11-28 206, 11-28 206

Veteran served active duty June 1967–June 1969 and appealed a July 2009 RO decision regarding hypertension.
VA previously granted service connection for hypertension as secondary to service‑connected PTSD; Veteran sought direct service connection and a compensable initial rating.
Medical records show blood pressure readings beginning to appear elevated in the 1990s; no hypertension diagnosis at enlistment (130/80) or at separation (140/86).
April 2016 VA medical examination (in‑person file review) concluded it is less likely than not that hypertension was incurred in or caused by an in‑service event; examiner found initial diagnosis years after service.
Blood pressure records show intermittent systolic spikes ≥160 but readings are predominantly below 160 and diastolic readings were not predominantly ≥100; high readings while off medication in 2008 were episodic.
Board denied (1) direct service connection for hypertension and (2) an initial compensable rating, finding the preponderance of evidence against the Veteran.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Direct service connection for hypertension	Veteran: hypertension began in service (stress in Vietnam) and manifested in late 20s; claims onset in service	VA: records show no hypertension at entry or separation; most probative VA exam finds diagnosis years after service	Denied — preponderance of evidence shows hypertension not incurred in or aggravated by service
Initial compensable rating for hypertension	Veteran: frequent spikes and higher readings off medication support compensable rating; rating should consider untreated levels	VA: rating based on predominantly observed readings while on treatment; readings are predominantly below compensable thresholds (systolic <160, diastolic <100)	Denied — readings are not predominantly at or above rating criteria; control by medication considered

Nieves‑Rodriguez v. Peake, 22 Vet. App. 295 (2008) (medical opinion probative value depends on reasoning and file review)
Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing probative value of medical opinions)
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir.) (lay evidence competency rules)
D'Aries v. Peake, 22 Vet. App. 97 (2008) (substantial compliance with remand directives)
Scott v. McDonald, 789 F.3d 1375 (Fed. Cir.) (VA notice/duty to assist principles cited)
Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (benefit of the doubt rule)
McCarroll v. McDonald, 28 Vet. App. 267 (2016) (rating evaluates level of control achieved by medication)
Yancy v. McDonald, 27 Vet. App. 484 (2016) (extraschedular referral not required absent record showing collective impact)