Citation Nr: 18143391 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 16-27 838 DATE: October 19, 2018 ORDER Entitlement to service connection for a left shoulder disability, to include strain and osteoarthritis, is denied. Entitlement to an initial rating of 50 percent for pes planus prior to June 14, 2016, is granted. Entitlement to an initial rating greater than 50 percent for pes planus from June 14, 2016, is denied. Entitlement to an initial rating of 10 percent for hypertension is granted. FINDINGS OF FACT 1. A left shoulder disability was not manifest in service, arthritis of the left shoulder was not manifest within one year of service, and there is no link between the left shoulder disability and active service. 2. Throughout the appellate time period, the Veteran’s pes planus is manifested by symptomatology that most closely approximates marked pronation of the feet that is not improved by orthopedic shoes or appliances. 3. The Veteran’s hypertension is manifested by multiple diastolic blood pressure readings of 100 or greater without medication, but not by diastolic pressure predominantly 110 or more or by systolic pressure predominantly 200 or more. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2018). 2. The criteria for a disability rating of 50 percent, but no greater, for bilateral pes planus have been met for the entire appellate time period. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5276 (2018). 3. The criteria for a disability rating of 10 percent, but no higher, for hypertension have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.104, DC 7101 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from November 2008 to May 2014. The Board notes that a January 2017 rating decision granted entitlement to increased ratings for the Veteran’s service-connected pes planus, with a 30 percent disability rating assigned prior to June 14, 2016, and 50 percent from that date. The rating decision indicated that the 50 percent disability rating was the highest schedular rating allowed for flat foot and the contemporaneous Supplemental Statement of the Case (SSOC) limited consideration of the claim to the period prior to June 14, 2016. That said, the Board notes that the rating assigned is not the highest rating available for the Veteran’s bilateral foot disabilities and, as such, the issue remains on appeal. Despite the RO’s statement regarding the rating being the highest rating available, the Board finds that the analysis in the January 2017 rating decision and SSOC, as well as prior adjudications, sufficiently contemplated the Veteran’s claim such that adjudication by the Board at this time will not prejudice the Veteran. 1. Entitlement to service connection for a left shoulder disability, to include strain and osteoarthritis Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012). Certain diseases, to include arthritis, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2018). As there is no evidence or claim that the Veteran was diagnosed with left shoulder arthritis within one year of service the above provision is not applicable. To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran contends that his current left shoulder disabilities are the result of his active service. Specifically, the Veteran contends that he incurred multiple strains of the left shoulder during service weakened the shoulder that resulted in a permanent injury to the left shoulder after service. In an August 2008 Report of Medical History, the Veteran denied a history of painful shoulder. An August 2008 Medical Screen of Medical History Report also included denials of a history of dislocated, swollen, or painful shoulder, as well as denials of limitation of motion or surgery involving the shoulders. In November 2010, the Veteran fell on the ice and injured his left shoulder, right elbow, and head. On examination, the left shoulder was tender to palpation over the superior scapular area, without any noted deformity. Pressing on the scapular bone itself was not tender, but the muscle tissue at the crest was tender. Pain was noted on impingement testing. There was no swelling, erythema, warmth, or misalignment. Motion was normal and did not cause pain. There was no instability. That said, there was weakness in the left shoulder secondary to pain. The assessment was most likely a sprain / muscle pain. In December 2013, the Veteran was treated for right shoulder tendonitis and his Report of Medical Examination in February 2014 listed a history of rotator cuff tendonitis and pain in the right shoulder, but made no mention of problems with the left shoulder. In-service treatment records otherwise document numerous treatments for right shoulder problems (for which the Veteran has been granted service connection) some incurred during participation in sports. In October 2015, the Veteran was afforded a VA Shoulder and Arm Conditions DBQ. The examiner diagnosed bilateral shoulder strain from 2015. The Veteran reported symptom onset from 2009 to 2012, as his left shoulder began to have pain when doing PT and popped often when moving. The condition had gotten worse and hurt when lifting objects. It popped when the Veteran was moving the shoulder. There was sharp pain from the scapula down the humorous to the elbow that made it difficult to use the arm, decreased motion, and resulted in pain and popping with movement. The examiner provided an extensive discussion of the Veteran’s medical history. The examiner concluded that it was less likely than not that the left shoulder disability was related to service. The rationale noted that there was only one episode of documented left shoulder pain when he fell on ice in 2010. There was an initial evaluation and three weeks later the Veteran complained of left back pain that was treated as a thoracic spine