Citation Nr: 22017442 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 17-17 410 DATE: March 25, 2022 ORDER Service connection for hypertension is granted. REMANDED Service connection for coronary artery disease (CAD) is remanded. Service connection for atrial fibrillation (to include supraventricular arrhythmia) is remanded. FINDING OF FACT The evidence of record indicates that the Veteran currently has hypertension which first arose during active-duty service. CONCLUSION OF LAW The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran honorably served from September 1970 to September 1973. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2018 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a September 2021 hearing and a transcript of those proceedings are of record. 1. Service connection for hypertension Generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Additionally, hypertension is classified as a "chronic disease" eligible for presumptive service connection under 38 C.F.R. § 3.309 (a). The Board may consider presumptive service connection for "chronic diseases" on three bases: (1) chronicity during service, (2) continuity of symptomatology since service, and (3) manifestations to a degree of 10 percent disabling or more within one year of the Veteran's separation from service. 38 C.F.R. §§ 3.303 (b), 3.307(a)(3); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). For VA purposes, hypertension is defined as diastolic blood pressure predominantly at 90 millimeters or greater. See 38 C.F.R. § 4.104, Diagnostic Code 7101. A 10 percent rating under Diagnostic Code (DC) 7101 is: (1) diastolic pressure predominantly 100 or more; or (2) systolic pressure predominantly 160 or more; or (3) a history of diastolic pressure predominantly 100 or more with continuous medication for required control. Turning to the facts of the instant case, the Board first notes that the Veteran has a current diagnosis of hypertension according to the May 2018 VA examination report. Accordingly, the Board finds that the first service connection requirement of a current disability has been satisfied. Next, regarding the next service connection requirement of an in-service incurrence, the Board notes that hypertension was not recorded on the Veteran's September 1970 enlistment examination. At that time, his blood pressure was measured as 138/88. But, in reviewing the Veteran's remaining service treatment records (STRs), the evidence indicates that the Veteran's blood pressure first became elevated during his active-duty service. Specifically, from October 1972 to December 1972, the Veteran displayed blood pressure readings of 140/80 and 154/112. The Veteran provided competent and credible testimony at his hearing that he was diagnosed with hypertension during service and was prescribed medication to treat his high blood pressure. This testimony is corroborated by STRs showing treatment for dizziness, chest pain, nose bleeds, and fainting spells. This contention is also consistent with the hypertensive blood pressure reading 154/112 taken on December 22, 1972. Finally, a VA examiner in May 2018 reviewed the medical evidence and determined that the Veteran was first diagnosed with hypertension in December 1973, within a year of separation from service. Considering the above, the Board concludes that the Veteran first displayed symptoms of a chronic disability during service, warranting a grant of service connection for hypertension presumptively. See 38 C.F.R. §§ 3.303 (b), 3.307(a)(3). As such, the Veteran's claim for service connection for hypertension is granted. REASONS FOR REMAND 2. Service connection for CAD 3. Service connection for atrial fibrillation (to include supraventricular arrhythmia) The Veteran contended during the September 2021 hearing that the above heart disabilities remaining on appeal are secondarily caused or related to his now service-connected hypertension. February 2019 treatment records from Atrium Health document an echocardiogram showing diagnoses for CAD and atrial arrhythmia and fibrillation. A medical opinion must be obtained on remand addressing this newly raised secondary service connection theory of entitlement. The matters are REMANDED for the following action: 1. Obtain any relevant outstanding VA or private treatment records. 2. Forward the Veteran's claims file to a qualified clinician for medical opinions addressing the following: (a.) Whether the Veteran's CAD and atrial fibrillation (to include supraventricular arrhythmia) are proximately due to service-connected hypertension? Why or why not? (b.) Whether the Veteran's CAD and atrial fibrillation (to include supraventricular arrhythmia) are aggravated by service-connected hypertension? Why or why not? *Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions). (Continued on the next page) The examiner is informed that a positive opinion indicating a nexus to service does not require certainty. Rather, if the weight of the evidence is in approximate balance for and against a nexus to service, the examiner should make a determination favorable to the Veteran. The examiner is asked to provide the underlying reasons for all opinions expressed and to apply and cite to peer-reviewed medical sources and generally accepted medical principles whenever possible. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kyle McKone 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.