BVA9503941 DOCKET NO. 91-49 382 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for a cardiovascular disability to include hypertension. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD J. Andrew Ahlberg, Associate Counsel INTRODUCTION The veteran served on active duty from January 1977 to December 1979 and from November 1980 to November 1983. This case comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from adverse rating action by the Waco, Texas, Regional Office (hereinafter RO). The development requested in the September 1992 remand was accomplished and the case is now ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL It is essentially contended that any current hypertension and heart disease was first manifested in service, and that service connection for a cardiac disability is therefore warranted. The veteran's representative has alternatively requested that the case be remanded in order to afford him a stress test. 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 the preponderance of the evidence is against the veteran's claim. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. While some borderline and elevated blood pressure readings were recorded in service, chronic hypertension was neither demonstrated, diagnosed nor treated in service or thereafter. 3. A chronic cardiovascular disability was not shown in service or within one year of separation from service. 4. No objective evidence of record links pathology or symptomatology in service to any current cardiovascular disability. CONCLUSION OF LAW A cardiovascular disability to include hypertension was not incurred in or aggravated by service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.307, 3.309 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran has presented sufficient evidence to conclude that his claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a). For reasons explained below, the Board concludes that the extra delay in its adjudication of the veteran's appeal that would result from a remand for the veteran to be afforded the stress test requested by the veteran's representative is not warranted. There is a sufficient amount of clinical findings contained elsewhere in the evidence of record to make an equitable decision in the veteran's appeal, and the Board is satisfied that the duty to assist mandated by 38 U.S.C.A. § 5107(a) has been fulfilled. In adjudicating a well-grounded claim, the Board determines whether (1) the weight of the evidence supports the claim or, (2) the weight of the "positive" evidence in favor of the claim is in relative balance with the weight of the "negative" evidence against the claim: The veteran prevails in either event. However, if the weight of the evidence is against the veteran's claim, the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Service connection may be granted for a disability resulting from injury or disease incurred in or aggravated by active service. 38 U.S.C.A. § 1131. Where a veteran served continuously for ninety days or more during a period of war or during peacetime service after December 31, 1946, and a cardiovascular disability to include hypertension becomes manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The following is a summary of the relevant clinical evidence of record. The service medical records, while reflecting treatment for chronic bronchial asthma, showed no treatment for or a diagnosis of hypertension or any other cardiovascular disorders. The in-service blood pressure readings were as follows: 115/70 and 110/72 in June 1981; 126/92 and 132/90 in June 1983; 140/100, 138/108, 138/118, 120/80 and 122/88 in September 1983; and 122/80 on the October 1983 separation examination. No heart disabilities were noted on the report from the separation examination and the veteran indicated on a Report of Medical History completed at that time that he had never had any heart trouble or high blood pressure. The post-service clinical evidence of record reflects VA outpatient treatment for a pectoral muscle sprain in January 1984, gastrointestinal complaints in August 1989, respiratory complaints related to his bronchial asthma and chronic obstructive pulmonary disease in December 1990, and acute pharyngitis and flu-like symptoms in January 1991. Blood pressures fluctuated during this time between 114/74 and 140/100. The veteran was hospitalized at a VA medical facility in March 1991 after he experienced sharp chest pain on deep breathing. The cardiovascular examination was negative and the veteran's blood pressure was measured at 140/90. An electrocardiogram was suggestive of pericarditis or early polarization, but showed no evidence of a myocardial infarction. It was concluded that the veteran's pain was musculoskeletal in nature rather than a manifestation of any cardiac dysfunction. In May and June 1991, the veteran again complained about chest pain and the assessment was musculoskeletal chest pain and possible costochondritis. In August and October 1991, the veteran received VA outpatient for breathing difficulties associated with asthma and the veteran received inpatient treatment to diagnose the source of chest pain at a VA medical center in November 1991. Blood pressure readings from May to October 1991 were 114/70, 100/70, 130/90 and 110/70. The cardiac examination during hospitalization was negative and an electrocardiogram upon admission revealed a normal sinus rhythm with changes consistent with early repolarization, unchanged from the March 1991 VA examination. It was determined that the chest pain was not the result of a myocardial infarction and the veteran was discharged from this facility within a few days without any complaints of chest pain. Diagnoses included mild paroxysmal diastolic hypertension. The veteran was again admitted to a VA medical center in December 1991, this time for treatment of substance abuse. It was indicated that an angiogram had been canceled due to his substance abuse, hypertension and asthma. His blood pressure at that time was recorded at 126/74 and the electrocardiogram again showed a normal sinus rhythm with early polarization but was otherwise normal. The veteran only described one incident of chest pain during this hospitalization which disappeared quickly after he took nitroglycerin. It was also indicated that the veteran did not show any symptoms of hypertension during his hospitalization and that no treatment for hypertension was indicated. An addendum to the hospital report reflects that a thallium exercise stress test was interpreted as normal showing evidence of right ventricular hypertrophy, left ventricular dilatation, an artifact vs. prior infarction and no ischemia. Reports from an October 1993 VA examination are of record. The examiner noted that there was no history of hypertension or hypercholesterolemia. Blood pressure was 120/88 supine, 120/86 sitting and 120/90 standing. An electrocardiogram was interpreted as being normal except for early repolarization. The diagnosis was possible ischemic heart disease due to coronary artery disease or cocaine use. It was noted that clinically the veteran was not in congestive heart failure and a stress test was recommended. The veteran was again admitted to a VA medical facility in June 1994 with complaints of sharp chest pain and dyspnea. The cardiovascular examination was negative and it was again felt that the chest pain was musculoskeletal in origin. After reviewing the evidence summarized above, the Board concludes that the weight of the "negative" evidence as to service incurrence of a cardiovascular disability to include hypertension is greater than the weight of the "positive" evidence pertaining to this issue. "A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service." Watson v. Brown, 4 Vet.App. 309, 314 (1993). The principal "negative" evidence in this case is the fact that there are no clinical findings showing such a relationship between a current cardiovascular disability and in-service pathology. While the veteran and his representative have stated that there is a link between the in-service elevated blood pressure readings and current cardiac pathology, such lay testimony as to medical causation is of minimal probative value. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992) In light of the lack of any objective clinical evidence of record linking a current cardiovascular disability to service, little purpose would be served by remanding this case so as to accomplish the requested stress test: While the testing would show current cardiovascular disability, it would not provide any information as to the relationship between any cardiac dysfunction shown by the stress test and in-service pathology. The Board notes that while there were some elevated and borderline blood pressure readings in service and after service, this "positive" evidence is outweighed by the fact that hypertension has not been definitively diagnosed nor has chronic hypertension been shown. Moreover, the veteran himself reported at the time of separation from service that he had not had a history of heart problems or hypertension. The significantly elevated readings in September 1983 and December 1990 coincided with exacerbations of his asthmatic disease, and the evidence does not show consistent elevations of blood pressure to sustain a diagnosis of essential, or chronic, hypertension. It was specifically noted that there were no signs of hypertension in December 1991 and no history of hypertension in October 1993. While possible ischemic heart disease is currently indicated, this was first shown many years after service, and there is nothing contained in the service medical records or post-service clinical evidence to link that disability to service. Therefore, the Board concludes that service connection for a cardiovascular disability to include hypertension cannot be granted on a "direct" basis. As there are no pertinent clinical findings or symptoms of record within the one year period beginning at separation from service, service connection on a "presumptive" basis is also precluded. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. ORDER Entitlement to service connection for a cardiovascular disability to include hypertension is denied. HOLLY E. MOEHLMANN 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. (CONTINUED ON NEXT PAGE) 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.