Citation Nr: 0811123 Decision Date: 04/04/08 Archive Date: 04/14/08 DOCKET NO. 04-09 265 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for hypertension, claimed as secondary to diabetes. 2. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: California Department of Veterans Affairs ATTORNEY FOR THE BOARD A. Barone, Associate Counsel INTRODUCTION The veteran had active service from February 1970 to March 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from multiple rating determinations of a Regional Office (RO) of the Department of Veterans Affairs (VA). The issue of entitlement to service connection for hypertension arises from an April 2003 RO rating decision. A notice of disagreement was received in September 2003, a statement of the case was issued in January 2004, and a substantive appeal was received in March 2004. The issue of entitlement to TDIU arises originally from a June 2005 RO rating decision. In the June 2005 rating decision, which addressed 9 other issues of service connection and disability ratings, the RO included a consideration of whether the veteran was entitled to TDIU; the RO denied entitlement to TDIU. The veteran then submitted paperwork advancing his contention of entitlement to TDIU in October 2005. In a June 2006 rating decision, the RO again denied entitlement to TDIU. A notice of disagreement on this issue was received in June 2006, a statement of the case on this matter was issued in July 2006, and a substantive appeal was received in August 2006. The Board notes that a November 1986 RO rating decision denied entitlement to service connection for hypertension; the veteran's claim at that time advanced a theory of direct service connection or service connection due to Agent Orange exposure. Since that time, the veteran has been diagnosed with and service-connected for diabetes mellitus, and he currently claims entitlement to service connected for hypertension primarily on the theory that it has been aggravated by his diabetes. The current claim for service connection for hypertension is, thus, under a new theory of entitlement; therefore, it is unnecessary to determine whether new and material evidence has been received to reopen the claim, and the Board will address this issue on the merits. FINDINGS OF FACT 1. Hypertension was not manifested during the veteran's active duty service or for many years thereafter, nor is hypertension otherwise shown to be causally related to the veteran's service; additionally, the veteran's current hypertension was not caused by nor aggravated by the veteran's service-connected diabetes mellitus, nor is hypertension shown to be caused by or aggravated by any service-connected disability. 2. The veteran's service-connected disabilities, with a current combined rating of 90 percent disabling, result in a disability picture which more nearly approximates an inability to obtain or retain substantially gainful employment consistent with his education and work experience. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by the veteran's active duty service, nor may it be presumed to have been incurred in such service. Neither has hypertension been caused or aggravated by any service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1112, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310(a) (2007). 2. The criteria for entitlement to a total rating based on individual unemployability due to service-connected disability have been met. 38 U.S.C.A. § 5107 (West 2000 & Supp. 2007); 38 C.F.R. §§ 3.340, 3.341, 4.7, 4.15, 4.16, 4.18, 4.19 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 The Board acknowledges the Veterans Claims Assistance Act of 2000 (VCAA). 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2002). This legislation provides, among other things, for notice and assistance to claimants under certain circumstances. VA has issued final rules to amend adjudication regulations to implement the provisions of VCAA. See 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). The intended effect of the regulations is to establish clear guidelines consistent with the intent of Congress regarding the timing and the scope of assistance VA will provide to a claimant who files a substantially complete application for VA benefits, or who attempts to reopen a previously denied claim. Preliminarily, with regard to the veteran's claim of entitlement to TDIU, there is no need to undertake any review of compliance with the VCAA and implementing regulations in this case since there is no detriment to the veteran as a result of any VCAA deficiency in view of the fact that the full benefit sought by the veteran is being granted by this decision of the Board. See generally 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a). With reference to the veteran's claim of entitlement to service connection for hypertension, after reviewing the claims folder, the Board finds that the claimant has been notified of the applicable laws and regulations which set forth the necessary criteria for the benefit currently sought. In a letter sent in August 2002, the claimant was informed of the information and evidence necessary to warrant entitlement to the benefit sought. Moreover, the appellant was advised of the types of evidence VA would assist him in obtaining as well as his own responsibilities with regard to identifying relevant evidence. See Quartuccio v. Principi, 16 Vet.App. 183 (2002); Charles v. Principi, 16 Vet.App. 370 (2002). The Board notes that the August 2002 letter was sent to the appellant prior to the April 2003 rating decision giving rise to the current appeal. The VCAA notice was therefore effectively timely. See Pelegrini v. Principi, 18 Vet.App. 112 (2004). The Board also notes that the August 2002 letter effectively notified the appellant of the need to submit any pertinent evidence in the