HYPERTENSION

G. A. WASIK · 2026 · Case ID: A26037914

MIXED

Summary

The Veteran served in the Army National Guard (ANG) from July 16, 1981, to October 30, 1981. The Veteran appeals the denial of service connection for hypertension and for stroke disorder as secondary to hypertension. The Board found that service connection for hypertension was not warranted. The Veteran alleged a diagnosis of hypertension in 1985, but this was contradicted by her own medical history reports from 1987 and 1991, where she denied having high blood pressure. The Board gave greater weight to the contemporaneous medical evidence over the later allegations. While a 1991 examination noted elevated blood pressure readings, the examiner specifically stated the Veteran did not have a history of hypertension at that time. A 2023 VA examination diagnosed hypertension, but opined it was less likely than not related to service, noting the lack of service connection evidence and the Veteran's denial of hypertension in subsequent medical history reports. The Board also denied service connection for stroke disorder as secondary to hypertension, as the prerequisite service connection for hypertension was not established. The Board remanded the claim for an increased rating for bilateral hearing loss due to a duty to assist error, as the February 2025 VA audiological examination was deemed insufficient for rating purposes due to inconsistencies between subjective and objective measures and a lack of explanation for these inconsistencies.

Rationale

Contemporaneous medical history reports from 1987 and 1991 deny hypertension.; Veteran's allegation of 1985 diagnosis is not probative.; No evidence of hypertension within one year of discharge.; VA examination opined less likely than not incurred in or caused by service.

Service Branch

ARMY NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250407-531158

Full Decision Text

Citation Nr: A26037914
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 250407-531158
DATE: April 22, 2026

ORDER

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for stroke disorder, as secondary to hypertension, is denied.

REMANDED

Entitlement to a compensable rating for bilateral hearing loss is remanded.

FINDINGS OF FACT

1. The evidence demonstrates that hypertension was not incurred in-service.

2. Competent evidence has not been presented supporting that the Veteran has a stroke disorder secondary to a service-connected disability; service connection has not been established for hypertension.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

2. The criteria for service connection for stroke disorder, as secondary to hypertension, are not 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 Army National Guard (ANG) from July 16, 1981, to October 30, 1981.

On June 3, 2022, VA received the Veteran's VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, regarding service connection for bilateral hearing loss, for high blood pressure, and for stroke. An October 5, 2022, rating decision, granted service connection for bilateral hearing loss and assigned an initial noncompensable rating, effective November 19, 2021, and denied service connection for high blood pressure, and for stroke as secondary to high blood pressure.

On July 24, 2023, VA received the Veteran's VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), regarding an increased rating for service-connected bilateral hearing loss, and service connection for high blood pressure and for stroke. A November 21, 2023, HLR decision, denied an increased rating for service-connected bilateral hearing loss, and found duty to assist errors regarding service connection for high blood pressure and for stroke in the form of need of development under the PACT Act (A December 2023 VA Toxic Exposure Risk Activity (TERA) Memorandum found that the Veteran did not participate in a TERA during active service). An August 14, 2024, rating decision, denied service connection for high blood pressure and for stroke.

On February 12, 2025, VA received the Veteran's VA Form 20-0995, Decision Review Request: Supplemental Claim, regarding service connection for high blood pressure and for stroke. Also on February 12, 2025, VA received the Veteran's VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, regarding an increased rating for service-connected bilateral hearing loss.

A March 13, 2025, supplemental decision, denied an increased initial rating for bilateral hearing loss, and denied service connection for high blood pressure and for stroke. An April 3, 2025, rating decision, denied service connection for high blood pressure and for stroke. Although the April 2025 rating decision found that new and relevant evidence had been received regarding the service connection claims for high blood pressure and for stroke, the record shows that the Veteran continuously pursued these claims since VA's receipt of her June 3, 2022, VA Form 21-526EZ. In this regard, a claimant may continuously pursue a claim by a timely and proper filing relating to specified administrative review options. 38 C.F.R. § 3.2500. Regardless of the April 2025 finding that new and relevant evidence had been submitted regarding the claims of service connection for high blood pressure and for stroke, these claims were not previously and finally denied. As such, the Board will adjudicate the service connection claims for high blood pressure and for stroke on the merits.

On April 7, 2025, VA received the Veteran's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), selecting the Direct Review docket. Therefore, regarding an increased initial rating for bilateral hearing loss, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the March 13, 2025, supplemental decision on appeal. 38 C.F.R. § 20.301. Regarding service connection for hypertension and for stroke, the Board may only consider the evidence of record at the time of the April 3, 202
As such, the Board will adjudicate the service connection claims for high blood pressure and for stroke on the merits.

On April 7, 2025, VA received the Veteran's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), selecting the Direct Review docket. Therefore, regarding an increased initial rating for bilateral hearing loss, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the March 13, 2025, supplemental decision on appeal. 38 C.F.R. § 20.301. Regarding service connection for hypertension and for stroke, the Board may only consider the evidence of record at the time of the April 3, 2025, rating decision. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision(s) on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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.

