HYPERTENSION

Summary

The veteran, who served in the Army from September 1990 to May 1991, including service in Southwest Asia, appeals the denial of service connection for hypertension and the reduction of his rating for a skin condition. The Board found that while the veteran has a current hypertension diagnosis and was exposed to toxic substances during service, the evidence did not establish a nexus to service. The Board noted the veteran's conflicting statements regarding the onset of his hypertension, finding his lay statements regarding its onset not credible. The VA examiner opined that hypertension was less likely than not caused by service exposures, attributing it to family history and lack of in-service treatment. The Board found the examiner's opinion probative and denied service connection for hypertension. Regarding the skin condition, the Board found the reduction in rating improper, as the evidence did not demonstrate actual improvement in the veteran's ability to function. The veteran's lay reports and submitted pictures indicated persistent symptoms. Therefore, the Board restored the 60 percent rating for the skin condition effective January 2, 2025. The claim for an increased rating for the skin condition was remanded for a new VA examination to assess current severity and the nature of flare-ups, including frequency, duration, precipitating factors, and alleviating factors.

Rationale

No competent/credible evidence of nexus to active duty service; Conflicting lay statements regarding onset of hypertension; VA examiner opined less likely than not caused by service exposures

Full Decision Text

Citation Nr: A26040545
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250710-563984
DATE: April 30, 2026

ORDER

Service connection for hypertension is denied.

The reduction in the rating of the skin condition was not proper and the 60 percent rating is restored effective January 2, 2025.

REMANDED

Entitlement to an increased rating greater than 60 percent for the skin condition is remanded.

FINDINGS OF FACT

1. The evidence shows that the Veteran has a current hypertension diagnosis. However, the credible evidence does not demonstrate an onset of hypertension during service or that the hypertension was caused by service, including toxic exposures in Southwest Asia. Further, the record does not show an onset of or treatment for hypertension during active duty for training (ACDUTRA), or inactive duty for training (INACDUTRA).

2. At the time of the reduction of the rating for tinea pedis, the evidence did not demonstrate actual improvement of the skin condition under the normal circumstances of life and work.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension are not met.?38?U.S.C. §§?1110, 5107(b);?38?C.F.R. §§?3.102,?3.303.

2. The reduction in rating of the skin condition from 60 percent to 0 percent was not proper and the 60 percent rating is restored effective January 2, 2025. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.105, 3.344, 4.71a Diagnostic Code 7813.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1990 to May 1991. This matter comes before the Board of Veteran's Appeal (Board) on appeal from March 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

As background, in December 2024, the Veteran filed his claims for service connection for hypertension and an increased rating for tinea pedis. In July 2025, the Veteran filed his VA Form 10182 Notice of Disagreement and selected the Evidence Submission docket. 

Based upon the selection of the Evidence Submission docket, the Board may consider the evidence of record as of March 21, 2025 and as of March 26, 2025-the dates of the respective rating decisions on appeal, and evidence submitted with or within 90 days of the VA's receipt of the VA Form 10182 on July 10, 2025. See 38 C.F.R. §§ 20.303. If the Veteran submitted evidence that was added to the record after March 21, 2025 and March 26, 2025 but before the 10182, or 90 days after VA's receipt of the VA Form 10182 on July 10, 2025, the Board did not consider it. 

As a final note, in August 2025, the Veteran was informed that he had a year from the date his rating decision was mailed to him or within 60 days of the date the Board received his NOD to switch his Board review option. The Veteran did not respond to the Board's August 2025 letter. As more than year passed since the March 2025 rating decisions were issued and the 60-day period specified in the August 2025 letter has lapsed, the Board finds that the period to switch his Board review option has expired. Accordingly, the Board will proceed with the adjudication of his appeal.

Service Connection

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent
 service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Consistent with this framework, service connection is warranted for a disease first 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).

With respect to the Veteran's Army Reservice service and National Guard service, service connection may only be granted for disability resulting from disease or injury incurred or aggravated in line of duty while performing active duty for training (ACDUTRA), or for disability resulting from an injury incurred or aggravated in line of duty while performing inactive duty for training (INACDUTRA).  38 U.S.C. § 101 (24); 38 C.F.R. § 3.6(a) (emphasis added). 

