HYPERTENSION

Summary

The veteran, who served from May 1993 to May 1997, appeals the denial of service connection for hypertension, diabetes mellitus type II, sleep apnea, and bilateral carpal tunnel syndrome. The veteran also sought service connection for PTSD and unspecified depressive disorder. The Board found that new and relevant evidence, including a June 2024 private medical opinion, warranted readjudication of the hypertension, diabetes, and sleep apnea claims. This opinion linked these conditions to obesity, which was secondary to the veteran's service-connected back disability. The Board granted service connection for hypertension, diabetes mellitus type II, and sleep apnea as secondary to the service-connected back disability. For PTSD and unspecified depressive disorder, the Board found that the evidence established an in-service personal assault, corroborated by a fellow servicemember's statement and the veteran's own testimony. A private psychologist's opinion linked these conditions to the in-service stressor. The Board found this opinion highly probative and granted service connection for PTSD and unspecified depressive disorder. The claims for carpal tunnel syndrome of the left and right upper extremities were remanded for initial adjudication on the merits, as the prior decision focused on the lack of new evidence rather than the merits, and the veteran provided testimony regarding in-service onset and symptoms.

Rationale

New and relevant evidence submitted post-hearing.; Private medical opinion links hypertension to obesity caused by service-connected back disability.; Opinion found probative and based on review of record and examination.

Full Decision Text

Citation Nr: A26028098
Decision Date: 03/27/26	Archive Date: 03/27/26

DOCKET NO. 200219-70681
DATE: March 27, 2026

ORDER

Readjudication of the claim of entitlement to service connection for hypertension is warranted.

Readjudication of the claim of entitlement to service connection for diabetes mellitus, type II, is warranted.

Readjudication of the claim of entitlement to service connection for sleep apnea is warranted.

Readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the left upper extremity is warranted.

Readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the right upper extremity is warranted.

Entitlement to service connection for hypertension as secondary to service-connected back disability is granted.

Entitlement to service connection for diabetes mellitus, type II as secondary to service-connected back disability is granted.

Entitlement to service connection for sleep apnea as secondary to service-connected back disability is granted.

Entitlement to service connection for posttraumatic stress disorder (PTSD) and unspecified depressive disorder is granted

REMANDED

Entitlement to service connection for carpal tunnel syndrome of the left upper extremity is remanded.

Entitlement to service connection for carpal tunnel syndrome of the right upper extremity is remanded.

FINDINGS OF FACT

1. An August 2019 rating decision denied entitlement to service connection for hypertension, diabetes mellitus, type II, sleep apnea, carpal tunnel syndrome of the left upper extremity, and carpal tunnel syndrome of the right upper extremity.

2. Since the August 2019 rating decision, new and relevant evidence has been received to readjudicate the claims of entitlement to service connection for hypertension, diabetes mellitus, type II, sleep apnea, carpal tunnel syndrome of the left upper extremity, and carpal tunnel syndrome of the right upper extremity.

3. There is persuasive medical opinion evidence that shows that the Veteran's hypertension, diabetes mellitus, type II, and sleep apnea are secondary to his service-connected back disability via an intermediate step of obesity.

4. The Veteran has been diagnosed with PTSD and unspecified depressive disorder that have been linked to a corroborated in-service stressor.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim of entitlement to service connection for hypertension have been met.  38 C.F.R. § 3.2501.

2. The criteria for readjudication of the claim of entitlement to service connection for diabetes mellitus, type II have been met.  38 C.F.R. § 3.2501.

3. The criteria for readjudication of the claim of entitlement to service connection for sleep apnea have been met.  38 C.F.R. § 3.2501.

4. The criteria for readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the left upper extremity have been met.  38 C.F.R. § 3.2501.

5. The criteria for readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the right upper extremity have been met.  38 C.F.R. § 3.2501.

6. The criteria for entitlement to service connection for hypertension have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310.

7. The criteria for entitlement to service connection for diabetes mellitus, type II  have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310.

8. The criteria for entitlement to service connection for sleep apnea have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310.