The Board is remanding the claim of entitlement to an increased rating for bilateral hearing loss, and any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand.

Service Connection

Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. §§ 1110. 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical 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).

Certain chronic diseases 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. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1112, 1113; 38 C.F.R. § 3.307(a)(3), 3.309(a).

Service connection may be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

A claim for secondary service connection requires medical evidence that connects the asserted secondary disability to the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). In order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. Id.

In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabriel v. Brown, 7?Vet. App.?36, 39-40 (1994); Gilbert v. Derwinski, 1?Vet. App.?49, 57 (1990). Further, competency of evidence differs from the weight and credibility of evidence. Competency is a legal concept that determines whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination regarding the probative value of the evidence to
Id.

The Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24?Vet. App.?428 (2011); See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms, as symptoms require only personal knowledge of what is observed using her senses, not medical expertise. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. See Barr v. Nicholson, 21?Vet. App.?303, 307 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. See Jandreau, 492 F.3d at 1377.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. To deny a claim, the evidence must clearly weigh against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for hypertension is denied.

The Veteran contends that service connection is warranted for her hypertension. In particular, she contends that she was first diagnosed with hypertension by private practice in Florida in 1985, before the birth of her first child. However, she reports she does not have those records, and they were destroyed in Hurricane Michael, in 2005.

For the following reasons, service connection for hypertension is not warranted.

As noted above, the Veteran served on active duty in the ANG from July 16, 1981, to October 30, 1981.

A July 1981 report of medical history shows that the Veteran answered "no" as to whether she then had or ever had high or low blood pressure.

A July 1981 report of medical examination shows abnormal clinical evaluation of the heart with a legible notation of tachycardia (120/min), along with additional illegible notations. The examination report shows a blood pressure reading of 112/70.

An April 1987 report of medical history shows that the Veteran answered "no" as to whether she then had or ever had high or low blood pressure.

An April 1987 report of medical examination shows abnormal clinical evaluation of the heart with the notation of apical systolic murmur. The examination report shows a blood pressure reading of 112/80.

An October 1991 report of medical history shows that the Veteran answered "no" as to whether she then had or ever had high or low blood pressure.

An October 1991 report of medical examination shows abnormal clinical evaluation of the heart with the notation "apical systolic click - no mlr." The examination report shows blood pressure readings of 152/108, 148/100, and 142/90. However, the examiner specifically noted that the Veteran does not have a history of hypertension. Nevertheless, the examiner noted that the Veteran had elevated blood pressure on examination and recommended that the Veteran continue to check her blood pressure to make sure it is not hypertension.

A December 2023 VA hypertension examination and medical opinion shows a diagnosis of hypertension. The Veteran reported that she was first diagnosed with hypertension in 1985 by private practice before the birth of her first child; however, she reported she does not have those records and the records were destroyed in Hurricane Micheal, in 2005. The examiner opined that the Veteran's hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted medical records showing a diagnosis of hypertension since 2020. The examiner also noted the October 1991 report of medical examination showing elevated blood pressure readings and documenting concern for hypertension, without any mention of medication management or diagnosis of hypertension. The examiner also considered the Veteran's report that she was first diagnosed with hypertension in 1985 and started medication then. Indeed, the examiner stated that it is well known that many medical records were lost in the catastrophic hurricane of 2005. However, the examiner stated that, in considering all information in available records, the Veteran's active service dates, and the Veteran's statement of diagnosis in 1985, there is no evidence for direct service connection of hypertension since active service was in 1981.

The Board finds the Veteran allegation of having hypertension since 1985 are undercut by her subsequent reports of medical history completed in 1987 and 1991 wherein she denies having or ever having had hypertension at those times. The Board places greater probative value on the contemporaneous medical evidence over the subsequent allegations made decades after the fact. The Board finds the Veteran's allegation of having been diagnosed with hypertension in 1985 to be without probative value.

The Board recognizes that hypertension is a chronic disease which may be presumed to have been incurred or aggravated if the disability is manifested to a compensable degree within one year of the Veteran's discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In this case the Veteran was not shown to have hypertension within a year of discharge from active duty service. Accordingly, service connection for hypertension on a chronic disease presumptive basis is not warranted.

The Board acknowledges the Veteran's contentions that she has hypertension due to service. However, the determination as to whether the Veteran has a hypertension disorder due to service is a medical determination that is beyond her competence to evaluate based upon her knowledge and expertise. The record does not indicate that the Veteran had any medical training or expertise. It follows that her assertion that she developed a hypertension disorder due to service is not probative. See Jandreau v. Nicholson, 492 F.3d 1372 (2007).

In summary, as the most probative evidence indicates that the Veteran's current hypertension disorder is not due to service, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for hypertension is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for stroke disorder, as secondary to hypertension, is denied.

The Veteran's sole contention has been that her stroke disorder is secondary to her hypertension.

For the following reasons, service connection for stroke disorder is not warranted.