Service Connection - Hypertension

As indicated above in the Conclusions of Law section, the Board finds that service connection for hypertension is not warranted. Accordingly, to this extent, the Board denies the Veteran's appeal.

Here, the Veteran contends that he has been on hypertension medication due to Operation Desert Storm for a long time. See July 2025 VA Form 10182.  He specifically reported that his hypertension was due to service. See December 2024 VA Form 21-526EZ.

First, the Board notes that RO favorably found that the Veteran had a current condition and was exposed to particulate matter and other substances during service. Under the AMA, any finding favorable to a veteran is binding on all subsequent VA adjudicators, unless the finding is rebutted by evidence of a clear and unmistakable error (CUE). See 38 C.F.R. § 3.104(c).  Accordingly, the Board finds that the first two elements of service connection are met, i.e. a current disability and an in-service event, the toxic exposures. See March 2025 Rating Decision. Thus, the remaining questions before the Board are whether there is a nexus between the hypertension and the Veteran's active-duty service, whether hypertension was incurred or aggravated in line of duty while performing ACDUTRA, or whether hypertension resulted from an injury incurred or aggravated in line of duty while performing INACDUTRA.

After reviewing the evidence of record, the Board finds that there is no competent or credible evidence that demonstrates a link between hypertension and the Veteran's active-duty service, showing an onset or aggravation during ACDUTRA, or that hypertension resulted from an injury incurred or aggravated during INACDUTRA. Turning to the active-duty service, aside from the Veteran's lay statement linking his hypertension to his service in Southwest Asia, the Board finds that no other evidence demonstrates a nexus between hypertension and service. The Board notes that the Veteran's conflicting reports of when the hypertension began has caused the Board to assign less probative weight to his lay statements. When determining the credibility of lay evidence, the Board may properly consider internal consistency, facial plausibility, and consistency with other evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). When he filed his claim, he reported that the condition began in 2000, which is approximately nine years after he separated from active-duty service and four years after he separated from the Army Reserve. Additionally, at the January 2025 VA examination, he reported that the condition had its onset in 2020. Based on the conflicting onset dates reported by the Veteran, the Board finds that the Veteran's lay statements regarding the onset of the hypertension are not credible. Further, the Board is interpreting his statement that he has been on hypertension medication due to service in Southwest Asia since forever as the Veteran stating that he has been on medication since service. However, the record shows that in April 1991, the Veteran's blood pressure was 120/70 which was normal by VA standards. Further, the record does not show elevated blood pressure readings until April 1995, which is after he separated from the Army Reserve in 1994. 

Moreover, the March 2025 VA examiner opined that it was less likely than not (likelihood is less than approximately balanced or nearly equal) that the hypertension was caused by the indicated toxic exposure risk activities), after considering the total potential exposure through all applicable military deployments of the veteran and the synerg
 his statement that he has been on hypertension medication due to service in Southwest Asia since forever as the Veteran stating that he has been on medication since service. However, the record shows that in April 1991, the Veteran's blood pressure was 120/70 which was normal by VA standards. Further, the record does not show elevated blood pressure readings until April 1995, which is after he separated from the Army Reserve in 1994. 

Moreover, the March 2025 VA examiner opined that it was less likely than not (likelihood is less than approximately balanced or nearly equal) that the hypertension was caused by the indicated toxic exposure risk activities), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner opined that the Veteran's positive family history for hypertension was the main cause for his hypertension. The examiner also considered the lack of in-service treatment for or diagnosis of hypertension. The examiner also reviewed the exposure information for environmental exposures in Southwest Asia, but did not find a positive relationship between the Veteran's in-service exposures and the development of hypertension. As the examiner provided adequate rationale and reviewed the Veteran's medical history, the Board finds that this opinion is entitled to significant probative weight. 

