HYPERTENSION

Summary

The veteran, an Army veteran who served from August 2004 to November 2008, appeals the denial of service connection for hypertension. The veteran contends that hypertension developed due to an IED blast experienced in service and reported elevated blood pressure readings, with a diagnosis from a private physician. However, service treatment records did not reflect any complaints, treatment, or findings related to hypertension, showing only sporadically elevated readings, particularly after the IED incident. Post-service records also showed elevated readings but no formal diagnosis of hypertension within the presumptive period or during the appeal period. A June 2020 VA examination found no diagnosis of hypertension, noting that while in-service records showed elevated readings, they were not consistent enough for a diagnosis. The Board found the veteran failed to demonstrate a current disability, as no competent evidence of a past or current hypertension diagnosis was provided. Consequently, the claim for service connection for hypertension was denied.

Rationale

No competent evidence of current diagnosis of hypertension; Service treatment records devoid of diagnosis or treatment for hypertension; Post-service records showed elevated readings but no diagnosis

Full Decision Text

Citation Nr: 23022226
Decision Date: 04/13/23	Archive Date: 04/13/23

DOCKET NO. 19-11 149
DATE: April 13, 2023

ORDER

Entitlement to service connection for hypertension, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA), is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran has had hypertension at any time during or approximate to the pendency of the claim.

CONCLUSION OF LAW

The criteria for entitlement to service connection for hypertension have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from August 2004 to November 2008.  He is a recipient of the Purple Heart.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision issued by a Department of Veteran Affairs (VA) Regional Office (RO).

This appeal was most recently before the Board in October 2019, at which time the Board remanded the issue on appeal for additional development.  The RO substantially complied with remand directives, and the appeal is properly returned for adjudication.  See Stegall v. West, 11 Vet. App. 268 (1998).  There has been no specific contention or allegation otherwise to address herein.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases, such as hypertension, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period (one year) following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309.

Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability.  38 C.F.R. § 3.310(a).  Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.  38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995).  In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

Entitlement to service connection for hypertension.

The Veteran contends that he developed hypertension due to the trauma of injury from an IED blast in service.  He reported that (1) he had been treated for hypertension; (2) his blood pressure was elevated and all or most of his readings were high; and (3) Dr. R. from the VA Hilo Medical Clinic diagnosed him with hypertension.  See NOD (March 2015).

Service treatment records (STR) reflect no complaints, treatment, or findings for hypertension.  On his April 2004 Report of Medical Examination (ROME) on enlistment,
. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra.

Entitlement to service connection for hypertension.

The Veteran contends that he developed hypertension due to the trauma of injury from an IED blast in service.  He reported that (1) he had been treated for hypertension; (2) his blood pressure was elevated and all or most of his readings were high; and (3) Dr. R. from the VA Hilo Medical Clinic diagnosed him with hypertension.  See NOD (March 2015).

Service treatment records (STR) reflect no complaints, treatment, or findings for hypertension.  On his April 2004 Report of Medical Examination (ROME) on enlistment, the Veteran's blood pressure as 140/78.  In service treatment records reflect systolic pressures ranging from 104 to 148 and diastolic pressures ranging from 63 to 82.  The Veteran's highest readings inservice were following injury from an IED blast (139/69, 148/76); blood pressure was otherwise normal.  The Veteran's October 2008 separation ROME reflects blood pressure of 138/75; the Veteran denied having or having a history of high blood pressure.  See generally, STR (December 2009).

Post-service treatment records reflect sporadically elevated blood pressure readings but do not reflect a diagnosis of hypertension within one year of separation from service or at any time during the appeal period.  See CAPRI (February 2019) (e.g., September 2012 Nursing Triage Note (blood pressure 130/83); October 2013 VA Nursing Outpatient Note (blood pressure 148/89).  An October 2013 sleep study record reflects the "patient was noted to be borderline mildly hypertensive (BP was 139/79 in evening).  Patient has history of high blood pressure. Recommend further evaluation)."  A January 2014 mental health note reflects the Veteran's blood pressure was 130/78.  See CAPRI at 300.  The Veteran was prescribed Prazosin for nightmares associated with his psychiatric disability and counseled about possible headaches related to rebound hypertension.  Id.  (Rebound hypertension occurs when blood pressure rises after you stop taking or lower the dose of a drug. -- www.medlineplus.gov, accessed March 30, 2023.)  None of the records, private or VA, reflect the Veteran was diagnosed with hypertension.

At a June 2020 VA examination, the Veteran reported that he was diagnosed with high blood pressure after his second tour and was told that his elevated blood pressure, which fluctuates, might be due to anxiety.  He also reported that he measured his blood pressure twice per day on his blood pressure machine at home.  As readings could not be done in office due to COVID-19 restrictions, the Veteran completed three blood pressure readings at home from June 24, 2020, to June 26, 2020.  The results were as follows:

6/26/20: 144/93		6/25/20: 145/88		6/24/20: 130/88

The examination report found that the Veteran did not have a diagnosis of hypertension.  The concurrent opinion indicated that a review of active-duty medical records noted a blood pressure measurement of 140/78 on enlistment and periodic elevated blood pressures during recovery from IED blast in 2006 but no pattern consistent enough to be diagnosed as hypertension.  In addition, in-service and post-service medical records were devoid of any diagnosis or treatment for hypertension.

The Board acknowledges the Veteran's contentions that he has hypertension related to his service.  However, he is not competent to diagnose himself with hypertension; and he has not provided competent evidence to reflect any past or current diagnosis of hypertension.  Hence, a current disability is not shown during or approximate to the filing of the claim.

It is noted that the existence of a current disability is the cornerstone of a claim for VA disability compensation.  38 U.S.C. §§ 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997).  In the absence of proof of a present disability due to in service disease or injury, there can be no valid claim.  Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

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Accordingly, the claim is denied. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776