Citation Nr: 0007300 Decision Date: 03/17/00 Archive Date: 03/23/00 DOCKET NO. 98-15 273 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michelle L. Nelsen, Associate Counsel INTRODUCTION The veteran had active duty from January 1969 to November 1971. He also had a period of active duty from December 1990 to May 1991, which is unverified. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In October 1998, the veteran submitted a statement in which he indicated a desire to amend his claim to include a heart disorder. There is no indication in the claims folder that the RO has addressed that claim. Therefore, the matter is referred to the RO for the proper action. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for the equitable disposition of the veteran's appeal. 2. Service medical records show a three-day blood pressure check protocol was accomplished in February and March 1991. The veteran was placed on Vasotec at that time. 3. Post-service medical records show continued a diagnosis of hypertension and continued prescriptions for blood pressure medication. CONCLUSION OF LAW The veteran incurred hypertension during active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.102 (1999). See Murphy v. Derwinski, 1 Vet. App. 78, 91 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). That is, the Board finds that the veteran has presented a claim which is not implausible when his contentions and the evidence of record are viewed in the light most favorable to the claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed to address the issue at hand. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may be demonstrated either by showing direct service incurrence or aggravation or by using applicable presumptions, if available. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994) (specifically addressing claims based ionizing radiation exposure). Direct service connection requires a finding that there is a current disability that has a definite relationship with an injury or disease or some other manifestation of the disability during service. Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). A disorder may be service connected if the evidence of record reveals that the veteran currently has a disorder that was chronic in service or, if not chronic, that was seen in service with continuity of symptomatology demonstrated thereafter. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494-97 (1997). Evidence that relates the current disorder to service must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage, 10 Vet. App. at 495-97. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." 38 C.F.R. § 3.303(b). Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establish that the disorder was incurred in-service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). Some chronic diseases are presumed to have been incurred in service, although not otherwise established as such, if manifested to a degree of ten percent or more within one year of the date of separation from service. 38 U.S.C.A. § 1112(a)(1); 38 C.F.R. § 3.307(a)(3); see 38 U.S.C.A. § 1101(3) and 38 C.F.R. § 3.309(a) (listing applicable chronic diseases, including hypertension). A periodic examination performed in May 1990, when the veteran was serving in the Reserves, showed a sitting blood pressure of 124/90 and a standing blood pressure of 112/82. On the accompanying report of medical history, the veteran denied any history of high blood pressure or medication usage. While the periodic examination of May 1990 included one elevated blood pressure reading, a second reading was essentially normal. However, service medical records dated in February 1991 indicated that the veteran began a three-day blood pressure check at that time. The blood pressure readings were as follows: 1) day one--130/90 in the left arm and 128/96 in the right arm; 2) day two--130/100 in the left arm and 132/110 in the right arm; and 3) day three--120/102 in the left arm and 140/98 in the right arm. Blood pressure averages were 126/97 in the left arm and 133/101 in the right arm. Additional blood pressure readings on the final day by the physician were 148/96 in the left arm and 154/98 in the right arm. The diagnosis was elevated blood pressure. All of the readings taken in that 3-day period were elevated. The physician prescribed Vasotec. Notes dated later in March 1991 showed blood pressure readings of 128/94 in the left arm and 130/96 in the right arm. Additional service medical records through May 1995 revealed that the veteran continued to take antihypertensive medication, Vasotec or Cardura. In addition, medical records from Toney Graham, Jr., M.D., dated from August 1992 to February 1996 showed that the veteran continued to take Vasotec. Considering the entire record, the Board finds that the evidence supports entitlement to service connection for hypertension. The evidence does not reveal a history or diagnosis of hypertension prior to the veteran's period of active duty beginning in December 1990. Although the specific diagnosis "hypertension" was not written in service medical records, the blood pressure readings recorded in February and March 1991 clearly satisfy the criteria for hypertension. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1 (specifies that, for purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90 mm or greater). Moreover, immediately following the completion of the March 1991 blood pressure check, the veteran was placed on antihypertensive medication. He continues to be diagnosed as having hypertension and continues to take medication for hypertension. Thus, the Board finds that the hypertension was shown to be a chronic disorder in service and that the veteran continues to have hypertension. Accordingly, the evidence supports entitlement to service connection for hypertension. 38 U.S.C.A. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a) and (b). ORDER Subject to the laws and regulations governing the payment of monetary benefits, service connection for hypertension is granted. RENÉE M. PELLETIER Member, Board of Veterans' Appeals