Finally, the Board acknowledges the Veteran's contention that his hypertension was caused by service. However, in light of the conflicting statements from the Veteran regarding its onset, and the lack of a probative, competent formal positive medical nexus opinion, the Board finds that there is no competent or credible evidence demonstrating that the hypertension to service. Moreover, the Veteran has not argued that the hypertension was aggravated during any period of ACDUTRA or INACDUTRA or had its onset during ACDUTRA. 

In sum, the Board finds that service connection is not warranted. There is no doubt to be resolved in this case. 38 U.S.C. § 5107.

The Propriety of the Reduction

When a reduction in an evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons. In addition, the RO must notify the Veteran that she has 60 days to present additional evidence showing that compensation should be continued at the present level. 38 C.F.R. § 3.105(e).

A Veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. 38 C.F.R. § 3.344. The United States Court of Appeals for Veterans Claims (Court) has consistently held that when a disability rating is reduced without following the applicable regulations, the reduction is void "ab initio" that is, the reduction was never valid from its outset. See Greyzck v. West, 12 Vet. App. 288 (1999).

Prior to reducing a Veteran's disability rating, VA is required to comply with several regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of a veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case, it must be determined not only that an improvement in a disability has actually occurred, but also that that improvement actually reflects an improvement in a veteran's ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342 (2000).

VA has the burden of establishing that the disability has improved. A rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating issue. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated (although post-reduction medical evidence may be considered in the context of considering whether actual improvement was demonstrated). Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992).

Where a disability rating has been in effect less than
342 (2000).

VA has the burden of establishing that the disability has improved. A rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating issue. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated (although post-reduction medical evidence may be considered in the context of considering whether actual improvement was demonstrated). Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992).

Where a disability rating has been in effect less than 5 years, reduction is warranted where reexamination of the disability discloses improvement of that disability. See 38 C.F.R. § 3.344(c).

Here, the Board finds that the procedures specified in 38 C.F.R. § 3.105(e) did not have to be complied with because the reduction in the rating did not result in a reduction of the Veteran's compensation payments, as the combined disability rating was not reduced, VA was not required to comply with the procedures specified in 38 C.F.R. § 3.105(e).

That notwithstanding, the Board finds that the record is insufficient to support a finding that the skin condition actually improved, resulting in an improvement in his ability to function under ordinary conditions of work and life. Rather, the evidence reflects that the Veteran continued to report that his feet were raw, secreted substances, and were flaky. The pictures submitted by the Veteran also support his contentions that his skin condition did not improve. The Board finds that his lay reports regarding his symptoms coupled with the pictures he submitted do not demonstrate sustained improvement in his ability to function under the ordinary conditions of work and life. Therefore, in considering the entire record and viewing the evidence in a light most favorable to the Veteran, the Board finds that the reduction in the rating of skin condition was not proper, and a restoration of the 60 percent rating, effective January, 2, 2025 is warranted.

REASONS FOR REMAND

Increased Rating - Skin Condition

Here, the Board finds that a remand is required for correction of an error by the RO in satisfying a regulatory or statutory duty. Specifically, in December 2024, the Veteran submitted a claim seeking a higher rating for the skin condition. Instead of adjudicating the increased rating claim, the RO reduced the rating for the skin condition. See March 2025 Rating Decision. As the RO should have adjudicated the increased rating claim, the Board finds that a remand is required to satisfy a regulatory duty. 

In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of the skin condition. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020).

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination to assess the current nature and severity of the service-connected skin condition. 

(a.) Please ask the Veteran to identify, whether he experiences flare ups of the skin condition, identify the:

i.	Frequency;

ii.	duration;

iii.	precipitating factors; and

iv.	alleviating factors.

(The Board reminds the Veteran that in asking the examiner to accept the history she provided, the Board is not at this time making an assessment of the credibility of her statements)

A discussion of the underlying reasons for any opinion expressed must be included in your report, to include reference to pertinent evidence of record and medical literature or treatises where appropriate. If you cannot provide the requested opinion without resorting to speculation, please expressly indicate this and state why that is so (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.).

 

 

S.C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Foster, 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.