Citation Nr: 0006279 Decision Date: 03/08/00 Archive Date: 03/17/00 DOCKET NO. 98-17 942A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for an eye disorder. ATTORNEY FOR THE BOARD Peter C. Lenart, Associate Counsel INTRODUCTION The veteran served on active duty in the military from October 1980 to March 1997. In September 1997 the Department of Veteran Affairs (VA) Regional Office (RO) in Montgomery, Alabama, issued a rating decision concerning the claims submitted by the veteran. The veteran timely appealed the RO's rating decision to the Board of Veterans' Appeals (Board). In June 1999, the Board issued a decision that resolved three of the veteran's claims. This same decision remanded the veteran's claims for hypertension and for myopia astigmatism to the RO for additional medical examinations. Evidence of record indicates that the veteran did not appear for several scheduled VA examinations. The RO has returned the veteran's appeal to the Board for resolution. FINDINGS OF FACT 1. The veteran's service medical records reflect what appear to be numerous elevated blood pressure readings during the course of his military service. 2. Medical records indicate that the veteran was diagnosed with labile hypertension within 4 months of his discharge from the military. 3. The veteran's diagnosis of labile hypertension does not constitute evidence of a chronic condition or current disability. 4. The veteran's diagnosis of myopia astigmatism is considered a developmental defect which is unrelated to military service, and objective medical evidence has not been submitted to that he currently has a chronic eye disorder related to service. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim of entitlement to service connection for hypertension. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim for service-connection for an eye disorder is not well- grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Hypertension To establish service connection for a claimed disability, the facts, as shown by the evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting active service, was aggravated therein. See 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1998). When a disease is first diagnosed after service, service connection may nevertheless be established by evidence demonstrating that the disease was in fact incurred during the veteran's service, or by evidence that a presumptive period applied. See 38 C.F.R. §§ 3.303, 3.307, 3.309. In order for a claim for service connection to be well- grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in- service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. Epps, 126 F.3d at 1468; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). In addition, the chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under he case law of the Unites States Court of Appeals for Veterans Claims (formerly, the United States Court of Veterans Appeal), lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded or reopened on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 498 (1997). The veteran's service medical records (SMRs) show that he had the following blood pressure readings during service: November 1991 - 132/94; July 1992 - 126/90; March 1993 - 140/92; a five day blood pressure check in March and April 1993 - 149/109, 139/91, and 143/97; March 1994 - 157/108 and 148/106; October 1994 - 136/94; July 1995 - 157/105; August 1996 - 151/101, 158/106, and 152/95; and March 1997 (separation examination) - 150/90. At the July 1997 VA examination, the appellant's blood pressure readings were 174/112 (sitting), 194/100 (recumbent), and 180/100 (standing), and a recheck of his blood pressure revealed a reading of 170/110 (sitting). Based on history provided by the appellant, to the effect that he experienced occasional elevated blood pressure which would return to normal on follow-up checks, and that his blood pressure was usually 135/82 but would sometimes become elevated when he went to a hospital or clinic, the examiner diagnosed labile hypertension. The Board acknowledges that, in this case, there was no specific medical opinion of record supporting the veteran's assertion of a nexus relationship between his post-service elevated blood pressure readings, and the high blood pressure readings that were recorded while he was in the military. However, given the veteran's diagnosis of "labile hypertension" within four months of discharge, the Board found it necessary to remand this case in June 1999 in order to determine whether the veteran's symptomatology represented a manifestation of a chronic disorder, that is, essential hypertension, rather than an acute and transitory disorder. Dorland's Illustrated Medical Dictionary, 28th edition, defines labile hypertension as borderline hypertension. It is a condition reflective of fluctuating blood pressure readings. The Board notes that the veteran himself reported his history of fluctuating readings during his July 1997 VA examination. He indicated that his pressure readings were usually 135/82, but that elevated readings were sometimes noted during hospital or clinic visits. Evidence of record indicates that the veteran was scheduled for a VA examination on September 15, 1999 but that he canceled the appointment. He was then scheduled for examinations on September 24, 1999, October 6, 1999, and October 14, 1999, but failed to appear for all of these appointments. In the absence of a current diagnosis of essential hypertension, the veteran has not demonstrated that he has a current chronic disability. In the absence of evidence of the claimed disability and, if so, of a nexus between that disability and the veteran's military service, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Myopia Astigmatism In its June 1999 remand, the Board noted that the veteran had been diagnosed with conjunctivitis while in service in November 1986, that hyperopic astigmatism was diagnosed in January 1997, and that the veteran had been treated for a two-day history of redness and soreness in both eyes in August 1996. In August 1997, during a VA eye examination, the veteran was diagnosed with myopic astigmatism, which the Board recognizes as refractive error, and considers as not service connectable as it is a congenital or developmental defect. See 38 C.F.R. § 3.303(c) 1998. However, that examination also revealed the presence of extensive, inferior, lattice degeneration without holes, tears, or detachment. A diagnosis of lattice retinal degeneration was made at that time. The Board remanded the veteran's claim in order to have him undergo an ophthalmologic examination, as this condition was noted five months after the veteran's discharge from the military. As discussed above, the RO scheduled the veteran for numerous VA examinations in order to evaluate his medical condition. The veteran failed to appear for these examinations. No additional medical evidence concerning the etiology of the veteran's lattice retinal degeneration has been submitted nor has it be shown that he has any other chronic eye disorder related to service. The evidence also shows the presence of myopia astigmatism. The Board must deny the veteran's claim for service connection for this condition on the same basis as it was denied by the RO -- that it is a congenital or developmental defect which is not subject to service connection under the applicable regulation. Therefore, the Board finds that the veteran's claim of service connection for an eye disorder is not well grounded as there is no medical evidence which would relate a chronic eye disorder to service. ORDER As evidence of a well-grounded claim for service connection for hypertension has not been presented, the claim is denied. As evidence of a well-grounded claim for service connection for an eye disorder has not been presented, the claim is denied. LAWRENCE M. SULLIVAN Member, Board of Veterans' Appeals