Citation Nr: 18147730 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 10-23 821 DATE: November 6, 2018 ORDER Entitlement to an initial compensable rating for hypertension is denied. REMANDED Entitlement to service connection for erectile dysfunction, including as secondary to hypertension is remanded. Entitlement to an evaluation in excess of 10 percent for degenerative joint disease of the left knee is remanded. Entitlement to an evaluation in excess of 10 percent for left wrist strain is remanded. FINDING OF FACT The Veteran’s hypertension is not manifested by diastolic pressure of predominantly 100 or more-or a history thereof-or systolic pressure of predominantly 160 or more. CONCLUSION OF LAW The criteria for an initial compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. § 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 2001 to October 2002 and from December 2002 to July 2004. 1. Entitlement to a compensable rating for hypertension is denied. Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran’s ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Court of Appeals for Veterans Claims (Court) has held that “staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App 119 (1999). In this case, the disability has not significantly changed and a uniform evaluation is warranted. The Veteran’s service-connected hypertension is rated as noncompensably disabling under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7101. Diagnostic Code 7101 provides for a 10 percent rating for 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. See 38 C.F.R. § 4.104, Diagnostic Code 7101. A 20 percent disability rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent disability rating for diastolic pressure predominantly 120 or more, while 60 percent rating is warranted for diastolic pressure predominantly 130 or more. Id. In a June 2015 decision, the Board granted service connection for hypertension. The Veteran was assigned a noncompensable evaluation from July 31, 2004. See May 2016 Rating Decision. The Veteran filed a notice of disagreement with the May 2016 decision and he was afforded a VA examination in February 2017. His treatment included hydrochlorothiazide and his blood pressure was 140/90. As noted in the June 2015 decision, the Board reviewed the Veteran’s blood pressure readings from separation and noted evidence as recent as 2013. Such evidence included VA examinations in September 2004 and March 2005. The Board found his blood pressure readings were under 160 systolic and 100 diastolic. See June 2015 Board Decision. Following the Board’s June 2015 decision, VA treatment records also include blood pressure readings from December 2010 to March 2016. None of these readings reflect systolic pressure of more than 160 or diastolic pressure of more than 100. See October 2016 VA CAPRI Exhibit. While the record demonstrates that the Veteran is required to take medication for control of his hypertension, blood pressure readings on VA examinations and treatment records do not demonstrate diastolic pressure predominantly 100 or more or systolic pressure is predominantly 160 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. Accordingly, a compensable rating for hypertension is not warranted for any time during the appeal period. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7. (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 370-71 (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). REASONS FOR REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims for the remaining issues on appeal. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). 2. Entitlement to service connection for erectile dysfunction, including as secondary to hypertension is remanded. The Veteran contends his erectile dysfunction is due to his hypertension. See September 2016 Claim. With regard to his claim, the Veteran was afforded a VA examination in October 2016; however, the examiner failed to offer sufficient rationale as to causation by hypertension and did not provide an opinion on whether the Veteran’s erectile dysfunction was aggravated by his service-connected hypertension. See October 2016 VA Examination. The Board finds that the October 2016 VA opinion is inadequate to decide the claim and the claim must be remanded for new VA opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). 3. Entitlement to an evaluation in excess of 10 percent for degenerative joint disease of the left knee is remanded. The Veteran contends his left knee disability warrants an increased evaluation, has worsened since his last examination, and that he experiences additional impairment from flare-ups and functional loss with repeated use over time. See August 2018 Appellate Brief. The Veteran was last afforded an examination pertaining to his service-connected left knee disability in June 2016. Review of this examination report reveals that range of motion testing in passive motion, weight-bearing, and nonweight-bearing situations were not conducted. See June 2016 VA Examination. The Court in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing conditions, and, if possible, with range of motion measurements of the opposite undamaged joint. Accordingly, the Board finds a VA examination should be obtained that addresses the nature and severity of his service-connected left knee disability, to include consideration of the requirements in Correia. See Barr, 21 Vet. App. at 311-12. 4. Entitlement to an evaluation in excess of 10 percent for left wrist strain is remanded. The Veteran contends his left wrist disability warrants an increased evaluation. See August 2018 Appellate Brief. The appeal was remanded by the Board in June 2015 with specific directives for determining the nature and severity of the Veteran’s left wrist disability. See June 2015 Remand. The Board notes two examination were obtained on remand; however, neither of these reports contain information regarding the involvement of the median nerve of the left wrist as specifically directed by the June 2015 remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, an additional opinion is necessary to decide the claim. Barr, supra. The matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records. 2. Obtain a medical opinion that addresses the nature of the Veteran’s erectile dysfunction. If deemed necessary by the examiner, schedule the Veteran for an examination. All indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. a. The examiner should offer comments, an opinion and a supporting rationale that addresses whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s erectile dysfunction is caused by his hypertension. b. The examiner should offer comments, an opinion and a supporting rationale that addresses whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s increased erectile dysfunction is aggravated (increased beyond the normal progression of the disease) by his hypertension. 3. Schedule the Veteran for a VA examination to ascertain the current severity and manifestations of the Veteran’s service-connected left knee disability. The claims file should be made available to the examiner for review in connection with the examination. The examiner must include range of motion testing of the left knee in the following areas: a. Active motion; b. Passive motion; c. Weight-bearing; and d. Nonweight-bearing. The examiner should offer an opinion as to whether pain could significantly limit functional ability during flare-ups or when the left knee is used repeatedly over a period of time. The examiner should specifically indicate whether, and at what point during, the range of motion the Veteran experienced any limitation of motion that was specifically attributable to pain. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner is asked to describe whether pain significantly limits functional ability during flares, or if pain has significantly limited functional ability during flares and if so, the examiner must estimate range of motion during flares. IF THE EXAMINATION DOES NOT TAKE PLACE DURING A FLARE, THE EXAMINER MUST GLEAN INFORMATION REGARDING THE FLARES’ SEVERITY, FREQUENCY, DURATION, AND FUNCTIONAL LOSS MANIFESTATIONS FROM THE VETERAN, MEDICAL RECORDS, AND OTHER AVAILABLE SOURCES. EFFORTS TO OBTAIN SUCH INFORMATION MUST BE DOCUMENTED. If there is no pain and/or no limitation of function, such facts must be noted in the report. 4. The Veteran should then be afforded a VA examination to determine the severity of his service-connected left wrist disability. The examiner should describe in detail any symptomatology related to the Veteran’s left wrist disability. In particular, the examiner should specifically indicate whether there is any moderate or severe incomplete paralysis or complete paralysis of the median nerve. The examiner should also determine if the Veteran’s left wrist disability is characterized as a moderate muscle injury, a moderately severe muscle injury or a severe muscle injury. It is noted that the functions of these muscles include extension of the wrist, fingers, and thumb and abduction of the thumb. The examiner should also conduct range of motion studies of the left wrist, expressed in degrees. The examiner should render specific findings as to whether, during the examination, there is objective evidence of pain on motion, weakness, excess fatigability, and/or incoordination associated with the left wrist. If pain on motion is observed, the examiner should indicate the point at which pain begins. The examiner should also indicate whether, and to what extent, the Veteran experiences likely functional loss of the left wrist due to pain and/or any of the other symptoms noted above during flare- ups and/or with repeated use; to the extent possible, the examiner should express any such additional functional loss in terms of additional degrees of limited motion. All necessary testing should be completed and any opinions rendered should be accompanied by rationale. L. BARSTOW Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Trickey, Jonathan