Citation Nr: 0005538 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 95-24 070A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for allergies. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Marisa Kim, Associate Counsel INTRODUCTION The veteran had active military service from July 1974 to July 1994. This appeal is before the Board of Veterans' Appeals (Board) from the February 1995 and March 1997 rating decisions from the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for hypertension and for allergies. A September 1999 Board decision remanded the case to afford the veteran a Board hearing. In September 1999, the veteran declined a hearing. This matter is before the Board for final appellate review. The veteran's letter, attached to the August 1995 appeal, stated disagreement with the February 1995 decision that granted service connection for sinusitis, evaluated as noncompensable. This matter is referred to the RO. FINDINGS OF FACT 1. The medical evidence shows repeated instances of elevated blood pressure in service and a diagnosis of hypertension within one year of separation from service. 2. The veteran has taken medication to control his blood pressure since 1986 and currently obtains only fair control. 3. The medical evidence includes a current diagnosis of allergies, diagnosis and treatment of allergies in service, and a nexus opinion linking allergies to service. 4. The medical evidence shows that the veteran is allergic to ragweed and that he has had hay fever since 1986. CONCLUSIONS OF LAW 1. Hypertension was incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. § 3.307, 3.309 (1999). 2. Allergies were incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Factual Background The June 1974 enlistment examination report showed that the veteran's health was normal, and no pertinent defects or diagnoses were noted. Service medical records documented the veteran's blood pressure, measured in millimeters of mercury (mm Hg), throughout 20 years of active service, as follows: Date Systol ic Diasto lic June 1974 110 70 March 1975 134 100 October 1975 130 90 October 1975 130 100 November 1975 130 80 November 1975 180 108 December 1975 180 110 December 1975 130 90 December 1975 132 84 December 1975 124 70 December 1975 120 88 September 1976 100 50 December 1977 150 90 December 1977 130 80 January 1978 130 92 February 1978 130 92 June 1978 144 90 November 1980 132 70 January 1981 126 88 March 1981 128 60 December 1986 102 80 November 1987 122 50 February 1988 128 70 December 1988 126 90 February 1989 132 78 April 1989 130 90 June 1989 102 60 July 1989 102 60 February 1990 150 88 March 1990 167 91 May 1990 137 81 June 1990 146 88 June 1990 167 91 August 1990 142 84 August 1990 137 101 August 1990 120 80 September 1990 140 84 September 1990 140 92 September 1990 154 94 September 1990 142 98 September 1990 152 88 October 1990 130 86 October 1990 148 80 November 1990 118 70 November 1990 162 90 November 1990 140 60 November 1990 142 70 November 1990 147 73 November 1990 144 84 November 1990 162 90 November 1990 172 90 November 1990 160 89 November 1990 148 84 November 1990 118 70 November 1990 140 84 December 1990 140 73 December 1990 130 80 January 1991 160 88 January 1991 150 92 January 1991 136 80 February 1991 143 78 February 1991 128 86 March 1991 140 86 March 1991 148 85 March 1991 167 82 March 1991 137 79 April 1991 148 75 May 1991 170 86 June 1991 148 77 July 1991 146 84 July 1991 120 88 August 1991 146 77 August 1991 148 84 September 1991 139 69 September 1991 135 72 September 1991 147 75 September 1991 123 80 September 1991 132 69 September 1991 135 83 October 1991 129 69 November 1991 132 69 November 1991 153 77 November 1991 149 89 December 1991 138 75 March 1992 120 80 June 1992 124 82 June 1992 120 81 October 1992 138 92 November 1992 140 80 November 1992 146 98 November 1992 150 78 December 1992 130 92 April 1993 130 80 April 1993 136 80 May 1993 120 68 June 1993 128 80 July 1993 120 88 July 1993 138 84 October 1993 138 80 April 1994 121 98 June 1994 160 100 The October 1975 assessment was a significant increase in blood pressure. In February 1978, the veteran reported hives in the past. Although hives were not present, he requested medication in case the hives returned. The assessment was an allergic reaction, and the examiner prescribed Atarax. The May 1979 assessment was allergic rhinitis. In August 1990, the veteran complained of weakness and dizziness, and the assessment was Sudafed sensitivity. The assessment was allergic rhinitis in September 1990 and November 1990. The December 1990 assessment was probable allergic rhinitis. The January 1991 assessment was allergic rhinitis, and the examiner prescribed Beconase and Seldane. The examiner doubted that allergies were the sole cause of the veteran's symptoms. Later in January 1991, the regional allergy consultant examined the veteran. The assessment was chronic nonallergic rhinosinusitis on a clinical basis with no allergic component by history or skin tests; however, the consultant stated that he agreed with the need to assess the allergic contribution. The March 1991 assessment was allergic rhinitis probably caused by cotton dust or local mold. The March 1991 dental history stated that the veteran had been under the care of a physician in the past year for chronic rhinosinusitis. In August 1991, the examiner noted that the veteran had a prior history of nonallergic rhinitis. Later in August 1991, the veteran went to the emergency room for an allergic reaction to Levsin medication. The assessment was an allergic urticarial rash. The rash was still present