Citation Nr: 18142422 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 18-02 290 DATE: October 15, 2018 ORDER Entitlement to a rating in excess of 10 percent for low back strain is denied. Entitlement to an initial rating in excess of 20 percent for radiculopathy of the left leg involving the sciatic nerve is denied. Entitlement to an initial compensable rating for erectile dysfunction is denied. Entitlement to an initial compensable rating for hypertension is denied. FINDINGS OF FACT 1. The Veteran’s low back strain has been manifested by 65 degrees of forward flexion of the thoracolumbar spine; but not by forward flexion greater than 30 degrees but not greater than 60 degrees. 2. The Veteran’s radiculopathy of the left leg has been manifested by moderate incomplete paralysis; but not by moderately severe or severe incomplete paralysis. 3. The Veteran’s erectile dysfunction has resulted in a loss of erectile power; but not with penile deformity. 4. The Veteran’s hypertension has been manifested by the need for continuous medication for control; but not by a history of diastolic pressure predominantly 100 mmHg 10 or greater, or systolic pressure predominantly 160 mmHg or greater. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for low back strain have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2017). 2. The criteria for an initial rating in excess of 20 percent for radiculopathy of the left leg have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520 (2017). 3. The criteria for a compensable initial rating for erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7522 (2018). 4. The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. § 1155; 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.404, Diagnostic Code 7101 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from November 1957 to September 1959. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) in July 2018. A transcript of the hearing is associated with the electronic claims file. The Veteran has perfected an appeal for the issue of entitlement to service connection for cerebrovascular accidents (CVA), secondary to his claimed traumatic brain injury (TBI). In a September 2017 decision, the Board specifically cited to evidence of record regarding the Veteran’s histories of head trauma and CVA in its denial of the request to reopen the previously denied claim of entitlement to service connection for residuals of TBI. At the July 2018 Board hearing, the Veteran testified that he has appealed the September 2017 Board decision to the United States Court of Appeals for Veterans Claims (Court). Therefore, the claim for entitlement to service connection for CVA is deferred since it is inextricably intertwined with the issue of service connection for the claimed TBI, currently before the Court. Duty to Notify and Assist VA has a duty to notify and assist Veterans in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2017). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Increased Schedular Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (2017); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In this case, the Board finds that based on the evidence, further staged increased ratings are not warranted. If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. § 4.45. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336–37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 1. Low Back Strain and Associated Radiculopathy A. Factual Background The evidence of record reflects that the Veteran was afforded a VA thoracolumbar spine examination in August 2017. The Veteran reported that his back disability has progressively worsened. He endorsed flare-ups with bending and picking up items, and other daily activities. The Veteran described his pain symptoms as “constant, dull nagging pain” located in the mid-low back with tenderness to touch. He further reported that when he experiences sharp pain, he also has radiating pain down his left leg into his left ankle, which causes imbalance and instability. The Veteran stated that he wakes up with pain, which increases throughout the day. Regarding functional loss or impairment, the Veteran further endorsed an inability to run or jog or perform house or yard maintenance. The Veteran further reported difficulty bending, carrying or lifting over 15 pounds, walking, driving over an hour, using stairs, standing for more than 30 minutes, sitting for more than 30 minutes, lying down, and household chores. The examination report noted that the Veteran uses a cane on an occasional basis. Upon physical examination, the Veteran displayed 0 to 70 degrees of forward flexion, 0 to 10 degrees of extension, 0 to 15 degrees of right lateral flexion, 0 to 10 degrees of left lateral flexion, and 0 to 20 degrees of lateral rotation bilaterally. The VA examiner reported that the Veteran exhibited pain on forward flexion, extension, and right lateral flexion. The Veteran further displayed moderate tenderness to palpation in the thoracic and lumbar spine regions. On repetitive-use testing, the VA examiner reported that there was additional loss of function or range of motion. After three repetitions, the Veteran displayed 0 to 65 degrees of forward flexion, 0 to 10 degrees of extension, 0 to 15 degrees of right lateral flexion, 0 to 15 degrees of