Citation Nr: 22015391 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 18-46 224A DATE: March 17, 2022 ORDER Service connection for hypertension is denied. Service connection for hyperfusion is denied. Service connection for a stomach condition is denied. Service connection for a lung condition is denied. REMANDED Entitlement to service connection for groin pain is remanded. FINDINGS OF FACT 1. The Veteran's hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The competent evidence of record is against finding that the Veteran has had hyperfusion at any time during or approximate to the pendency of the claim. 3. The competent evidence of record is against finding that the Veteran has had a stomach condition at any time during or approximate to the pendency of the claim. 4. The competent evidence of record is against finding that the Veteran has had a lung condition at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for hyperfusion have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a stomach condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for a lung condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from June 1970 to January 1972. These matters come before the Board of Veterans' Appeals from August 2017 and September 2018 rating decisions by the Department of Veterans Appeals (VA) Regional Office (RO). The Veteran participated in a hearing before the undersigned Veterans Law Judge (VLJ) in October 2021. A transcript of that hearing is of record. At the hearing, the Veteran's representative requested that the record be held open 60 days for the submission of additional evidence. No additional evidence has been received. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, the evidence must show: (1) the existence of a present 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, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). For the showing of a chronic disease in service, such as hypertension, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, as identified in 38 C.F.R. § 3.309(a), noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). 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). 1. Entitlement to service connection for hypertension The Veteran contends service connection should be established for hypertension. It is pointed out that the Veteran's service treatment records (STRs) show that he had elevated blood pressure readings while on active duty and it is contended that this marks the onset of the hypertension diagnosed years later. At the October 2021 Board hearing, the Veteran's representative argued specifically that the Veteran's STRs showed he entered service with no mention of hypertension, but at separation two years later, he was noted to have hypertension. The Veteran's representative further argued that the fact hypertension was not diagnosed until years later did not matter as it did not mean that the Veteran did not manifest this disorder during the intervening years. See October 2021 hearing transcript. Hypertension is persistently high arterial blood pressure with suggested threshold levels starting at 140mm/Hg systolic and 90mm/Hg diastolic. Dorland's Illustrated Medical Dictionary, 799 (27th ed. 1988). Note (1) to Diagnostic Code 7101 recognizes the disability of hypertension when the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension when the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104. The Veteran has a current diagnosis of hypertension as evidenced by a March 2017 private treatment record and VA treatment records. As noted, hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Therefore, the question to be resolved is whether the Veteran's current hypertension had its onset in service, within one year of service, or is otherwise related to his military service. The Veteran's STRs are silent for any complaints or treatment related to high blood pressure or hypertension during his service. In his December 1971 Report of Medical History, which the Veteran completed in preparation for his separation from service, he also denied having or ever having had high or low blood pressure. However, in the December 1972 service separation Report of Medical Examination, the Veteran's blood pressure was measured as 122/86 and a finding of hypertension was noted. He then underwent a four-day blood pressure check with the following results: Day 1: Morning 120/84 Afternoon 128/80 Day 2: Morning 130/84 Afternoon 132/80 Day 3: Morning 104/64 Afternoon 120/72 Day 4: Morning 110/72 Afternoon 104/68 The Veteran was then determined to be qualified for release from active duty. At the October 2021 Board hearing, the Veteran stated that he recalled having high blood pressure when clearing a post in service and therefore had to have it lowered. See October 2021 hearing transcript. However, as outlined above, there is no evidence in the STRs of any treatment being provided for hypertension beyond the monitoring described following the December 1971 service separation physical examination. There is also no evidence of any post-service treatment for hypertension for many years after service. The Veteran testified at the October 2018 hearing that he sought treatment through a private physician but could not recall when he started being treated for hypertension. A review of the Veteran's private treatment records show they include a diagnosis of essential hypertension as early as March 2017. Private treatment records from August 2017 again note a diagnosis of essential hypertension with elevated blood pressure of 171/103 in the left arm and 150/84 in the right arm. In May 2019, the Veteran submitted a letter dated that same month from his private physician, Dr. D.S., who stated that his office had been following and treating the Veteran for hypertension for "several years" and noted the medications that the Veteran was currently taking for his hypertension. This letter does not, however, date the diagnosis and treatment of hypertension to the Veteran's service or even to the years immediately following the Veteran's service. Rather, Dr. D.S. described treating the Veteran for "several years." He also did not provide an opinion as to the etiology of the hypertension. Accordingly, this letter from Dr. D.S. is not probative. The only medical opinion in the claims file that addresses the etiology of the Veteran's hypertension is from a VA examination conducted in August 2017. During that examination, the Veteran reported the onset of his claimed condition as the 1970s. He recalled having recurrent elevated blood pressure readings during service and being monitored multiple days during service. He also reported that the condition had gradually increased in severity over time. After examining the Veteran, the examiner diagnosed hypertension and indicated a date of diagnosis of 1970s. However, this date of diagnosis appears to be based on the Veteran's reported history, as the examiner also reviewed the claims file and opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. For rationale, the examiner reviewed specifically the December 1971 service separation examination, which noted an elevated blood pressure reading that required the Veteran to return for a 3-day monitoring and stated that the findings from the 3-day blood pressure checks did not meet the criteria for hypertension. The examiner highlighted that the Veteran, instead, had normal readings on 3-day blood pressure checks from December 20, 1971 to December 23, 1971. As such, the examiner concluded the Veteran's current hypertension was less likely than not due to service. The Board finds the August 2017 VA examiner's negative opinion to be highly probative. The examiner conducted a thorough