appellant's possession. In this regard, the appellant was advised of the need to produce evidence in support of his claim, that it was the appellant's responsibility to make sure that such evidence was received by the RO, and that the appellant needed to inform the RO about any medical evidence not yet submitted. The Board believes that a reasonable inference from such communication was that the appellant must furnish any pertinent evidence that the appellant may have. Therefore, the requirements of 38 C.F.R. § 3.159(b)(1) have been effectively met. The Board finds that all notices required by VCAA and implementing regulations were furnished to the appellant and that no useful purpose would be served by delaying appellate review to send out additional VCAA notice letters. During the pendency of this appeal, on March 3, 2006, the Court issued a decision in the consolidated appeal of Dingess/Hartman v. Nicholson, 19 Vet.App. 473 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. The Court held that upon receipt of an application for a service-connection claim, 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating or is necessary to substantiate the elements of the claim as reasonably contemplated by the application. Id. at 486. Additionally, this notice must include notification that a disability rating and an effective date for the award of benefits will be assigned if the benefits are awarded. Id. at 488. In the present appeal, there has been timely notice of the types of evidence necessary to establish a disability rating and an effective date for any rating that may be granted. The RO furnished the appellant with a letter in March 2006 which directly explained how VA determines disability ratings and effective dates. This notice was provided to the appellant prior to the most recent RO readjudication of this case and issuance of a supplemental statement of the case in November 2007. Furthermore, the Board finds that there has been substantial compliance with the assistance provisions set forth in the law and regulations. The record as it stands includes sufficient competent evidence. All available pertinent records, in-service, private, and VA, have been obtained. The veteran has been afforded a VA examination to evaluate the etiology of his hypertension in connection with this appeal; a VA examination report dated April 2005 and follow- up clarifying reports dated May 2005 and June 2005 are of record; another pertinent VA examination report is of record from January 2006. The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide the case and no further action is necessary. See generally 38 C.F.R. § 3.159(c)(4). No additional pertinent evidence has been identified by the claimant as relevant to this appeal. Under these circumstances, no further action is necessary to assist the claimant with this appeal. Analysis Service Connection for Hypertension The veteran is seeking entitlement to service connection for hypertension. The veteran has specifically claimed that his hypertension was caused by or aggravated by his service- connected diabetes mellitus. Service connection is in effect for diabetes mellitus, effective from June 2002. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as hypertension, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also 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). Additionally, disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Board also notes that secondary service connection on the basis of aggravation is permitted under 38 C.F.R. § 3.310, and compensation is payable for that degree of aggravation of a non-service- connected disability caused by a service-connected disability. Allen v. Brown, 7 Vet.App. 439 (1995). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet.App. 181 (1992); Wilson v. Derwinski, 2 Vet.App. 614, 618 (1992); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Board notes that the service medical records do not reflect any diagnosis of or symptomatology related to hypertension. On separation examination in February 1972, no defects or diagnoses were noted. His blood pressure reading was 120/82. The veteran was afforded a VA fee-basis examination in April 2005 which evaluated the effects of his diabetes mellitus, including in connection with any relationship to causing or aggravating hypertension. The April 2005 VA examination report shows that the veteran's blood pressure was recorded as "120/80, 120/88, 120/90" during the examination. The examiner's thorough inspection of the veteran, including appropriate diagnostic studies, is documented over the several pages of the report. The examining physician's analysis included a discussion that the veteran's "diabetes mellitus was diagnosed three years [a]go but he has been symptomatic at least the past five years...." Even accounting for this, however, the examiner was compelled to conclude that the veteran's hypertension was not caused by the diabetes mellitus: "He has been on treatment for hypertension for the past 25 years so it is not likely that it is caused by diabetes mellitus." Thus, the examiner has presented a persuasive rationale for drawing the medical conclusion that the veteran's current hypertension was not caused by his service-connected diabetes mellitus; the Board therefore views this medical opinion as probative competent medical evidence weighing against a finding that diabetes mellitus caused the veteran's hypertension. Although the April 2005 VA fee-basis examination report did not originally offer a clear discussion addressing whether the veteran's hypertension has been permanently aggravated by his diabetes mellitus, a May 2005 supplemental statement and a June 2005 addendum from the examiner offer clarifying discussion pertinent to this question. In this regard, the May 2005 supplement stated that "Whether the veteran has