left lateral flexion, 0 to 25 degrees of right lateral rotation, and 0 to 15 degrees of left lateral rotation. Pain, fatigue, and weakness were noted as factors that caused the Veteran’s functional loss. The August 2017 examination report indicated that pain, weakness, fatigability, or incoordination significantly limits functional ability with repeated use over a period of time. The VA examiner reported that the Veteran does not have guarding or muscle spasm of the thoracolumbar spine, or atrophy. The examination report reflects that the Veteran’s sensation to light touch was assessed as normal, and that straight leg raising tests were negative bilaterally. Regarding the Veteran’s radiculopathy, the August 2017 VA examiner reported that the Veteran has moderate intermittent pain in the left lower extremity, and assessed the Veteran’s severity of his left lower extremity radiculopathy as moderate. The examination report indicated that the Veteran’s radiculopathy involved the sciatic nerve. The VA examiner further indicated that the Veteran does not have ankylosis of the spine. While the August 2017 VA examiner indicated that the Veteran has Intervertebral Disc Syndrome (IVDS) of the thoracolumbar spine, the VA examiner reported that the Veteran has not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The VA examiner opined that the Veteran’s thoracolumbar spine disability impacts his ability to work. B. Analysis of Low Back Strain The Veteran’s low back strain is currently rated under Diagnostic Code 5237 for lumbosacral strain, and is assigned a 10 percent rating, effective September 28, 1998. See 38 C.F.R. § 4.71a, Diagnostic Code 5237. Disabilities of the spine are rated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, whichever method results in the higher rating. The General Rating Formula for Diseases and Injuries of the Spine provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. The Notes following the General Rating Formula provide further guidance in rating diseases or injuries of the spine. Note 1 specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note 2 states that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note 3 provides that in exceptional cases, an examiner may state that because of age, body habitus, neurological disease, or other factors not the result of disease or injury of the spine, the range of motion of spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note 2. Provided that the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note 4 provides that range of motion measurements are to be rounded to the nearest five degrees. Note 5 defines unfavorable ankylosis as a condition in which the entire cervical spine, the entire the thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Under the Formula for Rating IVDS Based on Incapacitating Episodes (in pertinent part) a 20 percent disability rating is warranted with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is warranted with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent disability rating is warranted with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) for purposes of evaluations under the Formula for Rating IVDS Based on Incapacitating Episodes, defines an incapacitating episode as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. The Board finds that a rating in excess of 10 percent for the Veteran’s service-connected low back strain is not warranted. The 10 percent evaluation is consistent with forward flexion greater than 60 degrees but not greater than 85 degrees. The evidence of record does not demonstrate forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. See 38 C.F.R. § 4.71a. All of the spine examinations affirmatively reflect findings of no ankylosis, and no other medical evidence of record reflects any such limitation of ankylosis of the spine. Accordingly, the 10 percent rating adequately represents any functional impairment attributable to the disability. See 38 C.F.R. §§ 4.10, 4.41 (2017). The Board notes that the August 2017 VA examiner indicated that the Veteran has IVDS of the thoracolumbar spine, but reported that the Veteran has not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran’s VA and private outpatient treatment records are silent for any notations of IVDS or incapacitating episodes, and the Veteran has not indicated that he suffers from incapacitating episodes as contemplated by the Incapacitating Episodes Formula. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula, Note 1. As such, the Veteran’s low back strain does not meet the criteria for IVDS as defined in the rating schedule. When evaluating disabilities of the spine, any associated objective neurologic abnormalities are to be rated separately under an applicable Diagnostic Code. 38 C.F.R. § 4.71a, General Formula, Note 1. Here, service connection for the Veteran’s left leg sciatic radiculopathy has already been granted and rated as 20 percent disabling. The issue of whether the Veteran is entitled to an initial rating in excess of 20 percent for left leg sciatic radiculopathy is decided herein. Therefore, any associated objective neurologic abnormalities are already contemplated by the assigned rating and decision herein. There is no evidence of any other nerve involvement during this period. As such, additional separate compensable ratings are not warranted at this time. 38 C.F.R. § 4.71a, General Formula, Note 1. The Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the criteria. See Doucette v. Shulkin, 28 Vet. App. 366, 369–70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). For all the foregoing reasons, the preponderance of the evidence is against a rating in excess of 10 percent at any time during the pendency of the claim for low back strain. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. C. Analysis of Radiculopathy of the Left Leg The Veteran’s left leg radiculopathy is currently rated under Diagnostic Code 8520 for the sciatic nerve, and is assigned a 20 percent rating, effective July 7, 2017. See 38 C.F.R. § 4.71a, Diagnostic Code 8520. Disability ratings for diseases of the peripheral nerves under Diagnostic Code 8520 are based on relative loss of function of the involved extremity with attention to the site and character of the injury, the relative impairment of motor function, trophic changes, or sensory disturbances. See 38 C.F.R. § 4.120 (2017). An 80 percent rating is assignable for complete paralysis of the sciatic nerve; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. A 60 percent rating may be assigned for incomplete paralysis of the sciatic nerve which is severe, with marked muscular atrophy. A 40 percent rating is assignable when moderately severe. A 20 percent rating may be assigned when moderate. A 10 percent rating may be assigned when mild. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Board also observes that the words “mild,” “moderate,” and “severe,” as used in Diagnostic Code 8520, are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 (2017). After a review of all the evidence, the Board finds that the weight of the evidence demonstrates that the Veteran has no more than moderate incomplete paralysis due to radiculopathy of the left leg. The evidence of record does not show that he experiences severe incomplete paralysis. The Veteran’s symptomatology most closely approximates the criteria for a 20 percent disability evaluation for radiculopathy of the left leg. As discussed above, the August 2017 VA examiner assessed the Veteran’s severity of his left lower extremity radiculopathy as moderate and indicated that the Veteran’s radiculopathy involved the sciatic nerve. The Board further finds that the preponderance of the evidence is against the assignment of a disability rating in excess of 20 percent for left leg radiculopathy. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369–70. All potentially applicable Diagnostic Codes have been considered. See Schafrath, 1 Vet. App. at 593. The Board concludes that a 20 percent rating, but no higher, for the Veteran’s radiculopathy of the left leg is warranted. As the preponderance of the evidence is against assigning higher ratings, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. 2. Erectile Dysfunction The Veteran contends he is entitled to an initial compensable rating for his erectile dysfunction. The Board notes that there is no specific disability rating for erectile dysfunction. The closest analogous code is 38 C.F.R. § 4.115b, Diagnostic Code 7522, which rates deformity of the penis with loss of erectile power. “Deformity” under DC 7522 means “a distortion of the penis, either internal or external,” based on the ordinary meaning of the term as gleaned from Dorland’s Illustrated Medical Dictionary. Williams v. Wilkie, 2018 U.S. App. Vet. Claims LEXIS 1037. The Board can find no other Diagnostic Code provision that would be more appropriate in rating the Veteran’s disability. There is no evidence that he has had removal of half or more of his penis, that there is internal deformity such as nerve or other structural abnormality, or that glans have been removed, such that would warrant consideration under Diagnostic Codes 7520 or 7521, respectively. Therefore, Diagnostic Code 7522 is most appropriate to rate this disability. Pursuant to Diagnostic Code 7522, two distinct elements are required for a compensable, 20 percent, disability rating: penile deformity and loss of erectile power. As the Veteran is not shown to have both penile deformity and loss of erectile power, the Board finds that a compensable evaluation for erectile dysfunction is not warranted. Furthermore, he has been awarded special monthly compensation under 38 U.S.C. § 1114, subsection (k), 38 C.F.R. § 3.350(a), due to loss of use of a creative organ, so he is in fact being compensated for loss of use. Therefore, a compensable rating is not warranted under Diagnostic Code 7522. In August 2017, the evidence of record reflects that the Veteran underwent a VA examination. The VA examiner referenced the Veteran’s diagnoses of erectile dysfunction, atrophy of the testis, and voiding dysfunction. The examination report noted that the Veteran is prescribed Sildenafil for his symptoms. The VA examiner reported that the Veteran’s voiding dysfunction causes increased urinary frequency of a daytime voiding interval between two and three hours, and nighttime awakening to void two times. The VA examiner further indicated that the voiding dysfunction causes hesitancy, weak stream, and decreased force of stream. The examination report indicated that the voiding dysfunction was of an unknown etiology. Regarding the Veteran’s