review of the claims file and specifically considered the Veteran's STRs, to specifically include the blood pressure readings noted at the time of the December 1971 service separation physical examination. The examiner also included an explanation for the rationale of their opinion, which was based on a finding that the blood pressure readings from the Veteran's 3-day monitoring in service did not meet the criteria for hypertension. At the October 2021 Board hearing, the Veteran and his representative emphasized that he was noted to have hypertension at the time of his December 1971 service separation physical examination. However, while there was an annotation of such on that examination report, it is noted that the blood pressure reading at the time was 122/86, which does not fall within the definition of hypertension. Moreover, as has been discussed, the Veteran also subsequently had his blood pressure monitored from December 20, 1971 to December 23, 1971, and these were all normal readings as noted by the August 2017 VA examiner. The fact that the Veteran may have had isolated elevated blood pressure readings during service is acknowledged. However, there is no evidence of blood pressure readings meeting the definition of hypertension based upon two or more readings on at least three different days. His post-service treatment records, as discussed above, also do not indicate that hypertension was diagnosed until many years after his separation from service. For that reason, the Board does not find that the Veteran's current hypertension was shown as chronic in service, or that it manifested to a compensable degree within one year of his separation from service. It is also not shown that he had continuity of symptomatology and the disability is not otherwise etiologically shown to be related to an in-service injury or disease. While the Veteran believes his current hypertension is related to an in-service injury, event, or disease, including the findings noted at the time of his service separation examination, he is not competent as a lay person to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. In conclusion, the Board finds the evidence is against granting the claim for service connection for hypertension. As such, the claim is denied. 2. Entitlement to service connection for hyperfusion, a stomach condition, and a lung condition In pursuit of his claims for service connection for hyperfusion, a stomach condition, and a lung condition, the Veteran has asserted generally that these conditions had their onset in service and that they have worsened over time. See October 2018 Notice of Disagreement (NOD). However, most recently, at the October 2021 Board hearing, the Veteran testified that he might have had some issues with his lungs in service, but he did not have any issues currently. He also testified he had no current diagnosis or problems regarding any of these three claimed conditions. See October 2021 hearing transcript. A review of the Veteran's STRs shows that they are silent for any complaints, findings, treatment, or diagnoses related to these conditions. This includes the April 1970 service entrance examination, which was normal, and the December 1971 service separation examination, which reported no findings related to the stomach, lungs, or hyperfusion. In the associated report of medical history, completed in December 1971, the Veteran similarly denied having or ever having had shortness of breath, pain or pressure in the chest, chronic cough, palpitation or pounding heart, or stomach, liver or intestinal troubles. Additionally, post-service treatment records are silent for any findings regarding the Veteran's stomach, lungs or hyperfusion. With regard to obtaining a VA examination pertaining to these conditions, there is no indication in the record, to include no competent evidence of record (other than the Veteran's lay assertions, which have been non-specific in this regard) showing that he has been diagnosed with hyperfusion or any condition relating to the lungs or stomach. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has recognized that there is not a duty to provide an examination in every case. See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). In this case, VA's duty to provide examinations is not triggered, and a VA examination regarding the Veteran's claims for service connection for hyperfusion, a lung condition, or a stomach condition is neither necessary nor warranted. Id. While the Veteran has asserted, through his pursuit of these service connection claims, that these conditions began in service and have worsened, there has been no evidence in the record of persistent or recurrent symptoms related to the hyperfusion or to any stomach or lung conditions. Additionally, it is again pointed out that at the October 2021 Board hearing, the Veteran stated he did not have any problems with these conditions currently and declined to provide further testimony. Thus, the Board concludes the weight of the competent and credible evidence establishes that the Veteran has not been shown to have a lung, stomach or hyperfusion disabilities at any time during the pendency of the claim or recent to the filing of the August 2018 claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). As the Veteran does not have diagnoses of a stomach condition, lung condition, or hyperfusion, there is no current disability, and the first element of service connection has not been met for any of these issues. Therefore, service connection must be denied. REASONS FOR REMAND 1. Entitlement to service connection for groin pain The Veteran has not been afforded a VA examination for his claim for service connection for groin pain. VA's duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006). The Veteran testified at the October 2021 Board hearing that he had recently been diagnosed with prostate cancer. His STRs also indicate he received treatment for acute groin pain in September 1971. The Veteran has further indicated that his claimed conditions, to include his groin pain, have existed since service and worsened over time. See October 2018 Notice of Disagreement (NOD). In light of the foregoing, the Board finds a VA examination for a medical opinion is necessary to determine whether the Veteran has a current disability related to the treatment he received in service for groin pain. Additionally, given the recent diagnosis of prostate cancer, development should be undertaken to obtain treatment records related to this diagnosis. The matter is REMANDED for the following actions: 1. With any assistance necessary from the Veteran, undertake appropriate efforts to obtain any relevant and outstanding VA or private medical records related to the claimed conditions of groin pain/prostate cancer and associate them with the claims file. 2. Thereafter, schedule a VA examination with an appropriate clinician to determine the nature and etiology of the Veteran's claimed condition of groin pain, to include prostate cancer. The claims file and a copy of this remand must be provided to the examiner and reviewed. The examiner must opine whether it is as least as likely as not (50 percent or greater probability) that the Veteran's prostate cancer, and any other diagnosis that may be rendered for the claimed condition of groin pain, is related to his military service. In doing so, the examiner must specifically consider the Veteran's STRs showing groin pain in service as well as his lay statements. (Continued on the next page) Any opinion offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinions without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, A. 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.