Citation Nr: 22015758 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 21-00 616 DATE: March 18, 2022 ORDER Entitlement to service connection for hypertension is granted. FINDING OF FACT The most probative evidence reflects that the Veteran's hypertension had its onset in service. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1964 to October 1985. This case comes to the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with the AOJ's determination, and the present appeal ensued. The Veteran's claim was previously before the Board in September 2021 when it was remanded for additional development. In passing, the Board notes multiple theories of service connection have been asserted, including secondary service connection and as due to herbicide agent exposure. The Board is granting this issue under the theory of direct service connection, as it is the greater benefit. Entitlement to service connection for hypertension Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b), Walker v. Shinseki 708 F.3d 1331. (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999). The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007). Competent medical evidence is evidence provided by a person who is considered qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. It may also include statements conveying sound medical principles found in medical treatises and/or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, VA shall give the benefit of the doubt to the Veteran. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis As an initial matter, the Board notes that the Veteran has been with hypertension, as noted in Veteran's private treatment. Private treatment records further show that the Veteran takes medication for hypertension. The Veteran's service treatment records show that at the Veteran's August 1985 separation physical his blood pressure was 140/88, and the medical provider indicated the Veteran has a history of high blood pressure. Additionally, in January 1973 the Veteran had a blood pressure reading of 146/92, and in December 1975 the Veteran's blood pressure was recorded twice, reading 140/80 and 140/84. Accordingly, the Board finds the second element of service connection to be met. The Veteran was provided with a VA medical examination in September 2021. The September examiner provide a favorable direct nexus opinion, finding that the Veteran's hypertension is at least as likely as not related to service, after an in-person examination and review of the Veteran's records. The examiner noted the Veteran's high blood pressure readings documented in service and noted that the Veteran has experienced chronic hypertension since his discharge. The examiner acknowledged the lack of issues related to hypertension prior to service. Finally, the examiner noted the Veteran has been seen routinely for hypertension since service, and it is currently being managed with medications. The Board considers the opinion rendered by the September 2021 VA examiner to be highly probative, given that it was furnished by the examiner following a review of the Veteran's claims file, an in-person examination that included a thorough medical history provided by the Veteran, and the opinion is supported by a clear rationale. An addendum medical opinion was obtained by the AOJ in December 2021, for clarification and reconsideration. The examiner provided an unfavorable medical nexus opinion, stating that the Veteran's separation physical blood pressure reading was an acute incident, and no evidence of a chronic condition was seen until 2012. This is inaccurate, as the earliest documentation of a diagnosis of hypertension in the Veteran's file is found in March 2007, in the Veteran's private provider treatment records. Additionally, the Veteran's service treatment records include more than one incident of a high blood pressure readings, specifically in January 1973 and December 1975. As the examiner's conclusion is based on an inaccurate factual premise, the medical opinion is of limited probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). Based on the above, the Board finds that the most probative evidence is in favor of a finding that the Veteran's current hypertension disability was incurred in active service and that service connection for hypertension is therefore warranted. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. W. Morgan, 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.