HYPERTENSION

Summary

The veteran, who served in the United States Air Force from August 1964 to August 1968, appeals the denial of service connection for hypertension and nephrolithiasis. The veteran argued that these conditions were secondary to service-connected diabetes mellitus or coronary artery disease, and also claimed direct service connection based on alleged in-service herbicide exposure. The Board acknowledged the veteran's service and the existence of current diagnoses for hypertension and nephrolithiasis. However, service treatment records were silent regarding complaints, treatment, or diagnoses of these conditions, and blood pressure readings during service were normal. A VA examination in October 2020 found no evidence of in-service incurrence or aggravation for nephrolithiasis, and concluded that hypertension was less likely than not related to service-connected conditions, predating them and being influenced by lifestyle factors. A subsequent addendum opinion also found nephrolithiasis less likely than not related to service-connected disabilities, citing a lack of supporting medical literature. The Board found no competent evidence supporting the claims on a direct, secondary, or presumptive basis, and therefore denied service connection for both hypertension and nephrolithiasis.

Rationale

Service treatment records silent for complaints, treatment, or diagnoses; Blood pressure readings during service were normal; VA examiner found hypertension less likely than not related to service-connected conditions; VA examiner noted hypertension predated diabetes and coronary artery disease; Contributing factors included obesity, alcohol use, and smoking history

Full Decision Text

Citation Nr: A22014656
Decision Date: 07/29/22	Archive Date: 07/29/22

DOCKET NO. 220407-234106
DATE: July 29, 2022

ORDER

Service connection for hypertension is denied.

Service connection for nephrolithiasis is denied.

FINDINGS OF FACT

1. The fails to persuasively show that diagnosed hypertension is secondary to service-connected diabetes mellitus or is otherwise related to an in-service injury or disease.

2. The fails to persuasively show that diagnosed nephrolithiasis is secondary to service-connected diabetes mellitus or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for nephrolithiasis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from August 1964 to August 1968. His service decorations include the National Defense Service Medal and the Vietnam Service Medal.

The rating decision on appeal was issued in May 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  The Veteran timely appealed the decision to the Board by requesting the Direct Review docket in the April 2022 Decision Review Requests: Board Appeal (Notice of Disagreement) (VA Form 10182). Therefore, the Board may only consider the evidence of record at the time of the May 2021 decision on appeal. 38 C.F.R. § 20.303.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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).

Service connection is warranted for a disability which is proximately due to, aggravated by, or the result of a service-connected disability. 38 C.F.R. § 3.310. A finding of secondary service connection requires competent medical evidence to connect the asserted secondary disability to the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Velez v. West, 10 Vet. App. 432 (1997).

If a Veteran was exposed to an herbicide agent during active military, naval, or air service, then certain diseases, shall be service connected even though there is no record of such disease during service. For the purposes of this section, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operation in the Republic of Vietnam during the Vietnam era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.313. 

Hypertension and Nephrolithiasis

The Veteran claims that his hypertension and nephrolithiasis was related to service. Specifically, the Veteran argues that hypertension and nephrolithiasis was due to service-connected diabetes mellitus or coronary artery disease. The Veteran has also argued that the hypertension and nephrolithiasis is related to in-service herbicide agent exposure.

Regarding the Veteran's claim that his hypertension and nephrolithiasis are the result of in-service herbicide exposure. While VA has conceded that the Veteran has been presumed to have been exposed to herbicides while in-service, neither hypertension nor nephrolithiasis are diseases subject to presumptive service connection based on herbicide exposure. However, this does not preclude the Veteran from service connection on a direct basis.

The Agency of Original Jurisdiction (AOJ) in the May 2021 rating decision in its favorable findings noted the Veteran to have diagnosis of both hypertension and nephrolithiasis. The Board is bound by these favorable findings and therefore the first element of a service connection claim has
 related to in-service herbicide agent exposure.

Regarding the Veteran's claim that his hypertension and nephrolithiasis are the result of in-service herbicide exposure. While VA has conceded that the Veteran has been presumed to have been exposed to herbicides while in-service, neither hypertension nor nephrolithiasis are diseases subject to presumptive service connection based on herbicide exposure. However, this does not preclude the Veteran from service connection on a direct basis.

The Agency of Original Jurisdiction (AOJ) in the May 2021 rating decision in its favorable findings noted the Veteran to have diagnosis of both hypertension and nephrolithiasis. The Board is bound by these favorable findings and therefore the first element of a service connection claim has been met.

Service treatment records are silent for complaints, treatment, or diagnoses related to hypertension and/or nephrolithiasis. Blood pressure readings during service were normal. Further, the Veteran underwent a VA examination in October 2020 to determine the etiology of the Veteran's nephrolithiasis. The examiner noted that although the Veteran's service treatment records note stomach pains and nausea, the examiner found these generic complaints to not be supported of any undiagnosed nephrolithiasis. Therefore, the Board finds the evidence fails to persuasively show an in-service incurrence or aggravation of a disease or injury. Therefore, the Veteran's service connection claim on a direct basis is denied.

Further, the October 2020 VA examination stated that the Veteran's hypertension is not proximately due to or aggravated by any of his service connected conditions. Specifically, the examiner found that the Veteran's hypertension predated both the Veteran's diabetes as well are coronary artery disease. This, combined with the Veteran's history of obesity, alcohol use, and smoking history, all are contributing factors in the development of hypertension, led the examiner to conclude that the Veteran's hypertension was less likely than not proximately due to or aggravated by the Veteran's service-connected disabilities.

A November 2020 addendum opinion was obtained to address the Veteran's secondary service connection claim for nephrolithiasis. The examiner found that the Veteran's nephrolithiasis is less likely than not proximately due to or aggravated by the Veteran's service-connected disabilities. Specifically, the examiner stated that well-established, peer reviewed medical literature fails to establish a connection between nephrolithiasis and any of the Veteran's service-connected disabilities, to include diabetes and coronary artery disease. 

Furthermore, neither the Veteran nor his representative has presented or identified any additional medical opinion or other competent evidence that supports the Veteran's claim on a direct, secondary, or presumptive basis.

Therefore, the Board finds that the evidence fails to persuasively show that service connection is warranted on either a presumptive, direct, or secondary basis. As such, the benefit of the doubt rule is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

 

 

SONJA S. AN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jorge Barroso, 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.