Citation Nr: 18144819 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-46 249 DATE: October 25, 2018 ORDER A compensable rating for hypertension is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT Hypertension is not manifested by systolic pressure predominantly 160 or greater, or by diastolic pressure predominantly 100 or greater. CONCLUSION OF LAW The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5103A; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1955 to September 1957 and from April 1958 to March 1974. Rating The Veteran contends that a compensable disability rating is warranted for his service-connected hypertension. The VA’s Schedule for Rating Disabilities is used to determine disability ratings once a disability is service-connected. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In the Rating Schedule, diagnostic codes are assigned to specific disabilities. These DCs designate percentage ratings based on the average functional impairment of the Veteran due to a service-connected disability. 38 C.F.R. §§ 3.321, 4.10. In every instance where the schedule does not provide a zero percent evaluation for a DC, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Veteran is currently assigned a noncompensable rating for hypertension under DC 7101. Under that DC, a 10 percent disability evaluation is warranted where diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or the individual has a history of diastolic pressure of 100 or more and requires continuous medication for control. A higher 20 percent rating is assigned when diastolic pressure is predominantly 110 or more or systolic pressure is 200 or more. In this case, the Board finds that a compensable rating for hypertension is not warranted. To that end, the medical evidence of record does not reflect a systolic pressure predominantly 160 or more. The highest measurement of systolic pressure, documented in January 2013 VA examination and January 2013 VA treatment records, were 151. Multiple other measurements, throughout the appeal period, all show systolic pressure of below 151. Similarly, diastolic pressure was never measured at 100 or higher during the appeal period. In fact, all the measurements taken throughout the appeal period all show diastolic pressure below 90, with the highest measurement of 84 in January 2014. While an addendum to the February 2013 VA examination reflects that continuous medication is required for the treatment of the Veteran’s hypertension, his diastolic pressure was never 100 throughout the appeal period for his hypertension to be consistent with the level of impairment contemplated by a compensable rating under DC 7101. In the June 2014 Notice of Disagreement, the Veteran stated that he authorizes the VA to obtain outstanding private medical records without identifying the specific records. Review of the record shows that the private treatment records identified by the Veteran have been obtained. The Veteran was provided VCAA notice letters in June 2012 and August 2012. In July 2012 and September 2012, he responded stating that there is no other outstanding evidence. For this reason, the Board finds that there are no outstanding treatment records that go towards substantiating the claim. In summary, the evidence does not establish a history consistent with diastolic pressure of 100 or more and the continuous use of medication for control, or systolic pressure of 160 or more, which does not satisfy the criteria for a 10 percent rating. REMANDED ISSUE The Board regrets further delay, but additional development is necessary before adjudicating the remaining claim. The Veteran contends that he has bilateral hearing loss caused by noise exposure in the military. He underwent an audiology examination in September 2012, where the examiner indicated that the test results were not valid for rating purposes without providing an adequate rational. For this reason, there is no audiological evaluations of record that produced valid test results that sufficiently address his disability picture. In the accompanying nexus opinion, the examiner concluded that a connection between the Veteran’s hearing loss and noise exposure in service cannot be rendered without resorting to mere speculation. For this reason, the Board finds that the VA examination and nexus opinion are inadequate and a remand is necessary before adjudicating this claim. The matter is REMANDED for the following action: 1. Update VA medical records. 2. Thereafter, schedule the Veteran for a VA examination to determine the etiology of his bilateral hearing loss. The claims file should be made available to the examiner, who should indicate in his/her report that the file was reviewed as part of the examination. The examiner should take a complete history from the Veteran. All indicated tests and studies should be completed. The examiner must describe all pertinent symptomatology. Following the completion of the examination, the examiner should provide an opinion answering the following question: Is the Veteran’s hearing loss at least as likely as not (a 50 percent or greater probability) related to his military service? The examiner is asked to address the Veteran’s lay statements and explain the impact, if any, of the Veteran’s noise exposure in the military due to his military occupational specialty (MOS). In addressing the plausibility or non-plausibility of delayed onset hearing loss, the examiner must discuss the Institute of Medicine (IOM) Report on noise exposure in the military, contemplating that the IOM report states that it is “unlikely” that the onset of hearing loss begins years after noise exposure occurs, but also states that “an individual’s awareness of the effects of noise on hearing may be delayed considerably after the noise exposure.” If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. J. CONNOLLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.SOLOMON