BVA9504472 DOCKET NO. 93-13 366 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: Georgia Department of Veterans Service WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD N. W. Fabian, Associate Counsel INTRODUCTION The veteran had active service from October 1978 to September 1981. The veteran previously filed a claim for compensation based on hypertension in August 1982. That claim was disallowed in November 1982 due to the veteran's failure to provide medical evidence and failure to report for an examination. Because the previous claim was not adjudicated based on the substantive merits of the case, in accordance with 38 C.F.R. § 3.104(a) new and material evidence is not required in order to determine the veteran's entitlement to service connection in conjunction with the current claim. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he was first diagnosed with hypertension while in active service and that the hypertension has continued to the present time. DECISION OF THE BOARD The Board of Veterans' Appeals (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 evidence supports the veteran's claim for service connection for hypertension. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the Department of Veterans Affairs (VA) Regional Office (RO). 2. The veteran's current hypertension may not be dissociated from the hypertension that began while the veteran was in active service. CONCLUSION OF LAW Hypertension was incurred in active service. 38 U.S.C.A. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a) and (d) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Upon review of the record, the Board concludes that the veteran's claim is well grounded within the meaning of the statutes and judicial construction. See 38 U.S.C.A. § 5107(a) (West 1991). The VA, therefore, has a duty to assist the veteran in the development of facts pertinent to his claim. Id. The pertinent evidence pertaining to the issue on appeal consists of private medical records from April 1984 through October 1991; health records from the veteran's employer from 1983 to March 1991; the report of a VA examination conducted in September 1991; and the veteran's written statements and testimony. The Board notes that the RO and the veteran have made numerous attempts to obtain the veteran's service medical records, but those records have not been located. The Board concludes, therefore, that all relevant data has been obtained for determining the merits of the veteran's claim. The VA has, therefore, fulfilled its obligation to assist the veteran in the development of the facts of his case as required by 38 U.S.C.A. § 5107(a). Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C.A. § 1131. Where a veteran served for 90 days in active service, and hypertension develops to a degree of 10 percent or more within one year from the date of separation from service, such disease may be service connected even though there is no evidence of such disease in service. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (1994). Hypertension warrants a 10 percent evaluation if the diastolic pressure is predominantly 100 or more, or when continuous medication is necessary for control of hypertension with a history of diastolic pressure predominantly 100 or more. See 38 C.F.R. § 4.104, Diagnostic Code 7101. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). The presumptive period is not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provision is intended as a liberalization applicable when the evidence would not otherwise warrant service connection. Id. Determinations regarding service connection are to be based on review of the entire evidence of record. See Wilson v. Derwinski, 2 Vet.App. 16, 19 (1991); 38 C.F.R. § 3.303(a). Once the evidence is assembled, the Secretary is responsible for determining whether the preponderance of the evidence is against the claim. See 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. Id. If, after careful review of all of the evidence, a reasonable doubt arises regarding service connection, such doubt will be resolved in favor of the veteran. See 38 C.F.R. § 3.102. The veteran contends that he was diagnosed with hypertension while in active service and that he has had hypertension since that time. According to the veteran's testimony at the RO hearing conducted in November 1992, he developed hypertension between November and December 1979 while stationed at Fort Carson, Colorado. Hearing Transcript, page 2. He was initially treated by a controlled diet but after two to three months he was given medication. T. 2. His medication was changed on three different occasions because his high blood pressure was not under control. T. 3. The veteran continued to take the medication that he had been given after he was discharged, but his high blood pressure was untreated from approximately 1982 to 1984 because he had no health insurance. T. 5. As stated previously, the veteran's service medical records cannot be located. He originally filed for compensation based on hypertension in August 1982. On that claim form he stated that he had high blood pressure that began in October 1980 and that he was treated for high blood pressure at the Army hospital in Dexheim, Germany, in October 1980. He had no treatment sources subsequent to discharge. In conjunction with his current claim the veteran submitted private medical records that show in April 1984 he was treated for high blood pressure. At that time his blood pressure was 144/94 and he was treated with the medication Hyloril. He was seen again in June 1984, at which time his blood pressure was 146/90. In July 1986 his blood pressure was 140/90; in June 1987 it was 170/110; in August 1987 it was 170/114; in February 1989 it was 190/120 and in May 1989 it was 180/116. In August 1987 his medication was changed to Vasotec. The report of an echocardiogram conducted in October 1989 shows that the veteran reported that he had had high blood pressure since age 18 and that the echocardiogram was required because X- rays showed that the veteran had cardiomegaly. Additional private medical records show that in October 1989 the veteran reported to the physician that he had had high blood pressure for ten years and that it was first diagnosed while he was in the Army. In October 1989 his blood pressure was 180/120. The physician stated as his impression that the veteran had refractory high blood pressure and cardiomegaly. The veteran was being treated with medication. In November 1989 his blood pressure was 160/100; in June 1990 it was 160/120; in July 1990 it was 140/100; in September 1990 it was 160/110; in October 1990 it was 150/90; in January 1991 it was 220/140; in February 1991 it was 180/130 and later in February 130/90; and in March 1991 it was 140/90. The veteran submitted health records from his employer covering the period April 1984 to June 1991. During that period of time the veteran's blood pressure was checked at least monthly. The blood pressure readings ranged from a low of 150/74 in May 1984 to a high of 210/140 in January 1991. According to the reports of physical examinations conducted by his employer, the veteran's blood pressure was 160/90 in March 1986; 150/98 in August 1988; and 150/110 in March 1991. The veteran had numerous absences from work due to uncontrolled high blood pressure. The report of a pre-employment physical examination for Hercules, Incorporated, shows that the veteran's blood pressure was 160/100. The report is not dated, but according to the veteran's hearing testimony he started working at Hercules in May 1983. T. 6. In conjunction with a VA examination conducted in September 1991 the veteran reported that he developed hypertension about one and a half years after he entered the service in 1978 while he was stationed at Fort Carson, Colorado. Initially he was treated by weight loss and diet, but after about three months he was placed on medication. The report of the physical examination shows that the veteran's blood pressure was 170/120 and the diagnosis was hypertension. All other body systems were normal. The veteran is entitled to service connection for hypertension if the evidence, viewed in its entirety, supports his contention that he developed hypertension in service that has continued to the present or if the evidence is in equal balance. The evidence clearly shows that the veteran has hypertension and that he has had the disorder since at least April 1984. The report of the pre-employment physical examination conducted in early 1983 shows an elevated blood pressure reading of 160/100. This reading was obtained approximately one and one half years after the veteran was discharged. Although not sufficient to establish the existence of hypertension during the presumptive period because it is a single blood pressure reading recorded more than one year after discharge, it is, nonetheless, evidence that supports the veteran's contention that he had hypertension while in service. The veteran has testified that he was diagnosed with hypertension while in active service and that he continued to be treated for hypertension until he was discharged. The Board finds the veteran's testimony to be highly credible because it is corroborated by the statements he made in the August 1982 claim and by the statements that he made in obtaining medical treatment in October 1989. The veteran's contentions are not refuted by any of the evidence in file. By resolving any reasonable doubt created by the absence of the veteran's service medical records in the veteran's favor, the evidence supports the conclusion that the veteran's current hypertension began during active service. ORDER Service connection for hypertension is granted. WILLIAM J. REDDY 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. 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.