strain from the fall. No further care for the left shoulder was required. In a March 2016 statement, the Veteran indicated that he strained or sprained his left shoulder many times during training and that he also had fallen on his shoulder. He believed that “all of the strains weakened the joint, tendons, and muscles around. I shot a basketball in November. My left shoulder slid out of joint and back in causing intense pain, limited range of motion, and the ability to move and use my arm.” A subsequent MRI showed tears in the rotator cuff and possible damage to the labrum. A March 2016 treatment record indicated that the Veteran had initially hurt his left shoulder playing basketball in November 2015 when he felt a “pop,” decreased range of motion, pain, and a possible dislocation. He tried physical therapy, steroid injection, and pain medication without relief. Then about 4 days previously he had been lifting a cup and the same symptoms occurred. Another March 2016 record indicated that the left shoulder pain had been ongoing for 4 months. The Veteran went up for a shot and it felt like his arm kept going. He felt a pop and had an “electric sensation” down the arm. It felt to the Veteran as if his shoulder had slid out of joint. He could not move the arm in the aftermath of the injury. In May 2016, the Veteran was noted to have undergone left rotator cuff surgery in April 2016 after a shoulder injury playing basketball. A June 2016 Shoulder and Arm Conditions Disability Benefits Questionnaire (DBQ) indicated that the Veteran had diagnoses of left shoulder impingement syndrome from November 2015, left rotator cuff tear from January 2016, and left subacromial / subdeltoid bursitis from January 2016. The Veteran reported several strains in the left shoulder from 2010 to 2014 while in service. An MRI showed left rotator cuff tendinopathy with partial-thickness tear, labral degeneration, and mild subacromial-subdeltoid bursitis. The Board concludes that the left shoulder disabilities had their onset after service and are not otherwise related to service. In reaching that opinion, the Board has considered the findings and conclusions from the October 2015 VA examination report. The examiner concluded that it was less likely as not that the Veteran’s current left shoulder disability was related to service. The rationale noted that there was only one episode of documented left shoulder pain when he fell on ice in 2010. There was an initial evaluation and three weeks later the Veteran complained of left back pain that was treated as a thoracic spine strain from the fall. No further care for the left shoulder was required. The Board finds this opinion the most probative of record, as the conclusion included a complete rationale based on all the evidence of record. The Board is aware of the provisions of 38 C.F.R. § 3.303(b), relating to chronicity and continuity of symptomatology in establishing service connection and that such provisions apply to those chronic conditions, such as arthritis, specifically listed in 3.309(a). See Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013). However, left shoulder arthritis was not noted during service, including at the time of examination shortly before separation from active service or within one year of separation from service. Moreover, prior to separation from service the Veteran discussed right shoulder problems, but made no mention of ongoing difficulties with his left shoulder. As such, the Board finds that there is no credible contention of a continuity of left shoulder problems from service. As such, the provisions of 38 C.F.R. § 3.303(b) are not for application. As to the Veteran’s general contentions that his left shoulder disability was incurred in or is otherwise related to his service, the Board finds his opinions to be of less probative weight. Although the Veteran may be competent to report shoulder pain, the Veteran has not contended that he has been experiencing ongoing shoulder pain from service and, to the extent that he is making such a claim, the Board finds such contentions not credible in light of his denial of the in-service reports discussed above. Had the Veteran been experiencing ongoing left shoulder problems, the Board finds it reasonable to conclude that he would have discussed such problems when discussing ongoing right shoulder issues. The Board acknowledges that the Veteran has some elementary level of medical training, education, and experience, based on his training as a nurse’s aide and x-ray technician; however, he has not provided any support for his contention that his left shoulder was weakened by in-service left shoulder strains that ultimately led to his post-service left shoulder injury. As such, the Board affords far greater probative weight to the opinions of the VA examiner. In summary, the Veteran does not contend that he experienced ongoing left shoulder problems from service and, to the extent that his contentions can be read as implicitly or explicitly raising such a claim, they are deemed not credible in light of his in-service and post-service reports. In light of the evidence, the Board concludes that the preponderance of the credible evidence is against the left shoulder claim, and that service connection for a left shoulder disability is not warranted. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). Separate DCs identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2018). The Veteran’s entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2018). VA must consider whether the Veteran is entitled to “staged” ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability and incoordination. