Citation Nr: 18146410 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-40 854A DATE: October 31, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for hypertension (HTN) is denied. FINDING OF FACT The Veteran’s HTN is not manifested by diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. CONCLUSION OF LAW The criteria for initial rating in excess of 10 percent for HTN have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.31, 4.104, DC 7101 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1972 to June 1976. This matter is on appeal from a July 2015 rating decision. Higher Initial Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2018). The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2018). While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods 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). Entitlement to an initial rating in excess of 10 percent for HTN The Veteran asserts that his service-connected HTN warrants a higher initial rating. The Veteran’s HTN is currently rated as 10 percent disabling under DC 7101. Under this code, a 10 percent rating is assigned for diastolic pressure predominately 100 or more or systolic pressure predominantly 160 or more or; minimum evaluation for a history of diastolic blood pressure predominately 100 or more requiring continuous medication. A 20 percent rating is assigned for diastolic readings of predominantly 110 or more, or systolic readings of 200 or more. A 40 percent rating is assigned for diastolic readings of predominantly 120 or more. A 60 percent rating is assigned for diastolic readings of predominantly of 130 or more. 38 C.F.R. § 4.104 (2018). After consideration of the entire record and relevant law, the Board finds that an initial rating in excess of 10 percent for the Veteran’s HTN is not warranted. Post-service private treatment records from 2008 to 2015 reflect only two instances in December 2009 where the Veteran’s diastolic pressure was over 110, specifically, 113 and 118. The remaining diastolic pressure readings from 2008 to 2015 were predominantly much lower than 110. Further, these private treatment records do not reflect any blood pressure reading where systolic pressure was 200 or more. While the Veteran was afforded a VA examination for his HTN in June 2015, where the examiner noted the Veteran’s treatment plan includes taking continuous medication, the Veteran’s blood pressure readings during the examination were 129/82, 125/81, and 123/72, with an average pressure reading of 125/78. Further, the examiner indicated the Veteran’s history of diastolic blood pressure elevation to predominantly 100 or more included levels of 102, 104, and 108, which are all below 110. The Board acknowledges that it may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 62-63 (2012). However, where the plain language of the diagnostic code contemplates the effects of medication, Jones is not applicable. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (the Board may properly consider ameliorative effects of blood pressure medication in adjudicating claims for increased ratings for hypertension, because medication is specifically mentioned in DC 7101). In sum, there is no evidence to support a finding of diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more to warrant an initial rating in excess of 10 percent for the Veteran’s HTN. While two of the Veteran’s diastolic pressure readings were slightly over 110 in 2009, the remaining diastolic and systolic pressure readings throughout the period on appeal are predominantly much lower than 110 and 200, respectively. Accordingly, the Board finds that the preponderance of the evidence is against the claim for an initial rating in excess of 10 percent for HTN; and therefore, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Houle, Associate Counsel