non-diabetic condition aggravated by diabetes mellitus, I cannot answer this question without speculating." In the context of the fact that the examiner addressed hypertension in the primary report as disability expressly not caused by diabetes mellitus, the May 2005 supplemental statement indicates that there is no basis for determining that the hypertension (a non-diabetic condition) has been aggravated by diabetes mellitus without resorting to speculation. The examiner offers a more definitive statement on this point, in the June 2005 addendum report. The June 2005 addendum explains that there is a clinical basis for finding that veteran's heart disease has been caused by the veteran's diabetes, but that there is no clinical basis for finding aggravation of any pathology not caused by the diabetes. The examiner states, with emphasis, "there are no non-diabetic conditions that are aggravated by the diabetes." The Board has considered the April 2005 VA fee-basis examination report, together with the May and June 2005 follow-ups, very carefully with regard to the medical conclusions pertinent to this appeal. In the Board's view, the medical analysis offered by the doctor competently and probatively weighs against the veteran's claim with regard to both a theory that hypertension was caused by diabetes mellitus or a theory that hypertension was aggravated by diabetes mellitus. The analysis offered expressly contemplates the veteran's hypertension pathology in analyzing the veteran's diabetes mellitus pathology. There is an unmistakable conclusion, complete with an explained medical rationale, finding that the hypertension is not a result of the diabetes mellitus. The May 2005 and June 2005 medical statements following from the April 2005 VA fee-basis examination, do not expressly refer to hypertension as clearly as the original April 2005 report does. The May and June statements indicate that the there is no medical basis for finding that any "non-diabetic condition" has been aggravated by diabetes. This has led the Board to take care in considering whether the doctor has categorized hypertension as a diabetic condition or not. The Board notes that the April 2005 discussion finding that hypertension was not caused by diabetes mellitus is stated immediately after a discussion of diagnoses associated with the diabetes mellitus pathology; this strongly suggests that the doctor considered hypertension to be a non-diabetic condition. The Board can find no suggestion, in any of the reports associated with the April 2005 examination, that the doctor ever considered the veteran's hypertension to be a diabetic condition. Thus, in the Board's view, the only reasonable interpretation of the doctor's findings, clarified in two follow-ups to the original report, is that no non- diabetic condition, including hypertension, has been aggravated by the diabetes mellitus. The doctor has discussed the diagnoses that may be causally linked to the diabetes mellitus, and these include the veteran's heart condition (discussed in the June 2005 addendum), peripheral neuropathy, and visual impairment (both discussed in the April 2005 report). The doctor's discussion expresses that the veteran's diabetes pathology does not aggravate any diagnosis which has not been otherwise etiologically attributed to diabetes, including hypertension. The Board finds that no useful purpose would be served by delaying appellate review to seek a fourth statement from this doctor to further clarify his statements. In January 2006, the veteran was afforded another VA fee- basis examination with another doctor which yielded pertinent findings regarding this issue on appeal. In this regard, the report reflects that the examiner conducting a thorough interview and physical examination of the veteran. The examiner confirmed the diagnosis of diabetes mellitus and expressly found related conditions of erectile dysfunction, peripheral neuropathy, and arteriosclerotic heart disease. Significantly, the examiner states that "There are no non- diabetic conditions that are aggravated by diabetes." Further, the examiner explains that the hypertension is not causally related to the diabetes: "The veteran's hypertensive condition is less likely a result of diabetes mellitus because the diagnosis of hypertension preceded the diagnosis of diabetes and there is no clinical evidence of renal complications." The Board considers this examination report, with its clear medical opinion and rationale, to be highly probative evidence weighing against the veteran's claim. Significantly, the January 2006 report's rationale adds to the rationale provided in the April 2005 report: the January 2006 report indicates that the absence of renal complications is medically significant in determining that the veteran's diabetes is not causing hypertension. There is no medical evidence of record to support the veteran's contention that his hypertension is due to or aggravated by his diabetes mellitus. The April 2005 VA examiner and the January 2006 VA examiner both opined that the veteran's hypertension was not caused by his diabetes mellitus and is not aggravated by his diabetes mellitus. The Board accepts these opinions as being the most probative medical evidence on the subject in this case, as they were based on thorough examinations, and rationales were provided for the opinions. See Boggs v. West, 11 Vet.App. 334, 343 (1998). Given the depth of the examination reports (including the follow-ups to the April 2005 report), the Board finds the examiners' findings to be probative and material to the veteran's claim. See Owens v. Brown, 7 Vet.App. 429, 433 (1995). Moreover, there is no competent medical opinion to the contrary with regard to the etiology of his hypertension. The Board has reviewed the outpatient treatment reports of record, both from VA and from private