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2018). The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 2. Entitlement to an increased rating greater than 30 percent for pes planus prior to June 14, 2016 3. Entitlement to an initial rating greater than 50 percent for pes planus from June 14, 2016 The Veteran’s bilateral pes planus is currently rated under DC 5276. See 38 C.F.R. § 4.71a, DC 5276 (2018). The Veteran claims that the current ratings do not accurately reflect the true nature and degree of his disability. DC 5276 provides ratings for acquired flatfoot. Mild flatfoot with symptoms relieved by built-up shoe or arch support is rated as noncompensably (0 percent) disabling. Moderate flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the atendo achillis, pain on manipulation and use of the feet, bilateral or unilateral, is rated 10 percent disabling. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 20 percent disabling for unilateral disability, and is rated 30 percent disabling for bilateral disability. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and is rated 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a. Service treatment records document multiple instances of treatment for cellulitis involving the feet. March 2013 x-rays showed minimal degenerative changes in both feet with no radiographic evidence of additional osseous pathology, including the calcaneus. In April 2013, the Veteran was diagnosed with plantar fasciitis and bilateral flat feet and that prior pain in the first and second metatarsophalangeal joints was likely gout and not cellulitis. Custom foot orthoses were discussed as a possible treatment. The Veteran was afforded a VA Foot Conditions, including Flatfoot (Pes Planus) DBQ in October 2015. The examiner diagnosed bilateral pes planus and heel contusions. The Veteran reported symptom onset in 2012, with both feet and heels swelling, turning bright red, and being hot to the touch. It was painful to walk. The condition had worsened in both feet and heels. They would swell up to 3 to 4 times per month, lasting 2 to 3 days, causing pain and making it difficult to walk. The bottoms of the feet were painful, with a tingling pain in the heels and sharp pain in the arches and towards the toes. There was pain in both feet while walking and running. There was pain in the bilateral feet that was accentuated with use and on manipulation. There was no indication of swelling with use or characteristic calluses. The examiner indicated that there was no extreme tenderness on the plantar surface of either foot. There was decreased longitudinal arch height bilaterally, without marked deformity, without marked pronation, without weight-bearing line falling over or medial to the great toe, without inward bowing of the Achilles tendon, and without marked inward displacement of the Achilles tendon. There was bilateral functional loss due to pain on movement, pain on weight-bearing, and interference with standing. Pain, weakness, fatigability, and/or incoordination did not significantly limit functional ability during flare-ups or with repetitive use over time. The Veteran did not use any assistive devices for his pes planus. The Veteran’s foot condition was not so severe that he would be equally well served by an amputation with prosthesis. The pes planus would interfere with occupational functioning by affecting standing and walking. In a March 2016 statement, the Veteran indicated that prior to service he had no problems with his feet. Since 2013, he had experienced ongoing problems with the feet, including warmth, swelling, and pain to palpation. He was diagnosed with plantar fasciitis and x-rays also showed degenerative changes to both feet. He saw a podiatrist who prescribed inserts for the Veteran’s boots and shoes. The inserts did not help, which the Veteran claims to have told his VA examiner. He continued to have issues with swelling in the feet and heels, which made walking difficult. The symptoms occurred 2 to 3 times per month and lasted 2 to 3 days. In May 2016, the Veteran’s feet were evaluated, at which time there was noted swelling and tenderness prominent on the bottom of the feet that was likely related to walking on hardwood floors with socks only. He was referred to orthotics. At his orthotics appointment, the Veteran reported intermittent arch pain, not necessarily on the first step or following rest. He was advised to avoid going barefoot and prescribed orthotics. If the orthotics were ineffective, the Veteran was advised to request a referral to podiatry for further assessment. A June 14, 2016, Flatfoot (Pes Planus) Disability Benefits Questionnaire (DBQ) diagnosed bilateral pes planus and plantar fasciitis from 2012, while in service. There was pain on use of the feet that was accentuated by use. There was pain on manipulation of the feet, and the Veteran’s pain was accentuated by manipulation. There was no swelling with use, but the symptoms were not relieved by arch supports. There was not extreme tenderness of the plantar surfaces on one or both feet. There was decreased longitudinal arch height on weight-bearing bilaterally and evidence of marked deformity of the foot. There was marked pronation of both feet and inward bowing of the Achilles tendon. The weight-bearing line fell over the great toe in both feet. There was not marked inward displacement and severe spasm of the Achilles tendon. There were no associated scars. The Veteran did not use any assistive devices. There was degenerative arthritis in both feet, as evidenced by x-rays. The Veteran worked 8 hours a day while walking and he had been working through the pain. In July 2016, the Veteran reported pain in one of his feet or ankles every couple of weeks for many years. (The Veteran is service-connected and separately rated for right and left ankle collateral ligament sprain and those issues are not before the Board.) In light of this record, the Board concludes that the severity of the Veteran’s bilateral pes planus disability appears to be consistent throughout the appellate time period and, as such, more closely approximate the criteria for a 50 percent rating under DC 5276 for the entire time period. 