Citation Nr: 0315852 Decision Date: 07/14/03 Archive Date: 07/22/03 DOCKET NO. 98-07 928 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for hypertension and coronary artery disease, claimed as secondary to service- connected prostate cancer. ATTORNEY FOR THE BOARD Jeffrey J. Schueler, Counsel INTRODUCTION The appellant had active service from August 1953 to September 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, where the RO inter alia denied service connection for hypertensive cardiovascular disease. In September 1999 and in April 2003, the Board undertook evidentiary development of the claim. As the evidence developed is favorable to the claim, there is no prejudice in adjudicating the claim without initial referral of the claim to the agency of original jurisdiction. FINDINGS OF FACT 1. The evidence supports a finding that the appellant's hypertension increased in severity secondary to treatment of the service-connected prostate cancer. 2. The evidence is in equipoise as to whether his coronary artery disease increased in severity due to treatment of the service-connected prostate cancer. CONCLUSIONS OF LAW 1. Hypertension is proximately due to or the result of treatment for service-connected prostate cancer. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2002). 2. Coronary artery disease is proximately due to or the result of treatment for service-connected prostate cancer. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.310 (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) redefined VA's duty to notify and to assist claimants for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156, 3.159, and 3.326 (2002). The Board finds that the RO has fully satisfied its duties of notice and assistance and that sufficient evidence is of record to decide the veteran's claim. If there were any deficiency of notice or assistance, it would not be prejudicial to the veteran, given the favorable nature of the Board's decision with regard to the issue on appeal. No further assistance in developing the facts pertinent to the issues is required. The appellant seeks to establish service connection for hypertension and coronary artery disease secondary to service-connected prostate cancer. He maintains that these disorders were aggravated by treatment in July 1991 at a private medical facility for his service-connected prostate cancer. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2002). Service connection on a secondary basis is warranted when it is demonstrated that a disorder is proximately due to or the result of a disorder of service origin. 38 C.F.R. § 3.310 (2002). To establish service connection on a secondary basis for a disorder clearly separate from the service-connected disorder, there must present medical evidence to support the alleged causal relationship between the service-connected disorder and the disorder for which secondary service connection is sought. Jones v. Brown, 7 Vet. App. 134, 137 (1994). When aggravation of a nonservice-connected condition is proximately due to or the result of a service-connected condition, the claimant shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The evidence of record indicates that the appellant currently has hypertension and coronary artery disease, and that he has been granted service connection for prostate cancer. He argues that his hypertension and coronary artery disease is related to treatment of his service-connected prostate cancer. In April 2002, the Board ordered additional evidentiary development, part of which was to include an examination to determine whether any cardiac disorder was at least as likely as not caused by or had been aggravated (made worse) by the service-connected prostate cancer. VA examination in April 2003 revealed diagnoses of hypertension and coronary artery disease, status post myocardial infarction in August 1990. The examiner reviewed the record, including records of private hospitalization in July 1991 for acute renal failure superimposed upon chronic renal failure due to obstructive uropathy from carcinoma of the prostate. The examiner reported on a comment made by the physician caring for the appellant in July 1991, to the effect that acute elevation in blood pressure "may well have been related to volume overload given in response to" a medication used in treatment of his renal failure. The examiner noted that the appellant's blood pressure was modestly elevated throughout the July 1991 hospitalization, which responded well to hypertensive medication without complications. The examiner opined that the hypertension was aggravated by the service-connected prostate condition when he was hospitalized for acute renal failure. Since then, the examiner remarked, the appellant had required a medication for control of hypertension. It was the examiner's opinion that it was at least as likely as not that hypertension was aggravated by treatment of the service-connected prostate condition. The appellant has service-connected prostate cancer, and the record includes current evidence of hypertension. The VA examiner' s opinion in June 2003 supports the appellant's contentions that hypertension was aggravated by treatment for the service-connected prostate condition in July 1991. It is the determination of the Board that the evidence supports entitlement to service connection for hypertension as secondary to the service-connected prostate cancer, to the extent that hypertension was aggravated by the service-connected prostate cancer over and above the degree of disability existing prior to the aggravation. The April 2003 examiner also stated that he could not "say that the cardiac condition or coronary artery disease per se" was aggravated by the prostate condition, though it "puts him at a higher risk for" coronary artery disease. The record includes no other medical evidence as to the relationship between the current coronary artery disease and the service-connected prostate cancer. The examiner's opinion on this question does not support either a connection between the two, or the lack of a connection, though it does appear to link a higher risk of coronary artery disease appears to prostate cancer. Here, the evidence appears in relative equipoise, in which case the claim is granted. See 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2002); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). It is the determination of the Board that, the evidence being in equipoise, entitlement is granted to service connection for coronary artery disease as secondary to the service-connected prostate cancer, to the extent that coronary artery disease was aggravated by the service-connected prostate cancer over and above the degree of disability existing prior to the aggravation. ORDER Service connection for hypertension, to the extent it was aggravated by the service-connected prostate cancer over and above the degree of disability existing prior to the aggravation, is granted. Service connection for coronary artery disease, to the extent it was aggravated by the service-connected prostate cancer over and above the degree of disability existing prior to the aggravation, is granted. ____________________________________________ MARJORIE A. AUER Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.