Citation Nr: 18159347 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 17-39 516 DATE: December 18, 2018 ORDER An initial compensable rating for the hypertension is denied. REMANDED Entitlement to service connection for irritable bowel syndrome, to include as secondary to the Veteran’s service-connected disabilities, is remanded. FINDING OF FACT The Veteran’s hypertension has not been manifested by blood pressure readings with diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more; or a history of diastolic pressure predominantly 100 or more with the requirement of continuous medication for control. CONCLUSION OF LAW The criteria for an initial compensable rating for hypertension are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1995 to August 2015. This matter comes before the Board of Veterans Appeals (Board) from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. Hypertension 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. Evaluation of a service-connected disability requires a review of a veteran’s medical history with regard to that disorder. However, the primary concern in a claim for an increased evaluation for a service-connected disability is the present level of disability. While the entire recorded history of a disability is important for more accurate evaluations, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where a veteran appeals the initial rating assigned for a disability, evidence contemporaneous with the claim and the initial rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time. Id. For VA compensation purposes, the term hypertension means that the diastolic (bottom number) blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic (top number) blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. The minimum, 10 percent, rating for hypertension requires 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. By way of history, in a January 2016 rating decision, the RO granted service connection for hypertension and assigned a non-compensable rating effective September 1, 2015. The Veteran disagreed with the non-compensable rating stating that his medical records show that he has a history of predominant diastolic blood pressure readings of over 100. For the purpose of reporting the blood pressure readings, the systolic blood pressure reading will be listed first, followed by a slash, and the diastolic blood pressure reading will be listed last. In 2014, the following blood pressure readings were noted: 138/94, 138/94, 157/105, 153/100, 136/90, 159/112, 163/107, 133/89, and 130/82 (four out of nine diastolic blood pressure readings of 100 or more). In 2015: 126/85, 119/80 (no diastolic blood pressure readings of 100 or more). Most recently, the Veteran was afforded a VA examination in August 2015. During that examination, his blood pressure readings were 130/84, 132/84, and 134/80. The examiner opined that there was “no objective medical evidence of a current, chronic hypertension condition seen.” The examiner noted that the Veteran is currently taking several medications for hypertension. There were no other pertinent physical findings, complications, conditions, signs and symptoms related to the Veteran’s hypertension. The examiner found that the Veteran’s hypertension did not impact his ability to work. While there were times of blood pressure spikes and the Veteran requires medication, the evidence has not demonstrated diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more. While the Veteran has required continuous medication to control his blood pressure, the evidence of record does not indicate diastolic pressure predominantly 100 or more. Based on the foregoing, the Board finds that the criteria for a compensable disability rating the Veteran’s hypertension are not met. As the preponderance of the evidence is against the claims for increased ratings, there is no doubt to be resolved, and compensable initial rating for the Veteran’s hypertension is not warranted. 38 C.F.R. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASON FOR REMAND Entitlement to service connection for irritable bowel syndrome, to include as secondary to diabetes mellitus type 2 and hypertension, is remanded. The Veteran contends that he has irritable bowel syndrome as a result of the medications he takes to control his hypertension and diabetes mellitus type 2 as the warning on his medications include diarrhea and upset stomach. He also asserts that he has irritable bowel syndrome related to his service. The Board acknowledges that the Veteran was afforded a VA examination in connection with this claim for service connection in August 2015, and that the VA examiner stated she was unable to diagnose the Veteran as having irritable bowel syndrome. In fact, the examiner noted that the “Veteran has not been seen in medical [and] no upper lower bowel series” had been conducted. Moreover, the claims file does not include any examination or treatment record reflecting that an upper and lower bowel series has since been completed. Therefore, it is unclear whether any testing was performed that pertained to the Veteran’s claimed irritable bowel syndrome to confirm a current diagnosis. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). As such, the Board finds that the Veteran should be afforded a new VA examination regarding the claim for service connection of irritable bowel syndrome. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). The matter is REMANDED for the following actions: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his gastrointestinal disability. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. The Veteran should be afforded an appropriate VA examination to determine the nature and etiology of his claimed irritable bowel syndrome. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The VA examiner should render an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran has irritable bowel syndrome (or any other gastrointestinal disability) that was caused by or incurred in active service. If there is no identified pathology, the examiner should determine if the Veteran has signs or symptoms of an undiagnosed illness or a medically unexplained chronic multisymptom illness. If the Veteran has irritable bowel syndrome or any other diagnosed gastrointestinal disability, but it is not related to his military service, the VA examiner should provide an opinion as to 1) whether his irritable bowel syndrome is proximately due to or the result of the Veteran’s service-connected diabetes mellitus type 2 or hypertension, or 2) whether his irritable bowel syndrome has been aggravated by the Veteran’s service-connected disabilities. “Aggravation” means an increase in severity of the disorder beyond any medically established baseline. The appropriate section of the Disability Benefits Questionnaire pertaining to aggravation opinions should be filled out for this purpose if possible. The provider is advised that the Veteran is competent to report symptoms, including continuity of symptoms, treatment, and diagnoses and the examiner must take into account, along with the other evidence of record, the Veteran’s statements in formulating the requested opinions. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 3. After completing any additional notification or development deemed necessary, the Veteran’s claims on appeal should be readjudicated. If the claim remains denied, the Veteran should be furnished with a supplemental statement of the case and afforded a reasonable opportunity for response. L. CHU Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jones Council, Associate Counsel