38 C.F.R. § 4.7. In reaching that conclusion, the Board recognizes that the October 2015 VA examination report indicated that there was no evidence of marked pronation of the feet, but the report also noted that x-rays or other imaging studies were not taken at that time. The June 2016 DBQ, by contrast, stated that imaging studies were available and found that the Veteran had marked pronation of both feet. There is no lay or medical indication that the Veteran’s condition worsened in the months between the examinations and, indeed, there is lay evidence indicating that his condition was unchanged. As such, the Board will afford the Veteran the benefit of the doubt that the Veteran’s condition was consistent throughout the appellate time period. The RO conceded in the January 2017 rating decision that there was conflicting evidence as to whether the Veteran’s flat foot disability was not improved by orthopedic shoes or appliances for the entire appellate time period and afforded the Veteran the benefit of the doubt that it was not improved. The Board finds no evidence to contradict this conclusion. As such, the Board concludes that a 50 percent rating is warranted for the period prior to June 14, 2016. Thus, the Veteran is in receipt of a 50 percent rating for the entire appellate time period, which is the maximum rating permitted under DC 5276. The Board acknowledges that the medical evidence also includes diagnoses of heel contusions and arthritis of the feet. Service treatment records prior to the appellate time period also include diagnoses of cellulitis and gout. That said, the primary symptoms associated with these problems are pain and swelling in the feet, which is specifically what is contemplated by and compensated for in the above 50 percent rating under DC 5276. The Board concludes that separate ratings would constitute impermissible pyramiding. The Board also finds that the Veteran’s overall foot symptomatology is best represented by and compensated under DC 5276, rather than 5284, as the symptoms are fully contemplated by the rating criteria of DC 5276. As the Veteran currently is receiving the maximum rating contemplated for the feet based on symptomatology that includes pain resulting in limitation of motion, absent loss of use of the feet, the DeLuca provisions and those of 38 C.F.R. §§ 4.40, 4.45 are not for application. See Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). As shown above, and as required by Schafrath, 1 Vet. App. at 594, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, regardless of whether they have been raised by the Veteran. In this case, the Board finds no provision upon which to assign a rating greater than 50 percent for the Veteran’s bilateral pes planus. Furthermore, the Board concludes that this award is warranted for the entire period under which this appeal has been pending, and that assignment of staged ratings is not for application. 4. Entitlement to a compensable initial rating for hypertension The Veteran’s hypertension is rated as noncompensable under DC 7101. The Veteran claims that the current rating does not accurately reflect the true nature and degree of his disability. Hereafter, blood pressure measurements are expressed in terms of systolic divided by diastolic pressure in millimeters of mercury (mmHg). DC 7101 provides ratings for hypertensive vascular disease (hypertension and isolated systolic hypertension). Hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control, is rated 10 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more, is rated 20 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 120 or more is rated 40 percent disabling. Hypertensive vascular disease with diastolic pressure predominantly 130 or more is rated 60 percent disabling. Note (1) to DC 7101 provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means 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. Note (2) provides that hypertension that is due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, is to be rated as part of the condition causing it rather than by a separate rating. Note (3) to DC 7101 provides that hypertension is to be rated separately from hypertensive heart disease and other types of heart disorders. 38 C.F.R. § 4.104, DC 7101 (2018). In September 2009, the Veteran had blood pressure readings of 150/104 and 165/102. The treatment provider ordered a 5-day blood pressure check. Another 5-day blood pressure check was ordered in May 2010 after a blood pressure reading of 137/91. In July 2010, the Veteran had blood pressure readings of 144/67 and 151/96 and he was prescribed Lisinopril for diagnosed hypertension. In January 2011, the Veteran’s blood pressure was 134/92. In May 2011, blood pressure was 139/87 and 150/87 on medication. In October 2011, the Veteran’s blood pressure was 132/90, although he reported that outside of the clinic it generally ran around 126/80-82. In February 2012, the Veteran’s blood pressure was 133/86. In July 2012, blood pressure readings included 152/96 and 129/93 during an appointment for knee pain and while on Lisinopril for his hypertension. In March 2013, the Veteran’s blood pressure was 140/95 while on medication. In December 2013, blood pressure readings included 151/89, 165/101, and 160/100 during a routine check-up. Numerous other in-service blood pressure readings were taken with diastolic readings less than 100 and systolic readings generally less than 160. In September 2014, the Veteran had observed blood pressures of 178/129, 172/111, and 149/96. In September 2015, while seeking treatment for low back pain, the