9. The criteria for entitlement to service connection for PTSD and unspecified depressive disorder have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304(f), 4.125(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1993 to May 1997.  This matter comes before the Board on appeal from a January 2020 Regional Office (RO) rating decision.  The Veteran was notified of this decision in a letter dated January 10, 2020.

In February 2020, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), on which
 disorder have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304(f), 4.125(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1993 to May 1997.  This matter comes before the Board on appeal from a January 2020 Regional Office (RO) rating decision.  The Veteran was notified of this decision in a letter dated January 10, 2020.

In February 2020, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), on which he listed the issues that are currently on appeal.  He requested that his case be placed on the Hearing Docket.  On March 28, 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge. 

The Board may only consider the evidence of record at the time of the notification letter of the appealed rating decision, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  

Thus, the Board may only consider the evidence of record at the time of the January 10, 2020, rating decision notification letter, as well as evidence submitted at the time of the March 28, 2024, Board hearing through June 26, 2024.  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801.

However, because the Board is remanding the claims of entitlement to service connection for carpal tunnel syndrome of the left upper extremity and carpal tunnel syndrome of the right upper extremity, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these claims.  38 C.F.R. § 3.103(c)(2)(ii).

New and Relevant Evidence and Service Connection

For claims that have been submitted on or after February 19, 2019, VA will readjudicate a claim if new and relevant evidence is presented or secured.  38 C.F.R. § 3.156(d).  (For claims submitted prior to this date, new and material evidence was required to reopen a claim.)  Relevant evidence is evidence that "tends to prove or disprove a matter at issue in a claim." 38 C.F.R. § 3.2501.  Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed.  Id.

Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).

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, or nexus, between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for listed chronic diseases, such as hypertension and diabetes mellitus, if such were shown as chronic in service; manifested to a compensable degree within a presumptive period (usually one year) after separation from service; or were noted in service with continuity of symptomatology since service.  38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Obesity may serve as an intermediate step when considering secondary service connection under 38 C.F.R. § 3.310.  See VAOPGCPREC 1-2017.  In Walsh v. Wilkie, 32 Vet.
 manifested to a compensable degree within a presumptive period (usually one year) after separation from service; or were noted in service with continuity of symptomatology since service.  38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Obesity may serve as an intermediate step when considering secondary service connection under 38 C.F.R. § 3.310.  See VAOPGCPREC 1-2017.  In Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020), the United States Court of Appeals for Veterans Claims (Court) held that proper interpretation of G.C. Prec. Op. 1-2017 requires consideration of both proximate causation and aggravation in its analytical framework: (1) whether the service-connected disability caused the veteran to become obese/aggravated the veteran's obesity; (2) if so, whether the obesity/aggravation of obesity as a result of the service-connected disability was a substantial factor in causing/aggravating the current disability; and (3) whether the current disability would not have occurred but for obesity caused/aggravated by the service-connected disability.  

1. Readjudication of the claim of entitlement to service connection for hypertension is warranted.

2. Readjudication of the claim of entitlement to service connection for diabetes mellitus, type II is warranted.

3. Readjudication of the claim of entitlement to service connection for sleep apnea is warranted.

Prior to the January 2020 rating decision that is currently on appeal, an August 2019 rating decision found that new and relevant evidence had not been received to reconsider the claims of entitlement to service connection for hypertension, diabetes mellitus, type II, and sleep apnea.  Later that month, the Veteran filed a VA Form 20-0995, Decision Review Request: Supplemental Claim, on which he cited these issues.  

The Board finds that new and relevant evidence has been submitted with respect to these three claims.  Specifically, in June 2024, within the post-hearing evidentiary window, the Veteran's accredited representative submitted a June 2024 etiology opinion from a private doctor who provided the following opinion:

After reviewing the Veteran's records and the scientific literature, from the above discussion it can be concluded that the Veteran's obstructive sleep apnea, diabetes mellitus type 2 and hypertensin are at least as likely as not due to obesity, which is secondary to his service connected physical issues.

The Board finds that the above evidence is new in that it was not of record at the time of the August 2019 rating decision.  It is relevant in that it links the Veteran's sleep apnea, hypertension, and diabetes mellitus to obesity caused by his service-connected disabilities.  Therefore, new and relevant evidence having been received, the claims of entitlement to service connection for hypertension, diabetes mellitus, type II, and sleep apnea are reopened, and readjudication is warranted.

4. Readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the left upper extremity is warranted.

5. Readjudication of the claim of entitlement to service connection for carpal tunnel syndrome of the right upper extremity is warranted.

Prior to the January 2020 rating decision that is currently on appeal, an August 2019 rating decision found that new and relevant evidence had not been received to reconsider the claims of entitlement to service connection for carpal tunnel syndrome of the left upper extremity and carpal tunnel syndrome of the right upper extremity.  Prior adjudications of these claims focused on the theory that the Veteran's carpal tunnel syndrome arose secondary to a service-connected neck disability.  Later that month, the Veteran filed a VA Form 20-0995, Decision Review Request: Supplemental Claim, on which he cited these issues.  

The Board finds that new and relevant evidence has been submitted with respect to these two claims.  Specifically, the Veteran has raised a new theory of entitlement and has provided testimony concerning in-service onset and symptoms after service.

He testified at his Board hearing that his military occupational specialty (MOS) of landing support specialist involved duties that resulted in carpal tunnel symptoms in service.  His representative noted that "a landing support specialist ... is similar to a longshoreman or a material handler type MOS."  (See Board hearing transcript, page 4.)  He described his duties as follows: 

A lot of the stuff that we dealt with was with chains and slings, and we would have to measure and weigh things in proportion to get it put on certain aircraft or certain transportation.

So, I
 submitted with respect to these two claims.  Specifically, the Veteran has raised a new theory of entitlement and has provided testimony concerning in-service onset and symptoms after service.

He testified at his Board hearing that his military occupational specialty (MOS) of landing support specialist involved duties that resulted in carpal tunnel symptoms in service.  His representative noted that "a landing support specialist ... is similar to a longshoreman or a material handler type MOS."  (See Board hearing transcript, page 4.)  He described his duties as follows: 

A lot of the stuff that we dealt with was with chains and slings, and we would have to measure and weigh things in proportion to get it put on certain aircraft or certain transportation.

So, I noticed this when dealing with the chains and the slings.  You have to hook them together.  And we would use these D-rings that had a long screw that'd come through it, and you'd have to crank that thing on.

And it wore my hands out.  I mean just the first one, and it would cramp.  My hands would cramp like crazy.

(See Board hearing transcript, page 4.)  He reported that his symptoms gradually worsened and that he was eventually transferred to clerical work, which also aggravated his symptoms.  (See Board hearing transcript, pages 5-6.)  He reported that, in addition to cramping, he would experience numbness in his hands.  (See Board hearing transcript, page 6.)  He testified that the symptoms did not resolve after he separated from service, and "It gradually kept getting worse."  (See Board hearing transcript, page 6.)  

The Board finds that the above evidence is new in that it was not of record at the time of the August 2019 rating decision.  It is relevant in that it relates to evidence of in-service onset of carpal tunnel symptoms and symptoms after service.  Therefore, new and relevant evidence having been received, the claims of entitlement to service connection for carpal tunnel syndrome of the left upper extremity and carpal tunnel syndrome of the right upper extremity are reopened, and readjudication is warranted.

6. Entitlement to service connection for hypertension is granted.

7. Entitlement to service connection for diabetes mellitus, type II is granted.

8. Entitlement to service connection for sleep apnea is granted.

As noted above, a June 2024 private medical opinion links the Veteran's hypertension, diabetes mellitus, and sleep apnea to obesity due to his service-connected back disability. Dr. R.P. noted that the Veteran "gained weight due to back issues." Dr. R.P. explained that physical inactivity and sedentary behavior can cause obesity. Dr. R.P. maintained that the Veteran's "weight gain can be attributed to his inability to exercise because of service connected physical conditions."

The Board finds this opinion to be highly probative, as it was authored by a physician who possesses the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159(a)(1).  See Cox v. Nicholson, 20 Vet. App. 563 (2007).  It is based on review of the record and interview and examination of the Veteran.  It provides an opinion that contains a rationale that cites to the facts of the Veteran's case.