when the veteran returned the next morning, and the examiner prescribed Decadron and Benadryl. The September 1991 assessment included nonallergic rhinitis. In November 1991, the veteran's skin showed no symptoms of a rash. The June 1992 assessment was allergic rhinitis. The November 1992 assessment was marginally elevated blood pressure. In April 1993, the veteran went to the clinic because he was unable to take decongestants. He was concerned about taking Seldane because of the recent scare he experienced with side effects from medications. The assessment was seasonal allergies. The October 1993 dental history stated that the veteran took Allergist for allergies and sinus problems. The June 1994 retirement examination report stated a summary of defects and diagnoses that included elevated blood pressure. The examiner also noted that the veteran had moderate hay fever all the time since 1986, manifested with headaches, recurrent sinusitis, frequent colds, dizziness, chest tightness, shortness of breath, and palpitating heart, treated with Seldane and Bactrim. The veteran had hives in an adverse reaction to Levsin in 1990. The veteran took no Levsin since and fully recovered with no complications and no sequelae. The veteran underwent a VA examination in January 1995. The veteran reported a history of hypertension, intermittently noted over the past 20 years that was never treated with medication. He also reported multiple environmental allergies to grass, pollen, dust, etc. that he treated with antihistamines as the occasion required. He reported an allergy to Levsin. The diagnoses included hypertension and multiple environmental allergies as described. The veteran went to the emergency room in April 1995 with complaints of allergy symptoms. The diagnoses were hypertension and seasonal allergic rhinitis to ragweed. He was discharged a few hours later with no change in his condition. Later in April 1995 and July 1995, the diagnosis was hypertension. The August 1995 appeal alleged that hypertension and allergies were the result of the pressures of military life and that allergy medication would be required for quite some time. He further alleged that his blood pressure remained around 175/100 since his examination in Charleston, South Carolina. The veteran underwent a VA examination in January 1997. The medical history stated that the veteran was found to have elevated blood pressure, with no symptoms, in 1986. Since then, he remained on medication to lower his blood pressure and currently took Fosinopril daily. A physician at the Vandenberg Air Force Base currently treated the physician. In 1987, the veteran twice underwent allergic skin testing and was found to be allergic to ragweed but to no other substances. The veteran's resting blood pressure was 150/88. The diagnosis was that the veteran's blood pressure was under fair control, and the electrocardiogram test of January 1997 was normal. The record included a microfiche of 34 pages of service department records that contained no medical evidence. Criteria The Court has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be established where the evidence demonstrates that an injury or disease resulting in disability was contracted in the line of duty coincident with military service, or if pre-existing such service, was aggravated therein. 38 U.S.C.A. § 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The claim of entitlement to service connection for hypertension. The claim of entitlement to service connection for hypertension is well grounded. The medical evidence included a current diagnosis of hypertension because the January 1995, April 1995, and July 1995 diagnosis was hypertension. For the limited purpose of well grounding the claim, the evidence showed an in-service diagnosis of hypertension because the October 1975 assessment was a significant increase in blood pressure, the November 1992 assessment was marginally elevated blood pressure, and the June 1994 retirement examination report noted elevated blood pressure in the summary of defects and diagnoses. Service medical records also documented the veteran's blood pressure on over 100 different examinations. As shown in the factual background, the systolic blood pressure was at least 160 mm Hg at 5 examinations between November 1975 to November 1990, and the diastolic blood pressure was at least 90 mm Hg at 26 examinations between March 1975 and June 1994. For the limited purpose of well grounding the claim, the June 1994 retirement examination report provided a medical nexus to service because the veteran filed his claim within 5 months after retirement from service. In Hampton v. Gober, 10 Vet. App. 481, 482 (1997), the Court held that the diagnosis during the separation examination constituted evidence of a current disability as well as a nexus to service when the veteran filed his claim approximately a month after service. Accordingly, the claim for service connection for hypertension is well grounded. If the claim is well grounded, the case will be decided on the merits, but only after the Board has determined that the VA's duty to assist under 38 U.S.C.A. § 5107(a) has been fulfilled. The RO obtained 20 years of service medical records and some post-service VA medical records. The veteran was afforded a VA examination. He filed numerous lay statements with the RO and declined numerous opportunities for scheduled hearings. In February 2000, his representative stated that the presentation already made seemed to be adequate. However, in January 1997, the veteran told the VA examiner that L.A., M.D., and A.A., M.D., treated him