence weighs persuasively against a finding that the Veteran's hypertension began during active service, within one year of separation from service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 1137, 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 from September 1987 to August 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision of the Atlanta Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, a Travel Board hearing was held before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In April 2020 and September 2021, this matter was remanded for additional development. The September 2021 Board decision also remanded the issues of entitlement to service connection for diabetes mellitus type II (diabetes) and a bilateral hip condition. In an October 2021 rating decision, the RO granted service connection for status post left and right hip replacement and diabetes with erectile dysfunction. As those awards represent full grants of the benefits sought with respect to those issues, those matters are resolved and are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for hypertension. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires 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 current disability and an in-service precipitating disease, injury or event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, such as hypertension, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Board also notes that service connection may be established for hypertension as chronic diseases and based on a continuity of symptomatology. 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The existence of a current disability is the cornerstone of a claim for VA disability compensation. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Lay statements may serve to support a service connection claim by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Although lay persons are competent to provide opinions on some medical issues, some medical issues fall outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt if the positive and negative evidence is in approximate balance, which includes, but is not limited to, equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The Veteran seeks service connection for hypertension. He has specifically contended that his hypertension is due to obesity because of an inability to exercise as a result of his service-connected low back disability. See February 2021 and November 2021 Statement in Support of Claims. The Veteran's service treatment records (STRs), to include his service separation physical examination report, are silent for any complaints, findings, treatment, or diagnoses related to high blood pressure or hypertension. Though the Veteran has alleged that his elevated blood pressure began in service, his June 1991 service separation report of medical history shows normal blood pressure. See February 2020 Board hearing transcript. His postservice treatment records also show that hypertension was not listed as an active problem until many years after his separation from service. Specifically, private treatment records indicate that a definitive diagnosis of hypertension was in November 2007. Based on the foregoing information, there is no evidence that the Veteran's current hypertension manifested in service or to a compensable degree in the first year following his separation from active duty service. Moreover, the Board finds that the evidence weighs persuasively against a finding that the Veteran has suffered from hypertension/high blood pressure continuously since service. See 38 C.F.R. § 3.303(b). Consequently, service connection for hypertension on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Service connection for hypertension may still be granted on a direct basis; however, the evidence weighs persuasively against a finding that a medical nexus exists between the Veteran's hypertension and his military service. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The question of whether the Veteran's hypertension is otherwise etiologically linked to his active service was addressed in multiple medical opinions. In July 2020 and December 2020, two separate VA examiners rendered a negative nexus opinion. However, as discussed in a September 2021 remand, the December 2020 opinion was determined to be insufficient for rating purposes. Additionally, the Board finds the July 2020 opinion insufficient for rating purposes because it did not address whether the Veteran's obesity was due to his service-connected low back disability. Therefore, those opinions will not be considered/discussed herein. In February 2021, a private neuropsychologist, F.N., opined that the Veteran's service-connected low back condition "contributed" to his obesity. This opinion, however, was also determined to be insufficient for rating purposes because it was stated in speculative terms. Notably, it did not contain a rationale for how the low back disability "contributed" to his obesity. Accordingly, the Board finds the February 2021 private opinion to have little to no probative value. In September 2021, the Veteran was most recently provided a VA medical opinion to address the etiology of his hypertension. The VA examiner rendered a negative nexus opinion and noted that there was no evidence that the hypertension condition would not have occurred if the obesity condition had not existed. The examiner specifically pointed out that the records were silent for treatment of hypertension between the Veteran's service separation in 1991 and 2007. The examiner explained that, while the Veteran had significant weight gain during those intervening years, there was no evidence that obesity was a substantial factor in the development of hypertension. In support of that opinion, the examiner cited to a Medscape article, stating that 90 to 95 percent of cases of hypertension were considered essential and were not caused by a secondary factor. Consequently, the examiner concluded it was less likely than not that the current claimed hypertension condition would not have occurred but for the obesity caused or aggravated by the service-connected low back condition. The Board finds the September 2021 VA medical opinion to be substantially compliant with the September 2021 Board remand directives. Though the opinion did not explicitly address whether the Veteran's service-connected low back condition caused or aggravated his obesity, the Board finds that that matter was intrinsically answered when the examiner concluded that it was less likely than not that the current claimed hypertension condition would not have occurred but for the obesity caused or aggravated by the service-connected low back condition. As such, the September 2021 VA opinion is sufficient for rating purposes. The Board finds that opinion to be highly probative, as it is based on a thorough review of the claims file and accurate understanding of the Veteran's medical history, is reasoned, and adequately supported by medical principles. Although the Veteran believes his current hypertension is related to his military service, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex and outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the September 2021 VA examiner's opinion. In conclusion, the Board finds that there is no probative evidence to warrant service connection for hypertension. The Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the evidence persuasively weighs against the Veteran's claim, it is not in approximate balance, and the doctrine is not applicable. Service connection for hypertension is denied. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Chu, Associate 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.