BVA9502962 DOCKET NO. 92-17 745 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Little Rock, Arkansas THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. J. Bohanan, Associate Counsel INTRODUCTION The appellant served on active duty from December 1954 to June 1958, March 1965 to March 1968, October 1974 to January 1977, and from November 1990 to January 1991. This appeal arises from a February 1992 Department of Veterans Affairs Regional Office, Little Rock, Arkansas (VARO) rating decision, which denied the appellant service connection for hypertension. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in substance, that his pre-existing hypertension was aggravated during service as the result of taking medication which was wrongfully prescribed for diabetes. He claims that, as a result of his failure to take proper medication for approximately one month, his hypertension is more difficult to control and his blood pressure readings are higher than they were prior to service. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that service connection should not be granted for hypertension. FINDINGS OF FACT 1. The appellant served on active duty from December 1954 to June 1958, March 1965 to March 1968, October 1974 to January 1977 and from November 1990 to January 1991. 2. The appellant suffered from hypertension subsequent to his October 1974 to January 1977 active duty and prior to his November 1990 to January 1991 recall to active duty. 3. The appellant took medication for diabetes for approximately one month during his final period of service and did not take medication for his hypertension during that time. 4. The appellant's blood pressure readings prior to his November 1990 recall to active duty are substantially the same as his blood pressure readings during and after his final period of active duty. 5. The appellant's blood pressure readings both during and after his final period of active duty do not indicate an exacerbation of the appellant's hypertension. CONCLUSION OF LAW Hypertension pre-existed the veteran's recall to active duty and was not aggravated by this period of military service. 38 U.S.C.A. §§ 1110, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306, (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is seeking service connection for hypertension. Under pertinent law and VA regulations, service connection may be granted if symptomatology attributable to hypertension appeared during service or if hypertension is clinically manifested within one year thereafter, in this case by January 1992. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.303, 3.306, 3.309 (1993). It is not necessary to have a diagnosis of a particular disability during service, but it is necessary to have manifestations sufficient to establish that a disability was present. 38 C.F.R. § 3.303(d) (1993). A pre-existing disorder is considered to be aggravated where there is an increase in disability during service, unless due to the natural progress of the disorder. 38 U.S.C.A. § 1153 (West 1991); 38 C.F.R. § 3.306(a) (1993). Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). Furthermore, we believe that this case has been adequately developed for appellate purposes by VARO and that we may therefore proceed to a disposition on the merits without the necessity of a remand for further records. For the sake of clarity, the Board will first review the appellant's pertinent medical history. We will then discuss the issue presented on appeal. MEDICAL HISTORY A September 1976 service medical treatment entry reported that the appellant complained of nervousness and a headache. He reported a history of high blood pressure and that he was "having a lot of family problems." The examiner observed a blood pressure reading of 150/100. A March 1978 VA examination reported that the appellant had "no knowledge of hypertension and ha[d] never been on therapy for any type of cardiovascular problem." The examiner observed the appellant's blood pressure to be 130/90 while sitting and 130/84 recumbent. A June 1981 military medical examination for enlistment in the Army Reserves National Guard reported a blood pressure reading of 138/70. The appellant indicated no history of "high or low blood pressure." A January 1985 military physical examination again reported a blood pressure reading of 138/70 and that the appellant claimed no history of "high or low blood pressure." January 1991 military medical treatment entries reported that the appellant claimed a history of diabetes mellitus and high blood pressure. He reported that he had been receiving treatment for high blood pressure from a civilian doctor, who prescribed 25 milligrams of Capoten twice daily. His blood pressure was 180/102. During his follow up appointment a week later, the appellant's blood pressure was 190/100. The examiner assessed that the appellant's hypertension was "not controlled" and recommended continued use of Capoten with rest and relaxation. A February 1992 VA examination reported that the appellant complained of hypertension. He reported that hypertension was originally diagnosed in June 1990 and that, initially, he mistakenly received "some sort of diabetic medication" and did not discover "the error" for 6 weeks. He was then prescribed Lopressor, 100 milligrams. He also complained of occasional hypotensive changes and a "near constant sinus headache." The appellant's blood pressure was 192/108 sitting, 169/105 recumbent, and 164/100 standing. The examiner diagnosed "[e]ssential hypertension" and found no indication of diabetes mellitus in the lab data. During the appellant's May 1992 hearing on appeal, he testified that he had a "little bit of high blood pressure" before he was called to active duty, for which he was taking 25 milligrams of Capoten a day. He claimed that he first discovered that he had high blood pressure in June of 1990. He testified that after entering the military he was prescribed Vasotec for his high blood pressure. However, his prescription was improperly filled with diabetic medication, which he did not discover for 32 days. He claimed that he currently took 200 milligrams of Lopressor per day, prescribed by his private physician, Clyde H. Underwood, M.D. A June 1992 statement from Dr. Underwood reported the appellant's blood pressure readings from April 1990 to March 1992 to be as follows: April 1990 180/98 May 1990 170/100 July 1990 202/102 September 1990 180/108 October 1990 170/100 March 1991 180/108 April 1991 170/100 July 1991 170/107 October 1991 156/100 November 1991 150/100 February 1992 170/102 March 1992 200/108 A November 1994 VA medical advisory opinion was submitted by Garry M. Reams, M.D. Dr. Reams expressed the opinion that the appellant's "sporadic" blood pressure elevation in 1976 did not make the diagnosis of hypertension, and that the appellant's hypertension "appears to have occurred between 1985 and 1990." He reported that appellant's increased reading in 1976 did not indicate a diagnosis of hypertension and examinations of record did not indicate vascular disease. ANALYSIS After having carefully reviewed all of the medical records and evaluated all of the evidence of record, the Board is of the opinion that the preponderance of the evidence is against the appellant's claim for service connection for hypertension. The objective medical evidence does not substantiate an aggravation of the appellant's pre-existing hypertension disorder. The Board places emphasis upon the November 1994 VA medical advisory opinion that the appellant's medical history demonstrated an isolated, borderline reading during service in 1976, with other readings done during and shortly after that particular reading being well within the limits of normal. The record shows that hypertension was not diagnosed and treated until April 1990, which preceded the appellant's final period of active duty. The Board has considered the testimony of the appellant on appeal and the written statements submitted by the appellant, claiming an etiological relationship between an error during service regarding his prescribed medication and his current elevated blood pressure readings. However, the Board finds that those statements have less probative value than the objective medical records during and after service. As the appellant is a layman, his contentions are not probative as he is not competent to provide an opinion on medical causation. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The appellant's blood pressure readings both before and after this period of service are substantially the same. Likewise, there is no medical opinion indicating a causal relationship between any failure to take medication during service and the appellant's current hypertension symptomatology. Therefore, after having carefully reviewed all of the medical records and evaluated all of the evidence of record, the Board is of the opinion that the objective medical evidence does not substantiate an aggravation of the appellant's pre-existing hypertension disorder. ORDER Service connection for hypertension is denied. KENNETH R. ANDREWS JR. Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.