providers, but finds that the etiology opinions contained in the April 2005 VA examination report (including its follow-ups) and the January 2006 VA examination report present the most probative evidence of record regarding this appeal. No other medical record directly addresses the essential questions of the etiology of the veteran's hypertension. The Board notes that VA treatment records from April 1985 diagnose hypertension with a history dating back to 1980, and medication dating back to 1982; the record reflects that this predates the veteran's diabetes diagnosis by approximately 20 years. The veteran does not dispute this chronology, including as reflected by his report of his history to the April 2005 VA examiner. The Board acknowledges that outpatient records contain references to treatment for hypertension and recorded blood pressure data from various dates during different phases of medication and treatment through the present time. The Board also acknowledges the veteran's assertion, indicated in his March 2004 substantive appeal, that aggravation of his hypertension is manifested by the need to increase his medication dosage to control his blood pressure. The Board is not competent to draw its own medical conclusions based upon the available blood pressure data, medication notes, and the veteran's assertions. Colvin v. Derwinski, 1 Vet.App. 171 (1991). In any event, the critical question in this case is not whether the veteran's hypertension has worsened, but whether it has been aggravated by his diabetes. The April 2005 VA examination report with its follow-ups, in addition to the January 2006 VA examination report, present competent medical evidence that the veteran's hypertension is neither caused by nor clinically aggravated by his diabetes; there is no finding in any other medical evidence which contradicts these competent medical opinions. There is otherwise no evidence of record, other than the veteran's contentions, that his hypertension is related to his service-connected diabetes mellitus. As the veteran is not a medical expert, he is not competent to express an authoritative opinion on this issue. Espiritu v. Derwinski, 2 Vet.App. 492 (1992); Grottveit v. Brown, 5 Vet.App. 91 (1993). In summary, there is no medical evidence to support the veteran's contention that his hypertension is due to or aggravated by his service-connected diabetes mellitus. Thus, service connection for hypertension is not warranted. This is a case where the preponderance of the evidence is against the claim and the benefit of the doubt rule is inapplicable. 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet.App. 49 (1991). TDIU In order to establish service connection for a total rating based upon individual unemployability due to service- connected disability, there must be an impairment so severe that it is impossible to follow a substantially gainful occupation. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the veteran's service connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet.App. 524, 529 (1993). For VA purposes, the term "unemployability" is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed.Reg. 2317 (1992). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. VA regulations establish objective and subjective standards for an award of total rating based on unemployability. When the veteran's schedular rating is less than total (for a single or combination of disabilities), a total rating may nonetheless be assigned provided that if there is only one service-connected disability, this disability shall be rated at 60 percent or more. When there are two or more disabilities, at least one disability must be ratable at 40 percent or more, and any additional disabilities must result in a combined rating of 70 percent or more, and the disabled person must be unable to secure or follow a substantially gainful occupation. See 38 C.F.R. § 4.16(a). A total disability rating may also be assigned on an extra-schedular basis, pursuant to the procedures set forth in 38 C.F.R. § 4.16(b), for veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in section 4.16(a). Thus, the Board must evaluate whether there are circumstances, apart from any non-service-connected conditions and advancing age, which would justify a total rating based on unemployability. A TDIU claim is an alternate way to obtain a total disability rating without recourse to a 100 percent evaluation under the rating schedule. See Parker v. Brown, 7 Vet.App. 116, 118 (1994). The veteran is service connected for post traumatic stress disorder (PTSD), evaluated as 50 percent disabling; peripheral neuropathy, right upper extremity associated with diabetes mellitus, evaluated as 30 percent disabling; diabetes mellitus (presumptively herbicide related), evaluated as 20 percent disabling; peripheral neuropathy, left upper extremity associated with diabetes mellitus, evaluated as 20 percent disabling; peripheral neuropathy, right lower extremity associated with diabetes mellitus, evaluated as 10 percent disabling; peripheral neuropathy, left lower extremity associated with diabetes mellitus, evaluated as 10 percent disabling; arteriosclerotic heart disease associated with diabetes mellitus, currently evaluated as 10 percent disabling; and erectile dysfunction associated with diabetes mellitus, evaluated as noncompensable. A bilateral factor of 5.5 percent is applicable in regard to the veteran's ratings under Diagnostic Codes 8515 and 8520. As indicated in the veteran's October 2007 rating reduction for his heart disease (from 60 to 10 percent), his combined rating currently remains at 90 percent despite that rating reduction. See 38 C.F.R. § 4.25. Thus, given that the veteran has one service- connected disability rated over 40 percent and his combined rating is over 70 percent, the veteran does meet the