BVA9504343 DOCKET NO. 93-06 207 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for essential hypertension. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from June 1943 to service retirement in December 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of February 1992 from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. After developing additional evidence in this case, the Board, in accordance with Thurber v. Brown, 5 Vet.App. 119 (1993), informed the veteran's representative in a February 6, 1995, letter of the additional evidence developed, and provided an opportunity to respond. In a February 10, 1995, response, the representative argued that the material should be forwarded to the RO for review. In response, we point out that the Board has been advised by the General Counsel of the VA that the practice of providing copies of medical opinions only to a claimant's representative (where the claimant is represented) is consistent with the general rule of law that notice to the representative is notice to the claimant. Absent an overriding provision of law, we find that the evidence in question was provided to the representative in this case, and that such provision satisfied the requirement of notice. Op. G.C. 49-93 (November 2, 1993). CONTENTIONS OF APPELLANT ON APPEAL It is contended that the RO committed error in failing to grant service connection for the veteran's currently manifested essential hypertension because it did not take into account or properly weigh the medical and other evidence of record. It is contended that hypertension became evident shortly after his separation from military service and well within the applicable presumptive period provided under 38 C.F.R. § 3.309 (1993). It is further contended that both service medical records and records of medical treatment during the initial post service year reflect clinical findings indicative of the presence of essential hypertension. 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 claim for entitlement to service connection for essential hypertension. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. Essential hypertension was not manifest during active service or during the initial post service year; hypertension was initially diagnosed in 1975, approximately 10 years following final service separation. CONCLUSION OF LAW Essential hypertension was not incurred in or aggravated by active service and the service incurrence of hypertension may not be presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is plausible and thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates a duty to assist the veteran in developing all pertinent evidence. In this connection, the Board notes that the RO has obtained medical evidence from all sources identified by the veteran and that the veteran has been afforded a VA examination. On appellate review, we see no areas in which further development might be productive. In order to establish service connection for claimed disability, the facts, as shown by 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. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may also be granted on a presumptive basis for certain chronic disabilities, including hypertension, when manifested to a compensable degree within the initial post service year. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). The veteran's service entrance examination, dated in June 1943, disclosed that his blood pressure was 138/90 and his cardiovascular system was otherwise normal. On examination in August and October 1944, no blood pressure or cardiac abnormalities were shown. Reports of medical examinations conducted in February 1946, February 1949, and February 1950 showed that his blood pressure was well within normal limits. A February 1953 report of neurological consultation to evaluate complaints of headaches disclosed blood pressure of 144/90. The examiner noted that the veteran's blood pressure was "a bit elevated" and recommended occasional checks. A vascular etiology for his headache complaints was ruled out. Reports of medical history and medical examination in February 1960 disclose no history or findings of elevated blood pressure, and blood pressure was shown to be 128/82. Reports of medical history and medical examination in February 1962 revealed no history or findings of elevated blood pressure, and blood pressure was shown to be 120/86. Service medical records dated in February 1963 showed that the veteran was seen for complaints of headaches. His blood pressure was 135/90. Reports of medical history and medical examination in January 1965 disclosed no history or findings of elevated blood pressure, and blood pressure was shown to be 120/80. While a report of the veteran's service retirement examination is not associated with the service medical records, a November 1965 chest X-ray disclosed no abnormalities and a November 1965 electrocardiogram was normal. The veteran's original claim for VA disability compensation benefits, received in January 1966, made no mention of hypertension. A report of VA examination, conducted in February 1966, disclosed no cardiac abnormalities and his blood pressure was 120/80. Service hospital outpatient clinic records dated from January 1966 to March 1991 disclosed no complaint, treatment, or findings of elevated blood pressure during the initial post service year. The first post service findings of elevated blood pressure are dated in June 1967, at which time his blood pressure was shown to be 134/96. The initial diagnosis of hypertension is dated in November 1975, and treatment with antihypertensive medication was initiated at that time. Service hospital outpatient clinic records thereafter report regular clinical findings of elevated blood pressure, controlled in varying degrees by medication. A report of medical history prepared by the veteran in March 1981 noted hypertension, treated with medication for 10 to 12 years. A VA hospital summary, dated in October 1987, shows that the veteran was admitted after a syncopal episode. Blood pressure was 140/90. The diagnoses at hospital discharge included labile hypertension. VA outpatient clinic records dated from May 1989 to May 1991 report frequent clinical findings of elevated systolic levels, while diastolic levels were controlled with medication. An entry in May 1991 cited a history of hypertension and noted good control. The veteran's initial claim for service connection for hypertension was received at the RO in July 1991, more than 25 years following final separation. In his claim, the veteran stated that he experienced hypertension "shortly after [his] retirement in 1967." It is noted that the veteran's actual service retirement occurred in December 1965. A report of VA examination, conducted in November 1991, cited a history offered by the veteran of being treated for hypertension for the past 25 years, i.e., since 1966. Blood pressure was 136/94 when sitting. The diagnosis was hypertension, presently treated with medication. A rating decision of February 1992 denied service connection for conditions which included essential hypertension, giving rise to this appeal. In June 1992, the veteran submitted altered copies of medical records in connection with his claim for service connection for hypertension. These records, when compared to copies of the original documents obtained directly from Womack Army Hospital in August 1991, show that records dated January 5, 1966, and June 19, 1966, had been altered by the insertion of bogus elevated blood pressure readings. The alterations appear to be done with a different pen and in a different handwriting from other portions of the clinical entries. In his substantive appeal, the veteran cited post service medical records purportedly showing that he had elevated blood pressure readings on January 5, 1966, on June 19, 1966, and on January 19, 1967, pointing out that the two earliest readings are "definitely within the presumptive period," while the third was dated only 19 days following the end of the presumptive period. In fact, the medical record contains no documents, altered or unaltered, dated January 19, 1967. In a May 1993 letter, the veteran stated, inter alia, "In January '66 I was seen two times at Womack with blood pressure very high and then again in January '67." (Emphasis in original). The veteran's service medical records contain no complaint, finding, or diagnosis of essential hypertension. We note that a clear demarcation between normal and high blood pressure has not been established. J. Willis Hurst, M. D., THE HEART 1041-1042 (6th ed. 1985); Charles K. Friedberg, M. D., DISEASES OF THE HEART 1475 (3d ed. 1966). Generally, however, a diagnosis of hypertension is based upon sustained blood pressure readings of 90 or more diastolic and/or 140/150 or more systolic. E. Braunwald, M. D., HEART DISEASE: A TEXTBOOK OF CARDIOVASCULAR MEDICINE 819-821 (3d ed. 1988); L. D. Hillis, M. D., et. al. eds, MANUAL OF CLINICAL PROBLEMS IN CARDIOLOGY 170 (3d ed. 1988). In this case, sustained elevated blood pressure readings are not shown in service. While the veteran argues otherwise, the medical evidence of record does not support his contention that essential hypertension had its onset during service. Our review of the medical evidence of record shows that essential hypertension was not manifest during active service, on the last examination conducted prior to service retirement, or during the initial post service year. Further, the report of VA examination conducted in February 1966 showed that the veteran's blood pressure was well within normal limits at 120/80. While the Board has given careful consideration to the contentions and assertions advanced by the veteran with respect to his claim, the submission of altered documents and the subsequent submission of written statements calling attention to those documents as dispositive of his claim greatly diminishes his credibility. Based upon the foregoing, the Board finds that the medical and other evidence in this case does not warrant entitlement to service connection for essential hypertension. ORDER Service connection for essential hypertension is denied. J. U. JOHNSON 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.