I think this is an astonishing and fairly recent decision because Dr. Boscarini's work is acknowledged in this decision- (as a treatise)
His work on PTSD has never been given much credence by VA-in the past -unfortunately-
And it is a good example of the way Relative Equipoise is supposed to work.
Citation Nr: 0521679
Decision Date: 08/10/05 Archive Date: 08/19/05
DOCKET NO. 93-23 884 ) DATE
On appeal from the
Department of Veterans Affairs Regional Office in Newark, New
Entitlement to service connection for hypertension.
Appellant represented by: New Jersey Department of
Military and Veterans' Affairs
ATTORNEY FOR THE BOARD
Ronald W. Scholz, Senior Counsel
The veteran served on active duty from July 1968 to April
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a February 1992 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
Newark, New Jersey which denied service connection for
The Board remanded the issue on appeal in October 1995,
November 1999, and September 2003. In its September 2003
Remand, the Board directed a VA examination to determine
whether the veteran's hypertension was caused or aggravated
by his service-connected PTSD.
FINDING OF FACT
The evidence of record is in equipoise with respect to the
question of whether the veteran's diagnosed hypertension is
secondary to his service-connected PTSD
CONCLUSION OF LAW
Hypertension is proximately due to the veteran's service-
connected PTSD. 38 U.S.C.A. § 1110, 5107 (West 2002); 38
C.F.R. § 3.102, 3.310 (2004).
REASONS AND BASES FOR FINDING AND CONCLUSION
In light of the favorable action taken herein, discussion of
whether VA duties pursuant to the Veterans Claims Assistance
Act of 2000 (VCAA) have been satisfied is not required. The
Board finds that no further notification or assistance is
necessary, and deciding the appeal at this time is not
prejudicial to the veteran.
The veteran has been service-connected for PTSD since May
Medical evidence of record reflects that the veteran has a
current diagnosis of hypertension.
Pursuant to a September 2003 Board Remand, the veteran
received a VA medical examination in April 2004. The
examining VA physician concluded there was no relationship
between the veteran's service-connected PTSD and his
hypertension and, further, that PTSD did not cause
hypertension or contribute to any exacerbations of
An April 2005 letter from Alfred M. Dipiero, D.O., noted that
the veteran had been under his care for hypertension, and
concluded that the hypertension resulted from the veteran's
Service connection may also be granted on a secondary basis
if a claimed disability is found to be proximately due to, or
is the result of, an established service-connected disease or
injury. Establishing service connection on a secondary basis
requires evidence sufficient to show: (1) that a current
disability exits, and (2) that the current disability was
either (a) caused by or ( aggravated by a service-
connected disease or injury. 38 C.F.R. § 3.310(a) (2004);
See Allen v. Brown, 7 Vet. App. 439, 446 (1995).
The Secretary shall consider all information and lay and
medical evidence of record with respect to benefits under
laws administered by the Secretary. When there is an
approximate balance of positive and negative evidence
regarding any issue material to the determination of a
matter, the Secretary shall give the benefit of the doubt to
the claimant. 38 U.S.C.A. § 5107( (West 2002); 38 C.F.R.
§ 3.102 (2004).
The evidence with respect to whether the veteran has a
current disability, hypertension, is not in dispute. The
record reflects that the veteran was first diagnosed with,
and treated for, hypertension, sometime in the 1970's.
In its September 2003 Remand, the Board directed that a VA
medical examination be conducted to determine whether the
veteran's service-connected PTSD caused or aggravated the
veteran's hypertension. Subsequently, two medical opinions
have been obtained and added to the file, both of which are
remarkably inadequate with respect to providing any rationale
for their diametrically opposed conclusions.
The first, a report of an April 2004 VA medical examination,
concluded that there is no relationship between the veteran's
service-connected PTSD and his hypertension. No rationale of
any kind, however, is provided for that conclusion.
The second, a letter from a private physician who has treated
the veteran for his hypertension for many years, concluded
that the veteran's hypertension resulted from his service-
connected PTSD. Again, no rationale of any kind is provided
for that conclusion.
Other than the two medical opinions discussed above, there is
no evidence of record with respect to the issue of secondary
service-connection for hypertension resulting from the
The Board finds that the evidence with respect to secondary
service-connection is in approximate balance, as there is no
sound basis for choosing one medical opinion over the other.
When there is an approximate balance of positive and negative
evidence regarding any issue material to the determination of
a matter, the benefit of the doubt shall be given to the
claimant and, accordingly, the claim must be granted.
In reaching this determination, the Board notes that the fact
that PTSD was recognized after hypertension was diagnosed is
not determinative, since the record is not lcear as to when
PTSD first existed. Furthermore, in reaching this
determiantion, the Board notes that the VA published
information in the Federal Register. The study did find a
statistically significant increased incidence of hypertension
and chronic heart disease among World War II veterans with
PTSD (odds ratio = 1.25 for hypertension and 1.19 for chronic
heart disease). The conclusion that PTSD may be associated
with cardiovascular disorders is also supported by a 1997
study finding that Vietnam veterans diagnosed with PTSD had a
significantly increased risk of circulatory disease many
years after service. (Boscarino JA. Diseases Among Men 20
Years After Exposure to Severe Stress: Implications for
Clinical Research and Medical Care. Psychosom Med 1997;
59:605-14.) 69 FR 60083-01. In view of the lack of reasoning
in each pertinent medical opinion, the favorable evidence at
least has some support in a document placed in the Federal
Register by VA.
Entitlement to service connection for hypertension, secondary
to the veteran's service-connected PTSD, is granted.
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs
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Astonishing Ptsd -hbp Bva Decision!
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