Citation Nr: A25028362 Decision Date: 03/26/25 Archive Date: 03/26/25 DOCKET NO. 240418-434102 DATE: March 26, 2025 ORDER Service connection for hypertension is granted. FINDING OF FACT The evidence is at least in approximate balance that the Veteran was diagnosed with hypertension within one year of separating from active service. CONCLUSION OF LAW The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1101(3), 1110, 1131, 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 in the United States Army from December 1986 to November 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2023 rating decision by a Department of Veterans Affairs (VA) regional office, which is the Agency of Original Jurisdiction (AOJ). The Veteran elected the Board's Direct Review docket. See April 2024 VA Form 10182. This restricts the Board's review to the evidence of record at the time of the December 2023 rating decision. 38 C.F.R. § 20.301. The Board notes that evidence was associated with the claims file after the December 2023 rating decision on appeal, which was during a period of time that is outside the applicable evidentiary window. Therefore, the Board has not considered this evidence in its present decision. 38 C.F.R. § 20.300(a). If the Veteran would like VA to consider the additional evidence that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and identify the evidence for the AOJ's consideration. 38 C.F.R. § 3.2501. Specific instructions for filing a supplemental claim are included with this decision. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Notwithstanding the lack of evidence of a disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). Where a veteran has at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases (such as cardiovascular-renal disease, to include hypertension) to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Service connection may be established under 38 C.F.R. § 3.303(b) if a chronic disease or injury is shown in service and subsequent manifestations of the same chronic disease or injury at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. The "continuity of symptomatology" provision applies only to the chronic diseases listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc). Service connection for hypertension. The first element of service connection is the existence of a current disability. The VA treatment records show that the Veteran has been diagnosed with and is currently being treated for hypertension. See September 2023 CAPRI; see also June 2009 C&P Exam; December 2009 Medical Treatment Record. Therefore, the first element of direct service connection has been established. The second element of direct service connection is an in-service incurrence or aggravation of an injury, event, or disease. Though the service treatment records (STRs) do not show a treating provider diagnosed the Veteran to have hypertension during service, including in the treatment notes covering the period while he was stationed in Korea, the records do show elevated blood pressure readings over the course of his active service. See June 2008 STRs. His systolic blood pressure value was recorded as high as 158 (May 2006) and diastolic at 106 (October 2006). In the April 2008 Report of Medical History, he confirmed a history of "[h]igh or low blood pressure" and reported that he had high blood pressure during his tour Afghanistan in 2007. See also December 2009 Medical Treatment Record; September 2021 STR. "Diagnosed for Tour of Duty in South Korea" (September 1999 to October 2006) and treated at the Darnall Medical Facility between October 2000 and October 2007. He denied taking any medications. The Board finds the second element of direct service connection has been established. The question left before the Board is whether the record supports the third element of direct service connection - that the hypertension manifested during active service and continued, that it manifested to a compensable degree within year of the veteran separating from service, or that it is somehow otherwise related to active service. 38 C.F.R. §§ 3.303, 3.307, 3.309. The Board finds the record shows the hypertension manifested to a compensable degree within one year of the Veteran separating from service. A February 2009 VA examination report documented blood pressure values of 138/84, 136/82, and 135/79. The examiner found no evidence to support a diagnosis of hypertension. However, in an April 2009 informal notice of disagreement (NOD), the Veteran reported that he had recently been diagnosed with hypertension. See April 2009 NOD. He did not disclose the name of his treating provider or the facility where he was diagnosed. He did not return a VA Form 21-4142. See May 2009 VCAA/DTA Letter. During a June 2009 VA examination, roughly 8 months after the Veteran had separated from service, he reported being diagnosed with hypertension and that he had been prescribed a thiazide diuretic (25mg of Hydrochlorothiazide per day). His blood pressure readings were 140/90, 140/92, and 140/90. The examiner identified hypertension as a current diagnosis but did not provide an opinion as to the etiology of the disease. The VA treatment notes show the Veteran established care at a VA facility in March 2010. See April 2011 & January 2017 CAPRI. He reported his outpatient prescriptions included Hydrochlorothiazide but that he had not taken the medication for an undisclosed period. His blood pressure was initially documented at 146/102. In April 2010, his blood pressure was recorded at 140/100. The Board acknowledges that the Veteran is not competent to self-diagnose hypertension. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Layno v. Brown, 6 Vet. App. 465, 471 (1994). However, he is competent to convey a contemporaneous medical diagnosis he had received from a provider, such as hypertension. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). He is also competent to report medications he had been prescribed, such as Hydrochlorothiazide. The Board finds the lay statement probative evidence that the Veteran was diagnosed with hypertension and that his symptoms were consistent with a compensable disability rating within one year of him separating from active service. Id.; see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Having considered the Veteran's credible reports and the medical evidence, the Board finds the record establishes that the Veteran was diagnosed with hypertension and that he required continuous medication for control of the disease within 1 year of him separating from active service. Therefore, the third and final element of service connection has been met. Resolving all reasonable doubt in the Veteran's favor, the Board finds service connection for hypertension granted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v, 21 F.4th at 781-82. T. V. Casey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Burden, 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.