In short, the Board finds that the criteria for entitlement to service connection for hypertension, diabetes mellitus, type II, and sleep apnea as secondary to service-connected back disability via an intermediate step of obesity have been met.  The benefit that is sought on appeal is granted.

9. Entitlement to service connection for PTSD and unspecified depressive disorder is granted.

The Veteran has claimed entitlement to service connection for PTSD and unspecified depressive disorder that he claims were incurred due to an in-service personal assault and subsequent harassment.  

Claims for service connection for PTSD require (1) medical diagnosis conforming to the requirements of section 4.125(a) (which requires that a diagnosis conform to the DSM-5 criteria), (2) an in-service stressor accompanied by credible and supporting evidence that the stressor claimed to be the cause of the disorder occurred in service, and (3) established medical evidence connecting the current disability to the stressor.  38 C.F.R. § 3.304(f); 38 C.F.R. § 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 138 (1997).

The Board finds that the evidence establishes the occurrence of an in-service personal assault that was described in detail by the Veteran in an October 2019 written statement and at his Board hearing.  (See Board hearing transcript, pages 14-16.)  The occurrence and details of this incident were corroborated in a May 2021 lay statement
 supporting evidence that the stressor claimed to be the cause of the disorder occurred in service, and (3) established medical evidence connecting the current disability to the stressor.  38 C.F.R. § 3.304(f); 38 C.F.R. § 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 138 (1997).

The Board finds that the evidence establishes the occurrence of an in-service personal assault that was described in detail by the Veteran in an October 2019 written statement and at his Board hearing.  (See Board hearing transcript, pages 14-16.)  The occurrence and details of this incident were corroborated in a May 2021 lay statement that was written by a fellow servicemember that was resubmitted in April 2024 during the post-hearing evidentiary window.  

(The Board further notes that the Veteran's service treatment records reflect that he sought treatment for facial trauma in July 1994 after he had been assaulted by another person.)  

The Board finds that the record also contains competent medical evidence of current diagnoses of PTSD and unspecified depressive disorder in the form of an August 2021 private medical evaluation and opinion that was resubmitted in April 2024 during the post-hearing evidentiary window.  

This opinion also provides a nexus between the Veteran's service and his current PTSD and unspecified depressive disorder.  The report contains a detailed review of the Veteran's pertinent medical history, including the Veteran's reported stressor events, and an evaluation of the Veteran.  The private psychologist provided the following opinion:

The PTSD and related depression were incurred in or caused by the in-service stressor of the personal assault that was followed by several months of harassment.  He reported a buddy statement confirming the same.  The depressive disorder is related to the PTSD.  He also has chronic pain and limitations from his service connected back condition that contributes to his depression, "There are multiple things going that is causing a lot ... of this."  

The Board finds this opinion to be highly probative, as it was authored by a psychologist who possesses the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159(a)(1).  See Cox v. Nicholson, 20 Vet. App. 563 (2007).  It is based on review of the record and interview and examination of the Veteran.  It provides an opinion that contains a rationale that cites to the facts of the Veteran's case.

In short, the Board finds that the criteria for entitlement to service connection for PTSD and unspecified depressive disorder have been met.  The benefit that is sought on appeal is granted.

REASONS FOR REMAND

1. Entitlement to service connection for carpal tunnel syndrome of the left upper extremity is remanded.

2. Entitlement to service connection for carpal tunnel syndrome of the right upper extremity is remanded.

As noted above, the RO's denial of these claims was based solely on the Veteran's failure to submit new and relevant evidence, and it has not yet adjudicated the claims on the merits.  The appellant has a procedural right to have one review of his appeal by the Secretary under 38 U.S.C. § 7104(a), and the AMA does not specifically revoke that right as provided by statute.  See 38 C.F.R. § 20.802(a) (stating that the Board may remand for correction of any other error by the agency of original jurisdiction in satisfying a regulatory or statutory duty if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim).  Thus, a remand for initial adjudication on the merits is appropriate.

The matters are REMANDED for the following action:

Readjudicate the issues of entitlement to service connection for carpal tunnel syndrome of the left upper extremity and carpal tunnel syndrome of the right upper extremity on the merits.  All evidence of record should be considered. 

							(continued on next page)

 

 

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Elizabeth Jalley, 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.