Citation Nr: 22014385 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 19-39 177 DATE: March 12, 2022 ORDER Entitlement to service connection for hypertension secondary to already determined to be service-connected disabilities, including posttraumatic stress disorder (PTSD), is granted. Entitlement to service connection for erectile dysfunction (ED), also as secondary to the service-connected PTSD and other service-connected disabilities, also is granted. FINDING OF FACT It is just as likely as not the Veteran's hypertension and ED are caused or aggravated by his service-connected PTSD or other service-connected disabilities that include Ischemic Heart Disease (IHD), Type II Diabetes Mellitus (DMII), and peripheral vascular disease and peripheral neuropathy. CONCLUSION OF LAW Resolving all reasonable doubt in his favor, the criteria are met for entitlement to service connection for hypertension and ED secondary to service-connected disabilities, including the PTSD. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1965 to May 1968. This appeal to the Board of Veterans' Appeals (Board) is from a December 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ_. Entitlement to service connection for hypertension and ED secondary to service-connected disabilities, including PTSD Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) indication the current disability was either (a) caused or (b) is being aggravated by the service-connected disability. See 38 C.F.R. § 3.310(a) and (b); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Board must fully consider the lay evidence of record. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to report on the onset of disability and, when applicable, continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence is competent, and this depends on whether the disability being claimed is simple or instead complex. Kahana v. Shinseki, 24 Vet. App. 428 (2011). 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. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran's claims for hypertension and ED are rooted in the notion of secondary service connection since he contends that they either were caused or are aggravated by his service-connected disabilities including his PTSD. And, after considering the relevant medical and other evidence, the Board concludes that it is at least as likely as not this posited correlation is true, so the claims must be granted rather than denied. In support of his claims, the Veteran submitted a September 2018 medical nexus opinion from his private primary care physician. This physician explained that, while he cannot know for certain how long the Veteran had hypertension prior to his diagnosis or definitively state its cause, it is at least as likely as not that his PTSD contributes to or exacerbates his hypertension and ED. This doctor's statement is uncontroverted. In further support of his claims, the Veteran also submitted medical records showing that he had been regularly treating with this physician for his hypertension and ED since at least 2014. As well, the Veteran submitted scholarly articles tending to support a correlation between PTSD and hypertension and ED. There is no "treating physician rule" requiring the Board to give deference to the opinion of the Veteran's primary care provider. Both the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) and the U. S. Court of Appeals for Veterans Claims (Veterans Court/CAVC) have specifically declined to adopt a "treating physician rule" that would give preference to statements from a treating physician. See White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Guerrieri v. Brown, 4 Vet. App. 467 (1993). And this is true even accepting that a treating physician may be more familiar with the Veteran's general state of health. That notwithstanding, the Board sees no reason in this particular instance why this doctor's supporting opinion should not be accepted since it is fully articulated and contains sound reasoning, which is where the bulk of the probative weight of any opinion is derived. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its underlying reasoning, that is, when there is factually accurate, fully articulated, and sound reasoning for the conclusion, not just from mere review of the claims file). Moreover, the Veteran also, as mentioned, submitted the medical treatise evidence or articles adding further credence to his claims. Where medical article or treatise evidence, standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on unsubstantiated lay opinion, a claimant may use such evidence to meet the requirement for a medical nexus. See Wallin v. West, 11 Vet. App. 509 (1998). However, an attempt to establish a medical nexus between service (or, here, service-connected disability) and a claimed disability solely by generic information in a medical journal or treatise "is too general and inclusive." Sacks v. West, 11 Vet. App. 314, 317 (1998) (holding that a medical article that contained a generic statement regarding a possible link between a service-incurred mouth blister and a present pemphigus vulgaris condition did not satisfy the nexus element). Still, medical treatise evidence can provide important support when combined with an opinion of a medical professional. Mattern v. West, 12 Vet. App. 222, 228 (1999). See also Rucker v. Brown, 10 Vet. App. 67, 73-74 (1997) (holding that evidence from scientific journal combined with doctor's statements was "adequate to meet the threshold test of plausibility"). And this is precisely what has occurred here with the additional submission of the supporting medical nexus statement from the Veteran's primary care provider. Certainly then, at the very least the medical and other evidence supporting these claims is as probative (meaning as competent and credible) as any evidence contrarily against these claims, if indeed not more favorable to these claims. So, in this circumstance, these claims must be granted. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Baronofsky 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.