for hypertension in October 1995 and December 1996, respectively, and that he was currently treated by a physician at the Vandenberg Air Force Base. The VA has a duty to assist because the referenced medical records, if they exist, are not included in the claims file. Although there was no technical diagnosis of hypertension in service, regulations provide that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Cardiovascular-renal disease, including hypertension, is a chronic disease that may be presumed to have been incurred in service if it is manifested to a compensable degree within one year following the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Since hypertension is an early symptom long preceding the development of cardiovascular-renal diseases in their more obvious forms, a disabling hypertension within the 1-year period will be given the same benefit of service connection as any of the chronic diseases. See 38 C.F.R. § 3.309(a) (1999). Under the criteria in effect at the time the veteran filed his claim, a compensable evaluation was warranted for hypertension which requires continuous medication for control. 38 C.F.R. § Part 4, Code 7101. Therefore, this case may be decided without the missing medical records because the veteran's hypertension was diagnosed within 1 year of the veteran's separation from service. Although his blood pressure is currently under fair control, the January 1997 examiner stated that the veteran has taken medication to lower his blood pressure since 1986, and he continues to take medication on a daily basis to control his blood pressure. Accordingly, hypertension was incurred in active service. The claim of entitlement to service connection for allergies. At the outset, the Board notes that diseases of allergic etiology, . . . may not be disposed of routinely for compensation purposes as constitutional or developmental abnormalities. See 38 C.F.R. § 3.380 (1998). Seasonal and other acute allergic manifestations subsiding on the absence of or removal of the allergen are generally to be regarded as acute diseases, healing without residuals. The determination as to service incurrence or aggravation must be on the whole evidentiary showing. The claim of entitlement to service connection for allergies is well grounded. The medical evidence included a current diagnosis of allergies because the January 1995 diagnosis included multiple environmental allergies, and the April 1995 diagnosis was seasonal allergic rhinitis to ragweed. The evidence showed an in-service diagnosis of allergies because the assessment was allergic rhinitis in September 1990, November 1990, January 1991, March 1991, and June 1992. The April 1993 diagnosis was seasonal allergies, and the June 1994 examination report included moderate hay fever in the summary of defects and diagnoses. In addition, the June 1994 retirement examination report provided a medical nexus to service because the veteran filed his claim within 5 months after retirement from service. See Hampton v. Gober, 10 Vet. App. 481, 482 (1997). Moreover, the veteran demonstrated continuing symptomatology of allergy symptoms from early in service to the present. He reported hives in February 1978, weakness and dizziness in August 1990, numerous hay fever symptoms to the June 1994 retirement examiner, and complaints of allergy symptoms to post-service examiners. Accordingly, the claim for service connection for allergies is well grounded. If the claim is well grounded, the case will be decided on the merits, but only after the Board has determined that the VA's duty to assist under 38 U.S.C.A. § 5107(a) has been fulfilled. The RO obtained 20 years of service medical records and some post-service VA medical records. The veteran was afforded a VA examination, he filed numerous lay statements with the RO, and he declined numerous opportunities for scheduled hearings. In February 2000, his representative stated that the presentation already made seemed to be adequate. However, in January 1997, the veteran told the VA examiner that L.A., M.D., and A.A., M.D., treated him for allergies in October 1995 and December 1996, respectively, and that he was currently treated by a physician at the Vandenberg Air Force Base. The VA has a duty to assist because the referenced medical records, if they exist, are not included in the claims file. Nonetheless, this case may be decided without the missing medical records because the evidence is in approximate balance for and against service connection for allergies. Against service connection, the January 1997 examiner stated that the veteran was allergic to ragweed but to no other substances, and several military examiners stated that the veteran had seasonal allergies. In support of service connection, the June 1994 retirement examination report stated that the veteran had moderate hay fever all the time since 1986, manifested with headaches, recurrent sinusitis, frequent colds, dizziness, chest tightness, shortness of breath, and heart palpitation, treated with Seldane. Indeed, post-service medical records show continuation of the symptoms since service, and the veteran continues to take Seldane. Moreover, the medical evidence documented the veteran's adverse reactions to other substances, including Levsin and Sudafed. The veteran will receive the benefit of the doubt because the evidence is in approximate balance for and against service connection for allergies. Accordingly, allergies were incurred in active service. ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for allergies is granted. V. L. Jordan Member, Board of Veterans' Appeals