schedular requirements for a total disability rating based on individual unemployability due to service-connected disabilities under 38 C.F.R. § 4.16(a). However, the Board must still determine whether the veteran's service-connected disabilities result in impairment so severe that it is impossible to follow a substantially gainful occupation. The Board emphasizes that a total rating based on individual unemployability is limited to consideration of service-connected disabilities. The veteran is currently assigned disability ratings with a combined rating of 90 percent. This in itself is indicative of significant disability. The Board's review of the claims- file, there appears to be no comprehensive medical opinion clearly evaluating the veteran's employability in light of the aggregate impact of his various service-connected disabilities. The Board notes that an August 2007 VA psychiatric examination, addressing only the veteran's disability from service-connected PTSD, indicates that the veteran was clinically found to "have occasional difficulty performing activities of daily living" and "has problems establishing and maintaining work relationships." The report further indicates that the veteran's service-connected PTSD manifests in "problems with co-workers and supervisors." Additionally, the August 2007 report includes a clinical finding that the veteran "has some difficulty with complex (two to three-step) commands." Thus, there is competent evidence showing some notable limitation in the veteran's psychiatric suitability for employment due to service-connected PTSD. The Board also notes that there is competent medical evidence suggesting that the veteran's physical suitability for employment appears to have been notably diminished by his service-connected diabetes pathology. The April 2005 VA fee- basis examination report remarks that "The claimant will have difficulty with prolonged walking and should change positions slowly because of his peripheral neuropathy." The January 2006 VA fee-basis examination report remarks that "With respect to the diabetic condition, the veteran should avoid performing strenuous physical activity, especially when fasting, to prevent hypoglycemia." The record reflects that the veteran was most recently employed in 2002, including as reported by the veteran in October 2005. The Board has also considered the lay testimony submitted by family members. The probative value of this evidence may be limited to an extent as the family members lack the medical expertise to competently attribute any particular deficits of employability to the veteran's service-connected disabilities. However, the lay accounts are informative in this case. A December 2005 statement from one of the veteran's sons indicates that the quantity of doctor's appointments the veteran requires precludes the possibility of gainful employment. This statement does not appear to be clearly contradicted by a broad review of the claims-folder and consideration of the veteran's numerous manifestations of service connected disabilities. Other lay statements submitted, also dated December 2005, describe significantly disruptive dizzy-spells and falling associated with the veteran's diabetic complications, as well as some additional accounts of the veteran's psychiatric symptoms associated with his PTSD. The Board finds the lay testimony in this case to be reasonably consistent with the objective evidence of record, and the Board finds the statements of the veteran and his family to be credible. The veteran's October 2005 claim indicates that he has had 3 years of college education. The Board acknowledges that there is no clear medical evidence which plainly demonstrates that any service connected disability individually renders the veteran unemployable for jobs consistent with his level of education. Furthermore, the Board acknowledges that there is no clear medical opinion of record which assesses the veteran's employability in the context of the combined aggregate of his service connected disabilities. However, the veteran already has a demonstrated 90 percent combined rating for service-connected disabilities. There is persuasive medical evidence that his service-connected psychiatric disability presents significant difficulty to the veteran's mental functioning in a workplace environment, and the medical evidence documents a service-connected diabetes pathology which significantly limits the veteran's physical capacities. Rather than remand this case for further development of the medical evidence in this regard, the Board believes that there is sufficient evidence supporting the veteran's claim for TDIU that, resolving reasonable doubt in favor of the veteran, a grant of the appeal is warranted under these circumstances. After reviewing the documented findings regarding the severity of the service-connected disabilities, the Board believes that the veteran would have a difficult time securing and following substantially gainful employment due to both psychiatric and physical limitations. Granted the veteran has other nonservice-connected disabilities which no doubt also result in impairment. However, the Board believes that an individual with the veteran's particular combination of disabilities, education, and work experience would be unable to follow a substantially gainful employment even if he or she were otherwise in good health. ORDER Entitlement to service connection for hypertension, to include as secondary to diabetes, is not warranted. To this extent, the appeal is denied. Entitlement to a total rating based on individual unemployability due to service-connected disability is warranted. To this extent, the appeal is granted, subject to applicable laws and regulations governing payment of VA monetary benefits. ____________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs