HYPERTENSION

Summary

The veteran, who served from August 1992 to January 1999, appeals the denial of service connection for hypertension. The veteran claimed hypertension was secondary to his service-connected sleep apnea. The Board reviewed the evidence, including private treatment records showing hypertension since 2016 and sleep apnea diagnosed in 2019. A VA examiner in December 2021 opined that the veteran's hypertension was less likely than not proximately due to his sleep apnea, citing medical literature on atherosclerosis. The Board found this opinion probative and persuasive, noting the lack of competent medical evidence to refute it or support the veteran's lay assertion of causation. The Board also considered a submitted medical article but found it too general and lacking a specific nexus to the veteran's case. The Board denied secondary service connection for hypertension. Additionally, the Board found no evidence of hypertension onset in service or manifestation within one year of discharge, nor any competent evidence linking it to service or toxic exposures. The VA examiner's opinion regarding toxic exposure and hypertension was also found to be against the claim, as the examiner stated that the specific exposures were not medically accepted causes of hypertension. The Board concluded the evidence persuasively weighed against the claim, denying service connection for hypertension.

Rationale

No competent medical evidence linking hypertension to sleep apnea; VA opinion found probative and persuasive; Veteran's lay assertion of causation is not competent medical evidence

Full Decision Text

Citation Nr: A26020570
Decision Date: 03/06/26	Archive Date: 03/06/26

DOCKET NO. 251104-603588
DATE: March 6, 2026

ORDER

Entitlement to service connection for hypertension is denied.

FINDING OF FACT

The Veteran's hypertension did not have its onset in service, or manifest to a compensable degree within one year of service discharge and there is no competent evidence linking it to any incident of service or service-connected disability.  

CONCLUSION OF LAW

The criteria for service connection for hypertension are not met.  38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.  

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1992 to January 1999.

In a November 2024 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for hypertension.  The Veteran timely appealed the denial and requested "Evidence Submission" review.  See VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), received November 4, 2025.  Under this option, the Board is limited to review of the evidence in the record at the time of the November 2024 rating on appeal in addition to evidence submitted up to 90 days after the VA Form 10182.  38 C.F.R. § 20.303.  Any evidence submitted outside of these periods has not been considered by the Board.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

The Veteran is seeking service connection for hypertension on a secondary basis related to his sleep apnea.  See November 2021 VA Form 21-526. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the "nexus" requirement.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).  Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Certain chronic diseases such as hypertension are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service.  38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).  Continuity of symptomatology may also provide a basis for a grant of service connection for those diseases defined as "chronic" by VA.  38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder.  38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 446 (1995) (en banc).  In order to establish service connection for a claimed secondary disorder, there must be medical evidence of a current disability; evidence of a service-connected disability; and medical evidence of a nexus between the service-connected disability and the current disability.  See Wallin v. West
 § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder.  38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 446 (1995) (en banc).  In order to establish service connection for a claimed secondary disorder, there must be medical evidence of a current disability; evidence of a service-connected disability; and medical evidence of a nexus between the service-connected disability and the current disability.  See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-7 (1995).  Secondary service connection may be found in certain instances in which a service-connected disability aggravates another disorder.  38 C.F.R. § 3.310(b).  

On August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted.  Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity.  38 U.S.C. § 1168.  An August 20024 VA TERA Memo reflects that the Veteran participated in a TERA and was potentially exposed to asbestos being aboard two vessels and to harmful chemicals such as lead based on his military occupational specialties as an ammunition handler, stowage member, and small arms operator.  

hypertension

Although the Veteran contends his hypertension is related to his service-connected sleep apnea disability, the competent medical evidence of record fails to support this assertion.

Private treatment records show the Veteran had a history of hypertension and snoring since at least 2016.  and a sleep apnea diagnosis was confirmed in 2019.  See clinical records from IHA Canton Family Medicine.  

When examined by VA in December 2021, the Veteran reported a history of treatment for hypertension since 2016 and that the medications help control it.  After examination and review of the record, the examiner concluded that the Veteran's hypertension was less likely than not proximately due to or the result of his service-connected sleep apnea condition.  Citing to Up To Date, an online medical reference, the examiner noted that hypertension (high blood pressure) is caused by narrowing and plaque buildup associated with atherosclerosis/coronary artery disease, which puts added force against the artery walls over time, thereby damaging the arteries.  Therefore, a nexus is not established. 

After weighing the evidence, the Board finds that service connection for hypertension is not warranted.  The VA opinion is both probative and persuasive medical evidence in this case, as it is based upon a review of the claims file and supported by sound medical rationale.  The VA examiner considered the medical history as found in the record, the onset and course of the pertinent symptoms, the Veteran's assertion that his hypertension is related to his sleep apnea and reviewed current medical literature in support of the conclusion.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion.  The claims file contains no competent medical evidence refuting it.  