Veteran had a blood pressure of 165/121. Another September 2015 treatment visit included a blood pressure of 150/90. Also in September 2015, the Veteran was restarted on Lisinopril for his hypertension. An October 2015 private treatment record indicates that the Veteran’s hypertension medication was increased. The Veteran was afforded a VA Hypertension DBQ in October 2015. The examiner diagnosed hypertension. The Veteran noted onset in 2012 when his blood pressure was noted to be elevated. After monitoring for several days, it remained elevated and he was started on medication. The condition had gotten worse in that it had been staying at 150/100 or higher and the Veteran still was trying to get it under control with medication. The Veteran was on continuous medication, specifically Lisinopril 20mg. The examiner concluded that the Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more. On testing, the Veteran’s blood pressure was 138/88, 140/90, and 138/90. In November 2015, the Veteran reported that his blood pressure was in the 120s over 80s when he checked it. In January 2016, the Veteran was noted to be controlled. In a March 2016 statement, the Veteran indicated that his blood pressure began running high in 2009 after entering service. He claimed there was a history of diastolic pressure greater than 100 and a history of systolic pressure of 160 or above until he was placed on medication. After service and stopping his medication, his blood pressure returned to running in the 150 to 160 systolic range and the 100 to 113 diastolic range. His doctor was concerned and restarted the Veteran on medication. A March 2016 treatment record document blood pressure of 173/112 during treatment for left shoulder pain. A May 2016 Hypertension DBQ noted a diagnosis of hypertension from approximately 2010. The Veteran had been diagnosed while on active duty and had been taking medication intermittently for several years. A blood pressure reading in September 2014 were 178/129 and 165/121; in September 2015 the readings were 148/96 and 136/94; and later in September 2015 they were 152/100 and 148/98. The examiner indicated that the Veteran had a history of a diastolic blood pressure elevation to predominantly 100 or more prior to the prescription of medication. In May 2016, the Veteran was observed to have a blood pressure of 144/101 with a recheck of 154/96 during a period of high anxiety. In August 2016, the Veteran’s blood pressure was 147/100, but on recheck it was 120/80. Otherwise, the treatment records indicate diastolic blood pressure ranging primarily from the low 60s to low 90s. In his June 2016 substantive appeal, the Veteran indicated that his medical file showed ongoing elevated blood pressure readings and that he finally was put on medication, which normalized the readings generally but he still had episodes of blood pressure that was elevated to unsafe levels. Thus, there is conflicting evidence as to whether the Veteran had a history of diastolic blood pressure elevation to predominantly 100 or more. The October 2015 examiner concluded that the Veteran did not; however, the May 2016 examiner clarified that the Veteran did have such a history prior to the prescription of medication. Moreover, the evidence indicates that in September 2014 and September 2015 the Veteran had multiple diastolic blood pressure readings of 100 or greater. The Board recognizes that several of these readings were taken during periods intense physical pain that might have adversely affected the Veteran’s blood pressure. That said, based on his blood pressure readings observed during this time period he was restarted on hypertension medication, which suggests that the medical professionals at the time were concerned about his blood pressure to the extent that regular medication was deemed necessary. The Veteran has been on Lisinopril since that time, with resulting significantly better control of his blood pressure. As such, the Board will afford the Veteran the benefit of the doubt and finds that a 10 percent rating for his hypertension is warranted for the entire appellate time period. The Board concludes that a rating greater than 10 percent is not warranted. As noted, the Veteran had several diastolic blood pressure readings over 110 and, as such, consideration of a higher rating is warranted. That said, the October 2015 VA examiner specifically found that the Veteran did not have a history of even diastolic blood pressure of predominantly 100. In addition, the majority of his extremely elevated readings occurred during periods of extreme physical pain. At no point, has the Veteran had systolic pressure predominantly greater than 200. In light of this record, the Board concludes that the severity and frequency of the Veteran’s hypertension more closely approximate the criteria for a 10 percent rating under DC 7101. 38 C.F.R. § 4.7. the Board notes that the Court of Appeals for Veterans Claims (Court) recently held in Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) that “when a condition is specifically listed in [VA’s scheduled for rating disabilities], it may not be rated by analogy.” Id. at 3. In other words, “[a]n analogous rating... may be assigned only where the service-connected condition is ‘unlisted.’” Id. at 2 (quoting Suttman v. Brown, 5 Vet. App. 127, 134 (1993)). In any case, no other DC is appropriately applied. The Board has considered alternative DCs relating to cardiovascular conditions, but finds that they are inapplicable in this case. See 38 C.F.R. § 4.104, DCs 7000-7123 (2018). In summary, for the reasons and bases set forth above, the Board concludes that a 10 percent rating, but no more, is warranted for the Veteran’s hypertension for the entire period of this appeal. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. J. Houbeck, Counsel