Here, the record shows that the Veteran has a history of ischemic cerebrovascular accident (CVA) in 1992 and thus, the first element of service connection is met. However, as set out above, the Board has found that service connection is not warranted for hypertension. Therefore, the second element of secondary service connection is not met. Wallin, 11 Vet. App. 509, 512 (1998).

Accordingly, the claim is denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (holding that, where the law and not the evidence is dispositive, the Board should deny the claim on the ground of the lack of legal merit or the lack of entitlement under the law).

REASONS FOR REMAND

Entitlement to a compensable rating for bilateral hearing loss is remanded.

The Veteran contends that she is entitled to a compensable rating for her bilateral hearing loss.

The Board finds
Therefore, the second element of secondary service connection is not met. Wallin, 11 Vet. App. 509, 512 (1998).

REASONS FOR REMAND

Entitlement to a compensable rating for bilateral hearing loss is remanded.

The Veteran contends that she is entitled to a compensable rating for her bilateral hearing loss.

The Board finds that remand is necessary to correct a duty to assist error that occurred prior to the March 2025 AOJ decision on appeal.

Under the AMA, remands are limited to correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal and (2) AOJ errors in satisfying a regulatory or statutory duty if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a). In the present appeal, a pre-decisional duty to assist error occurred because the Veteran was not afforded an adequate VA examination.

Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

For VA purposes, an examination for hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85(a). Examinations must be conducted without the use of hearing aids. Id.

By way of background, the Veteran submitted her original claim of service connection for bilateral hearing loss, on June 3, 2022, and an October 2022 rating decision granted service connection for bilateral hearing loss and assigned an initial noncompensable rating, effective November 19, 2021.

In July 2023, VA received the Veteran's HLR request regarding the October 2022 rating decision, and a November 2023 HLR decision denied an increased rating for bilateral hearing loss.

On February 12, 2025, VA received the Veteran's VA Form 21-526EZ, regarding her claim of an increased rating for bilateral hearing loss. Because the February 2025 claim is a non-initial rating claim, the appeal period for review begins one year prior to February 12, 2025, the date VA received the Veteran's claim. Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010) (holding that a veteran's claim for increased disability compensation must be filed within one year of an increase in the disability, as shown by the evidence, to obtain an effective date earlier than the date of the claim).

As such, turning to the evidence of record, the period on review begins February 12, 2024, one year before the Veteran submitted her February 12, 2025, VA Form 21-526EZ.

The Veteran underwent a December 2024 private audiological examination. However, this examination is not
, 2025, the date VA received the Veteran's claim. Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010) (holding that a veteran's claim for increased disability compensation must be filed within one year of an increase in the disability, as shown by the evidence, to obtain an effective date earlier than the date of the claim).

As such, turning to the evidence of record, the period on review begins February 12, 2024, one year before the Veteran submitted her February 12, 2025, VA Form 21-526EZ.

The Veteran underwent a December 2024 private audiological examination. However, this examination is not in compliance with 38 C.F.R. § 4.85(a), which requires use of the Maryland CNC word recognition test, as the Maryland CNC word recognition test was not used during the December 2024 private audiological examination. See Savage v. Shinseki, 24 Vet. App. 259 (2011); see generally 38 C.F.R. § 4.85(a). As such, the December 2024 private examination is not adequate.

The Veteran underwent a VA audiological examination in February 2025. The audiometric testing indicated pure tone thresholds of 65, 80, 85, and 95 in the right ear and 70, 80, 85 and 90 in the left ear at 1000, 2000, 3000, and 4000 Hertz, respectively. The average of the pure tone thresholds at 1000 Hertz through 4000 Hertz was 81.25 decibels for each ear. The audiologist determined that the overall test results were not valid for rating purposes due to inconsistencies between subjective and objective measures. However, in the provided rationale, the audiologist fails to explain whether these inconsistent test results were due to the Veteran, the examiner, or another external factor such as testing conditions. In addition, the audiologist does did not indicate that they attempted to provide another examination to determine the current severity of the Veteran's bilateral hearing loss. Instead, it appears that the audiologist simply concluded that the test results were invalid. See Kahana, 24 Vet. App. at 435 (holding that the Board is obligated to reject insufficiently detailed medical reports, for instance, where a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail). Therefore, the Board finds that the February 2025 VA examination is insufficient for rating purposes. Although the audiologist noted that word recognition scores are valid for rating purposes (96 percent in each ear), a rating for hearing loss cannot be assigned solely on the basis of speech recognition scores. 38 C.F.R. § 4.85. As such, the February 2025 VA examination is not adequate.

Accordingly, no adequate examination exists for VA rating purposes within the applicable review period. Based on the foregoing, the issue of entitlement to a compensable rating for bilateral hearing loss is remanded to correct a duty to assist error that occurred prior to the rating decision on appeal.

(Continued on the next page.)

The matter is REMANDED for the following action:

Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected bilateral hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Emmart, Timothy T.

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.

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