09-12 389
09-12 389
| Board of Vet. App. | May 31, 2017Background
- Veteran served active duty in the U.S. Army (Oct 1965–Oct 1967), with service in Vietnam; awarded combat decorations.
- Claim: service connection for hypertension, asserted either directly from service or secondarily from service‑connected diabetes mellitus and/or PTSD.
- Administrative history: initial RO denial (June 2008), hearing before a DRO (Nov 2008), multiple remands, and several VA medical examinations and addendum opinions (2008–2016).
- Medical facts: first clinical diagnosis of hypertension in Dec 2006 (roughly 40 years post‑service); service records show an isolated elevated BP on entry and lower BP at discharge; no evidence of hypertension within one year of discharge.
- Multiple VA examiners and addendum opinions concluded it is less likely than not that hypertension was caused or aggravated by the Veteran’s service, diabetes, or PTSD; medical literature submitted by the Veteran’s representative was found to be inconclusive/correlative rather than causative.
- Board findings: hypertension not manifest in service or within one year after discharge; not proximately due to or aggravated by a service‑connected disability. Claim denied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for hypertension on a direct basis | Hypertension was related to military service (noted elevated BP at induction/discharge) | STRs show only isolated elevated entry reading; no diagnosis/manifestation in service or within one year after discharge | Denied — no in‑service incurrence or presumptive manifestation within one year |
| Presumptive service connection for hypertension (chronic disease presumption) | Hypertension should be presumed service‑connected if manifested to 10% disabling degree within one year of separation | First diagnosis in 2006, ~40 years post‑discharge; no evidence of compensable manifestations within one year | Denied — no evidence hypertension manifested to required degree within one year |
| Secondary service connection — hypertension due to service‑connected diabetes mellitus | Diabetes caused or aggravated hypertension | VA examinations and addendum opinions: less likely than not causal/aggravating; diabetes was controlled when hypertension first diagnosed | Denied — insufficient nexus/aggravation evidence |
| Secondary service connection — hypertension due to service‑connected PTSD | PTSD caused or aggravated hypertension; medical literature suggests correlation | VA examiners found no established causal link; literature submitted is correlative/speculative and less probative than case‑specific exams | Denied — no competent evidence of causation/aggravation |
Key Cases Cited
- Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.) (elements required for service connection)
- Hickson v. West, 12 Vet. App. 247 (Vet. App.) (standards for lay/medical evidence and nexus)
- Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir.) (evidentiary principles for service connection)
- Allen v. Brown, 7 Vet. App. 439 (Vet. App.) (standard for secondary service connection/aggravation)
- Obert v. Brown, 5 Vet. App. 30 (Vet. App.) (limitations on speculative medical evidence)
- Beausoleil v. Brown, 8 Vet. App. 459 (Vet. App.) (probative value of medical literature)
- Libertine v. Brown, 9 Vet. App. 521 (Vet. App.) (medical evidence must be specific and probative)