The Board has also taken into consideration the Veteran's lay statements.  However, his assertion that his hypertension is related to his sleep apnea, treads into the realm of medical expertise.  This is especially true where a particular condition is not readily amenable to mere lay diagnosis or probative comment regarding etiology.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  The evidence does not reflect that the Veteran has the requisite medical training, expertise, or credentials needed to evaluate cardiovascular disorders or render a competent opinion as to medical causation.  Here the probative value of his competent lay assertions regarding the etiology of his hypertension is outweighed by the medical evidence of record, including the VA medical opinion.  Consequently, service connection on a secondary basis for hypertension is denied.

The Board has also considered the submitted article how
  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  The evidence does not reflect that the Veteran has the requisite medical training, expertise, or credentials needed to evaluate cardiovascular disorders or render a competent opinion as to medical causation.  Here the probative value of his competent lay assertions regarding the etiology of his hypertension is outweighed by the medical evidence of record, including the VA medical opinion.  Consequently, service connection on a secondary basis for hypertension is denied.

The Board has also considered the submitted article how sleep apnea affects blood pressure.  Medical treatise evidence can, in some circumstances, constitute competent medical evidence, especially when combined with an opinion of a medical professional.  See Sacks v. West, 11 Vet. App. 314, 317 (1998); see also 38 C.F.R. § 3.159(a)(1).  However, generic information in a medical journal or treatise is normally too general and inconclusive to constitute the sole basis for establishing a medical nexus to a disease or injury.  Mattern v. West, 12 Vet. App. 222, 227 (1999).  In this case, the submitted article was not accompanied by a medical opinion, is general in nature, and does not relate to the specifics of the Veteran's particular medical history, and do not purport to establish any medical principles that in turn establish a basis for granting service connection in this case.  Thus, the Board finds that the medical article is afforded no probative value as it relates to a nexus.

Because there is no competent medical evidence relating hypertension to a service-connected sleep apnea disability, the claim cannot be granted on a secondary basis.  38 C.F.R. § 3.310; Allen, supra; see also, Wallin, Reiber, supra.  

The Board is also unable to attribute the post-service development of hypertension to service on a direct basis.  As noted above, the Veteran himself is not alleging the onset of a hypertension in service and service treatment records are negative for signs or symptoms suggestive of hypertension.  Likewise, there is no evidence that hypertension was manifested to a compensable degree within one year of separation from service in 1999.  As noted above, private treatment records show a hypertension since 2016.  Because there is no objective evidence that the Veteran was diagnosed with hypertension within one year of service discharge, service connection may not be made on a presumptive basis.  38 C.F.R. §§ 3.307, 3.309(a). 

Furthermore, there is no competent evidence linking the Veteran's hypertension to his military service.  In an August 2024 VA opinion, the examiner determined that the Veteran's hypertension is less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the Veteran's total potential exposure through all applicable military deployments and the synergistic, combined effect of all of his toxic exposure risk activities.  The examiner explained that the listed TERA exposures are not medically accepted as causing or aggravating hypertension and that asbestos and lead exposures are not known causes of hypertension.  The examiner noted that while "harmful chemicals" is a very broad term, it can be said that chemical exposures of the type listed are not considered to cause or aggravate hypertension in general and found no evidence to support the contention. 

The VA opinion is both probative and persuasive medical evidence, as it is based upon a review of the record and is supported by sound medical rationale.  The VA examiner considered the Veteran's history of in-service toxic exposure and the onset and course of his symptoms, in determining the likelihood or not that hypertension developed as a result of exposure to environmental hazards during service.  See Nieves-Rodriguez, 22 Vet. App. 304.  The record contains no competent medical evidence refuting it.

To the extent the Veteran may now assert that his hypertension is related to toxic exposures during service, such an assertion treads into the realm of medical expertise.  This is especially true when, as in this case, it involves allegations that it was caused by exposure to an environmental hazard such as contaminated water, and where that factual predicate has not been established.  See Jandreau, 492 F.3d at 1377; Woehlaert, 21 Vet. App. 456, 462.  Therefore, the Veteran's lay statements cannot be accepted as competent evidence of a nexus.  The Board again notes that he has not alleged that hypertension began in service; his claim is based on the allegation that service connected sleep apnea led
 the Veteran may now assert that his hypertension is related to toxic exposures during service, such an assertion treads into the realm of medical expertise.  This is especially true when, as in this case, it involves allegations that it was caused by exposure to an environmental hazard such as contaminated water, and where that factual predicate has not been established.  See Jandreau, 492 F.3d at 1377; Woehlaert, 21 Vet. App. 456, 462.  Therefore, the Veteran's lay statements cannot be accepted as competent evidence of a nexus.  The Board again notes that he has not alleged that hypertension began in service; his claim is based on the allegation that service connected sleep apnea led eventually to its development.  The only medical evidence on this contention is against the claim.

Accordingly, the evidence is persuasively against the claim and there is no reasonable doubt to be resolved.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bryant, Jeana R

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.