erectile dysfunction, the VA examiner noted that the Veteran has used medications for treatment of the condition but is unable to maintain an erection. Upon physical examination, the August 2017 VA examiner reported that the Veteran’s penis was normal. The VA examiner further assessed the Veteran’s testes as abnormal, noting the size one-half to one-third of normal bilaterally, and considerably softer than normal bilaterally. The examination report indicated that complete atrophy was not observed. The VA examiner further indicated that the Veteran’s epididymis was tender to palpation bilaterally. The examiner attributed the cause to the Veteran’s mental health disorders and not to any structural or internal deformity. The record otherwise demonstrates an ongoing diagnosis of erectile dysfunction, without evidence of deformity of the penis. Thus, there is no evidence of penile deformity. The Board recognizes that the Veteran’s erectile dysfunction causes significant problems with sexual activities, for which he requires medication. However, as noted above, in order to obtain a compensable disability rating there must be evidence of penile deformity. The Veteran is being separately compensated for the loss of use of a creative organ or, in this case, his difficulties obtaining and maintaining an erection sufficient for intercourse and ejaculation. The Board concludes that the most probative evidence of record weighs strongly against finding that he has any penile deformity. The Board is sympathetic to the Veteran’s erectile problems and associated difficulties; however, as noted above, the current awarded special monthly compensation under 38 U.S.C. § 1114, subsection (k), 38 C.F.R. § 3.350(a), due to loss of use of a creative organ, compensates the Veteran for these difficulties. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369–70. All potentially applicable Diagnostic Codes have been considered. See Schafrath, 1 Vet. App. at 593. The Board concludes that an initial compensable rating for the Veteran’s erectile dysfunction is not warranted; as the preponderance of the evidence is against assigning a compensable rating, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. 3. Hypertension The Veteran contends he is entitled to an initial compensable rating for his service-connected hypertension. The Veteran is currently assigned a noncompensable rating under Diagnostic Code 7101, effective July 7, 2017. All blood pressure measurements are in units of pressure of millimeters of mercury (mmHg). Hypertension is defined by VA regulations to mean “that the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm.” 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Hypertension “must be confirmed by readings taken two or more times on at least three different days.” Id. Pursuant to Diagnostic Code 7101, a 10 percent rating is assigned for essential hypertension when diastolic pressure is predominantly 100 or more, or; systolic pressure is predominantly 160 or more, or; as a minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is assigned for diastolic pressure that is predominantly 110 or more, or; systolic pressure that is predominantly 200 or more. A 40 percent rating is assigned for diastolic pressure that is predominantly 120 or more. A 60 percent rating is assigned where diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. The evidence of record reflects that the Veteran submitted a claim for service connection for hypertension in a Fully Developed Claim (VA 21-526EZ) received on July 7, 2017. In May 2017, VA outpatient treatment records reflect that the Veteran’s blood pressure was “usually well controlled” on the current medication regimen. The Board notes that VA outpatient treatment records from May and June 2017 documented blood pressure readings of 137/91, 126/78, 139/76, and 113/72. The evidence of record reflects the Veteran was afforded a VA examination for his service-connected hypertension in August 2017. The examination report indicated that the Veteran’s treatment plan includes continuous medication for hypertension. The VA examiner indicated that the Veteran is prescribed Amlodipine, Nitrostat, and two supplements. The examination report indicated that the Veteran does not have a history of a diastolic blood pressure elevation to predominantly 100 or more. The VA examiner recorded the Veteran’s blood pressure at 142/72, 119/64, and 122/68, for an average of 127/68. Thereafter, VA outpatient treatment records dated June 2018 indicate that the Veteran had a blood pressure reading of 136/82. Regrettably, the Board finds that the Veteran has required continuous medication for hypertension control during the period on appeal but that he does not have a history of diastolic pressure predominantly 100 or greater, or systolic pressure predominantly 160 or greater. Therefore, his service-connected hypertension is best evaluated as noncompensable. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369–70. All potentially applicable Diagnostic Codes have been considered. See Schafrath, 1 Vet. App. at 593. The Board concludes that a compensable for the Veteran’s hypertension is not warranted; as the preponderance of the evidence is against assigning a higher rating, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. A. Ong, Associate Counsel