Citation Nr: 0002755 Decision Date: 02/03/00 Archive Date: 02/10/00 DOCKET NO. 99-05 201 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Nancy S. Kettelle, Counsel INTRODUCTION The veteran had active service from March 1967 to March 1969. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. In a hearing held at the RO in October 1999, the veteran testified before the undersigned Member of the Board. Review of the record shows that in a May 1999 rating decision, the RO determined that new and material evidence to reopen a previously denied claim for service connection for degenerative arthritis of the left hip had not been submitted. In a letter dated in June 1999, the RO notified the veteran of the decision and provided information concerning his appellate rights. In his October 1999 hearing testimony the veteran referred to his left hip, but he did not indicate disagreement with the May 1999 decision. The Board points out to the veteran that without a timely notice of disagreement from him, the RO decision denying his claim will become final. 38 U.S.C.A. § 7105 (West 1991). FINDING OF FACT The claim for service connection for hypertension is not plausible. CONCLUSION OF LAW The claim for service connection for hypertension is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Applicable law provides that service connection may be granted for disability resulting from disease or injury incurred or aggravated during service. 38 U.S.C.A. §§ 1110, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306 (1999). Further, if hypertension is manifested to a degree of 10 percent within a year of separation from service, service incurrence may be presumed. 38 U.S.C.A. §§ 1101, 1112 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection may also be established for disease first diagnosed after discharge from service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a preliminary matter, the Board must determine whether the veteran has presented evidence of a well-grounded claim, that is, whether he has presented a claim that is plausible and meritorious on its own or capable of substantiation. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78 (1990); Grottveit v. Brown, 5 Vet. App. 91 (1993); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). The United States Court of Appeals for Veterans Claims (Court) has stated repeatedly that 38 U.S.C.A. § 5107(a) unequivocally places an initial burden on a claimant to produce evidence that a claim is well grounded. See Grivois v. Brown, 6 Vet. App. 136 (1994); Grottveit at 92; Tirpak at 610-11. To satisfy the burden of establishing a well- grounded claim for direct service connection, there must be: (1) a medical diagnosis 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 an in-service injury or disease and the current disability. Where the determinative issue involves medical causation or diagnosis, competent medical evidence to the effect that the claim is plausible is required. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). A claim also may be well grounded if the condition is observed during service, continuity of symptomatology is demonstrated thereafter and competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 497 (1997). If the veteran has not submitted evidence of a well-grounded claim, the claim must fail, and VA has no duty to assist the veteran in the development of the claim, including providing a medical examination and opinion. See Epps, supra; Caluza v. Brown, 7 Vet. App. 498, 504 (1995). At the veteran's service entrance examination in November 1966, his blood pressure while sitting was 138/90. In the report of medical history in December 1968 in conjunction with the veteran's separation examination, the physician commented that high blood pressure existed prior to service with no sequelae. On examination in December 1968, the veteran's blood pressure while sitting was 120/76. The veteran's service medical records do not otherwise mention his blood pressure and include no complaint, finding or diagnosis of hypertension. Post-service medical evidence includes the report of a December 1975 physical examination by J.P. Hill, M.D., in conjunction with a retrograde pyelogram. At that time, the veteran's blood pressure was 150/90. At a VA general medical examination in November 1976 the veteran gave a history of having had high blood pressure only on examination and said it quieted down when he was recumbent. He stated he had never been checked for any high blood pressure and had never had any cardiac symptoms. His blood pressure while sitting was 139/90. Clinical records dated from September 1984 to July 1997 from Lake Cumberland Medical Associates show that in September 1991 the veteran was diagnosed as having hypertension. VA outpatient records dated from September 1997 to March 1999 show continuing treatment for hypertension. In a note dated in April 1998, a social worker noted that the veteran reported that he had some problems with hypertension while he was stationed in Germany in service. At a VA examination in January 1998, the veteran reported that when he was inducted into the service, his blood pressure initially was found to be high. The veteran stated that the examiner had him lie down for a while, at which point his blood pressure apparently was such that he could be accepted into service. The veteran said that over the years he had known that his blood pressure had been somewhat high, but he did not know the numbers. He reported he had received treatment for high blood pressure for the last three to four years and was presently treated with Hydrochlorothiazide by VA. On examination, the veteran's blood pressure was 117/98. The diagnostic impression included hypertension. At the hearing in October 1999, the veteran testified that he did not know of having high blood pressure when he entered service. He also testified that at his service separation examination, the doctor told him his blood pressure was too high to discharge him. He testified he was made to lie down for 20 or 30 minutes until his blood pressure was taken again. The veteran testified that he thought it was somewhere around 1977 when he was actually diagnosed as having hypertension and was put on medication. He said that in around 1970 or 1971, he had been told his blood pressure was borderline high and before 1977 he had been told he had high blood pressure. The veteran's representative noted that the physician who treated the veteran when he came out of service was deceased. The veteran testified that he believed his high blood pressure started while he was on active duty. Upon review of the evidence, the Board finds that the veteran's claim for service connection for hypertension is not plausible as the service medical records do not show a diagnosis of hypertension in service, there is no medical evidence suggesting the presence of hypertension within a year of the veteran's discharge from service, nor is there medical evidence suggesting that the veteran's hypertension is otherwise etiologically related to service. In particular, the Board observes that the physician's December 1968 notation that hypertension existed before service with no sequelae does not support the service connection claim on either an incurrence or aggravation basis, and does not make the claim plausible. The Board acknowledges that the veteran has testified that that the physician told him at his separation examination that he had high blood pressure and that he also testified that he was told he had borderline high blood pressure within a few years after service. There is, however, no medical evidence corroborating the veteran's testimony. The Court has held that the connection between what a physician said and a layman's account of what he purportedly said, filtered through a layman's sensibilities, is simply too attenuated and inherently unreliable to constitute medical evidence. Robinette v. Brown, 8 Vet. App. 69, 77 (1995). The Board is left with the veteran's assertions regarding the etiology and time of onset of his hypertension. However, the veteran, as a lay person, is not competent to furnish medical opinions or diagnoses. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). With a claim such as this, where the determinative issue involves medical diagnosis and etiology, competent medical evidence is required to fulfill the well-grounded claim requirement of 38 U.S.C.A. § 5107(a). See Heuer v. Brown, 7 Vet. App. 379, 384 (1995). Thus, the veteran cannot meet his initial burden either by relying on his statement about what he was told by a physician or by relying on his own opinions. As the veteran has presented no competent evidence to support his claim, the claim for service connection for hypertension is not well grounded and must be denied. ORDER Service connection for hypertension is denied. SHANE A. DURKIN Member, Board of Veterans' Appeals