Citation Nr: 18152461 Decision Date: 11/27/18 Archive Date: 11/23/18 DOCKET NO. 16-34 132 DATE: November 27, 2018 ORDER Entitlement to an initial, compensable rating for service-connected hypertension is denied. Entitlement to an initial, compensable rating for service-connected residuals of Achilles tendon rupture is denied. FINDINGS OF FACT 1. The Veteran’s diastolic pressure is not predominantly 100 or more, his systolic pressure is not predominantly 160 or more, and the Veteran does not have a history of diastolic pressure predominantly 100 or more or systolic pressure of 160 or more that requires continuous mediation for control. 2. The Veteran’s service-connected residuals of Achilles tendon rupture has been manifested by no more than slight disability. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.104, Diagnostic Code 7101. 2. The criteria for an initial compensable rating for service-connected residuals of Achilles tendon rupture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. Part 4, including §§ 4.71, 4.71a, Diagnostic Code 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 2007 to January 2012. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The February 2015 rating decision granted service connection and assigned initial, noncompensable ratings for hypertension and residuals of Achilles tendon rupture. The Veteran has not raised any issues that are not discussed herein, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Initial Increased Rating Claims Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). In all claims for an increased rating, VA has a duty to consider the possibility of assigning staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Where, as in the instant case, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to a Compensable Evaluation for Hypertension The Veteran is seeking an initial compensable rating for hypertension. The Veteran has been assigned a noncompensable rating under Diagnostic Code 7101. Diagnostic Code 7101 provides the rating criteria for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under that Diagnostic Code, a 10 percent evaluation is assigned 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 constant medication for control. A 20 percent evaluation is assigned for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent evaluation is assigned for diastolic pressure predominantly 120 or more. A 60 percent evaluation is assigned for diastolic pressure predominantly 130 or more. See 38 C.F.R. § 4.104, Diagnostic Code 7101. In his October 2015 notice of disagreement, the Veteran noted that he was on blood pressure medication during his most recent exam and that was the reason for his numbers reading as normal. The Veteran further contended that his readings would be higher if he were not on medication and that he should not be punished for using medication. The Veteran is seeking a 30 percent rating for hypertension, a rating not considered by the Diagnostic Code. Blood pressure measurements contemporaneous with the Veteran’s claim do not satisfy the requirements for a compensable rating. Treatment records from 2006 to 2015 document approximately 35 to 40 diastolic readings ranging between 68 and 100 and systolic readings ranging between 95 and 145. The Veteran was diagnosed with hypertension in 2009 and was prescribed lisinopril for the condition in 2013. Only one blood pressure measurement from a private examiner in May 2013 was 140/100 and is the only documented instance of the Veteran’s diastolic blood pressure reading 100. A single isolated blood pressure reading does not necessarily support the finding that the Veteran had a history of diastolic pressure predominantly more than 100 or systolic pressure predominantly more than 160. Thus, the medical evidence shows that the Veteran does not meet the criteria for a compensable evaluation because the Veteran does not have a history of diastolic blood pressure predominantly 100 or higher or a history of systolic blood pressure predominantly 160 or higher. Furthermore, in his Form 9, the Veteran contends that his compensation examination for hypertension should have been done by a VA cardiologist and may have resulted in the wrong decision. A specialist is not necessary for a hypertension examination and the Board finds that the November 2014 VA examination was adequate. The examiner reviewed the Veteran’s electronic claims file, noted the Veteran’s history of hypertension, current medication, and conducted three current blood pressure readings. The Veteran’s readings during the November 2014 examination were 124/80, 120/80, and 116/75. The examination is fully adequate as it was provided by a medical professional who is qualified through education, training, or experience to offer medical diagnosis, statements, and opinions. See Cox v. Nicholson, 20 Vet. App. 563, 569 (2007). The Veteran also contends that his blood pressure is well-controlled on medication and, because of the medication, does not meet the rating criteria for a compensable evaluation. He states that he would have higher blood pressure absent medication and that he should not be punished for using medication. This argument is unavailing. The Veteran has been prescribed medicine to treat his hypertension; however, a higher rating may not be assigned based solely on the fact that the Veteran uses medication to treat his symptoms. Cf. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) In Jones, the U.S. Court of Appeals for Veterans Claims noted that, “[a]bsent a clear statement [in the diagnostic code] setting out whether or how the Board should address the effects of medication . . . the Board may not deny entitlement to a higher disability rating on the basis of relief provided by medication.” Diagnostic Code 7101 specifically contemplates the use of medication to control hypertension, and in McCarroll v. McDonald, 28 Vet. App. 267 (2016), the U.S. Court of Appeals for Veterans Claims specifically held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications. Entitlement to a compensable evaluation for service-connected hypertension is therefore denied. 2. Entitlement to a Compensable Evaluation for Residuals of Achilles Tendon Rupture The Veteran is seeking an initial compensable rating for residuals of Achilles tendon rupture. The Veteran has been assigned a noncompensable rating under Diagnostic Code 5271 for limited of motion of the ankle. The Veteran contends that he is entitled to a compensable evaluation for his service-connected residuals of Achilles tendon rupture. Specifically, the Veteran points to his November 2014 compensation examination and the physician’s notation that the Veteran’s plantar flexion was abnormal. The examiner noted that normal plantar flexion is 0-45 degrees and the Veteran’s flexion during the exam was 0-40 degrees. The Veteran is seeking a 30 percent rating for residuals of Achilles tendon rupture, a rating not considered by the Diagnostic Code. Diagnostic Code 5271 addresses limited motion of the ankle. Under that code, a 10 percent evaluation requires moderate limited motion and a 20 percent evaluation requires marked limited motion. Words such as “moderate” and “marked” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The Board notes that the November 2014 examination did not use the terms moderate or marked and gave no objective findings in support of the disability as moderately severe. The examiner indicated that the Veteran reported experiencing mild flare-ups several times a month accompanied by minimal functional loss and increased pain. The examiner noted that, while the examination did neither support nor contradict the Veteran’s statements regarding functional loss during flare-ups, flare-ups were noted and described as mild. Additionally, functional ability during flare-ups was not significantly limited by pain, weakness, fatigability, or incoordination. All procurable data was solicited from the Veteran regarding flare-ups regarding frequency, duration, characteristics, severity, and function loss. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). As noted above, the November 2014 examination noted that the Veteran’s plantar flexion was limited at 0 to 40 degrees rather than the normal 0 to 45 degrees. The Veteran’s 5 degrees limitation was not accompanied by functional loss. No pain was noted on examination and there was no evidence of pain with weight bearing. The Veteran was able to perform repetitive use testing and there was not additional loss of function or range of motion following repetitions. Muscle strength was normal and the Veteran does not require the use of assistive devices. The Board has considered whether a higher rating is appropriate under 38 C.F.R. §§ 4.40, 4.45, and 4.59, and concluded that such is not warranted. A 10 percent evaluation is not warranted for limitation of motion of the ankle unless the evidence shows moderate limitation of motion of the ankle or painful motion of the ankle. The Veteran’s 5 degrees limitation and does not result in any functional impairment. Such amounts to an overall mild level of disability. The noncompensable rating is appropriate. Entitlement to a compensable evaluation for service-connected residuals of Achilles tendon rupture is therefore denied. In rendering the above decision, the Board is cognizant that the Veteran is competent to report certain obvious symptoms of disability, but not to identify a specific level of disability. Barr v. Nicholson, 21 Vet. App. 303 (2007); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Competent evidence concerning the nature and extent of the Veteran’s service-connected disabilities has been provided by the medical professionals who have examined him. The overall medical findings adequately address the criteria under which these disabilities are evaluated. Because the weight of evidence is against the Veteran’s claim, the benefit-of-the-doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Goreham, Law Clerk