Citation Nr: 18150859 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 15-03 858A DATE: November 16, 2018 ORDER Entitlement to a compensable disability rating of 10 percent, but not higher, for hypertension is granted. FINDING OF FACT For the entire period on appeal, the Veteran’s hypertension required continuous use of medication for control and resolving any reasonable doubt in the Veteran’s favor, he has a history of diastolic pressure predominantly of 100 or more. CONCLUSION OF LAW Resolving any doubt in the Veteran’s favor, the criteria for a 10 percent rating, but no higher, for hypertension are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7 4.104, Diagnostic Code 7101 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Coast Guard from May 18, 1987 to May 29, 1987 and from July 1987 to June 2007. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, NC, which continued the noncompensable evaluation for hypertension. The Veteran requested a Travel Board Hearing on his Form 9 dated February 2015, this request was subsequently withdrawn in writing by the Veteran in July 2015. 1. Entitlement to a compensable disability rating for hypertension. Disability evaluation ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155 (2012). Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2017). Separate Diagnostic Codes (DC) identify the various disabilities and the criteria for specific ratings. In every instance where the rating schedule does not provide a noncompensable evaluation for a diagnostic code, a noncompensable evaluation shall be assigned when the criteria for compensable rating are not met. 38 C.F.R. § 4.31 (2017). Under the provisions of Diagnostic Code (DC) 7101 for hypertension, also known as hypertensive vascular disease, a 10 percent rating is warranted 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. A 20 percent rating is warranted where diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more; and a 40 percent rating is assigned for diastolic pressure of predominantly 120 or more. The highest rating of 60 percent rating is assigned for diastolic pressure of predominantly 130 or more. 38 C.F.R. § 4.104 (2017). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. §§ 3.102, 4.3 (2017). The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 U.S.C. § 4.1 (20107); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as here, the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of “staged” rating is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). As part of a January 2007 rating decision, the Veteran was granted service connection for hypertension and assigned a noncompensable evaluation effective July 1, 2007. In October 2012, the Veteran submitted increase rating claim. The Veteran contends that he should be a compensable rating for his hypertension. He argues that he takes hypertensive medications to control his hypertension disability. Additionally, he points that his medical record evidences blood pressure readings above 100 mm/Hg diastolic whenever he is not taking his medications. Turning to the evidence of record, in January 2013, the Veteran underwent a VA compensation examination for his hypertension. The examiner confirmed a diagnosis of essential hypertension with an onset in 2006. Since 2005 the Veteran has been prescribed Lisinopril, which he claims has been increased over the years to manage his condition. Upon clinical examination, the Veteran’s blood pressure readings in January 2013 are noted as 152/86, 148/82, and 138/80. The examiner indicated that the Veteran had no history of a diastolic blood pressure elevation to predominantly 100 or more, and was taking continuous medication to control his blood pressure. The examiner remarked that the hypertension disability does not impact the Veteran’s ability to sustain employment. The Veteran’s VA medical records reflect the following blood pressure readings: 150/88 on July 2016 and 135/60 on February 2013. The Veteran’s private medical treatment records dated September 2013 show blood pressure readings of 102/70; and 140/80. Additional private treatment records from Dr. A. dated May 2014 denote the Veteran’s continuous Lisinopril and Atenolol prescriptions, show blood pressure readings of 132/82, and evidence prescription strength changes. A notation by Dr. A. dated July 2014 indicates a need to evaluate the Veteran’s blood pressure stability in four to six weeks, giving inference to reason that the condition may not be fully under control. Private medical records from September 2014 show blood pressure readings of 105/60 and notes the Veteran has borderline blood pressure readings. Dr. A.’s letter states that since November 2014, the Veteran’s blood pressure readings were 167/97, 148/102, 177/108, 146/91, 180/113, 167/106, and 152/99. Dr. A. indicated that the Veteran’s blood pressure readings evidenced significant hypertension off medication and shows the [Veteran] requires medical management in order to control his hypertension. Review of the Veteran’s private medical record contain a December 2014 treatment letter by Dr. A., which reflects that the Veteran sought medical treatment and requested stopping all blood pressure medications in November 2014 in order to assess the need for anti-hypertensive medications. Additional private treatment records dated April 2016 show blood pressure readings of 120/70 and 110/70. In his March 2013 Notice of Disagreement (NOD), the Veteran indicated that due to his history increased blood pressure readings and his continuous medication intake, he was entitled to a compensable rating for his service connected disability. The Veteran further noted that he was taking two different medications to control his blood pressure. He was originally prescribed Lisinopril 20mg, but due to increased blood pressure readings the Lisinopril prescription was increased to 40mg. He further stated that in addition to the Lisinopril, he was also prescribed Atenolol 50mg. In an October 2014 Statement in Support of [his] Claim, the Veteran avers that Dr. A. added a third blood pressure medication to his daily regimen, Dyazide 37.5-25. The Veteran avers that without him taking three different medications his blood pressure readings would be higher. Further, the Veteran indicated that if not for continuous medication, his blood pressure would be higher and he would be at a risk for coronary artery disease. The Veteran also asserts that his VA medical records demonstrate that his blood pressure was high while taking medications. Initially, the Board recognizes the Veteran's statement that without continuous medication, his hypertension would elevate to higher levels. The Board may not discount the effects 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, VA has contemplated the effects of medication as a factor to be considered when rating hypertension under DC 7101. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (holding that Jones does not apply to DC 7101). In other words, the rating criteria for hypertension already take into account the ameliorative effects of medication. Id. As such, the Board is not required to discuss the ameliorative effects of medication when evaluating whether the Veteran is entitled to a higher rating for hypertension. Nevertheless, for the reasons discussed below, the Board finds that a higher rating for the Veteran's hypertension is warranted. Although the Veteran's VA examination report does not show diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more at any time during the appeal period, in his substantive appeal the Veteran claims his hypertension has worsened since the 2013 VA examination. Furthermore, the Veteran’s private treatment records indicate that he requires continuous medical treatment for hypertension. (See Dr. A., Letter dated February 2015; VA Form 9 dated February 2015; Appellate Brief dated October 2018.) Accordingly, the Board will resolve any reasonable doubt in favor of the Veteran and find that, at the very least, a history of diastolic pressure predominantly 100 or more is demonstrated. This finding coupled with the fact that the Veteran's hypertension has required continuous medication for control entitles him to the minimum 10 percent rating under DC 7101 for the entire appeal period. A rating higher than 10 percent however is not warranted as the record has not shown the Veteran's hypertension to be manifested by diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Neither the Veteran nor his 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, 69-70 (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.) As such, the Board is not required to discuss the ameliorative effects of medication when evaluating whether a Veteran is entitled to a higher rating hypertension. (Continued on the next page)   The Board finds that the probative medical evidence for and against the claim is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement of 10 percent rating percent, but no higher, for the service-connected hypertension is warranted for the entire appellate period, subject to the laws and regulations governing the payment of monetary benefits. K. J. Alibrando Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Steele, Associate Counsel