Citation Nr: 18119862 Decision Date: 07/19/18 Archive Date: 07/19/18 DOCKET NO. 15-09 658 DATE: July 19, 2018 ORDER Entitlement to an initial compensable rating for hypertension is denied. REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome, to include as secondary to service connected status post left thumb trigger finger surgery and/or strain, bilateral fingers right hand, is remanded. FINDING OF FACT Although the Veteran requires continuous medication for blood pressure control, his diastolic pressure has not been predominantly 100 or more, nor his systolic pressure predominantly 160 or more, during the appeal period. CONCLUSION OF LAW The criteria for an initial rating in excess of 0 percent for hypertension have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1980 to August 2002. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) rating decision dated December 2013. Therein, relevant to this appeal, the RO (1) granted service connection for hypertension, with a 0 percent rating, and (2) denied service connection for bilateral carpal tunnel syndrome, to include as secondary to the Veteran’s service connected left thumb trigger finger surgery, and/or strain, bilateral fingers right hand. The Veteran testified before the undersigned Veterans Law Judge in October 2017. A transcript of this hearing is associated with the claims file. The Board has thoroughly reviewed all evidence in the claims file. Consistent with the law, the analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim, and the Board’s reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The Veteran must not assume the Board has overlooked evidence that is not explicitly discussed herein. In addition, pertinent regulations for consideration were provided in the February 2015 Statement of the Case and are not repeated here in full. As an initial matter, in the March 2014 notice of disagreement, the Veteran and his then-representative asserted VA failed in its duty to assist in regards to the hypertension claim “by not providing an adequate exam when there was a plausible basis”. The Board finds this argument meritless. VA provided the Veteran a VA examination for his hypertension in September 2013. The Veteran and his then-representative provided no evidence or reasoning why the examination was inadequate. To the contrary, the examination report shows the examiner reviewed the Veteran’s claims file, conducted an in-person examination, and provided the information needed to rate hypertension under VA’s rating schedule. Neither the Veteran nor either of his former attorney representatives raised any other issues with the duty to notify, the duty to assist, or the conduct of his Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist or Bryant hearing deficiency argument). Thus, the Board need not discuss any potential issues in this regard. 1. Increased rating for hypertension. The Veteran contends entitlement to a higher initial rating for his service-connected hypertension disability, currently rated as noncompensable under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101. Disability ratings are determined by comparing the Veteran’s symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. VA has considered the level of the Veteran’s impairment throughout the entire period on appeal, including the propriety of staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board finds an initial compensable disability rating in excess of 0 percent is not warranted for any portion of the period on appeal. DC 7101 provides for a 10 percent rating where the individual has diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; a history of diastolic pressure predominantly 100 or more and requires continuous medication for control. 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 is warranted for diastolic pressure predominantly 120 or more, and a 60 percent rating is warranted for diastolic pressure predominantly 130 or more. Id. Service connection has been granted effective date of claim, December 2012, so blood pressure readings from that date to the present are most relevant in determining the appropriate rating for his hypertension. In September 2013, the Veteran underwent a VA examination for his hypertension claim. The examiner measured the Veteran’s blood pressure three times, which showed 148/87, 157/104, and 145/95. Therefore, there are no recordings of systolic pressure of 160 or more. As for diastolic pressure, only one of three readings was 100 or more, so it cannot be said his diastolic pressure is predominantly 100 or more. However, to warrant the next higher rating of 10 percent, the Veteran could also have a history of diastolic pressure predominantly 100 or more that requires continuous medication for control. Therefore, the Board has reviewed the Veteran’s service treatment records and post-service medical records. Although the Veteran has taken continuous medication to control his hypertension since January 2000, the Veteran’s blood pressure readings, both in-service and post-service, do not establish diastolic pressure predominantly 100 or more. Between June 1994 and March 1999, the Veteran had his blood pressure measured 30 times, only five of which readings, taken in February 1999 and March 1999, showed his diastolic pressure measured 100 or more. In April 1999, the Veteran underwent an initial hypertension screening where his blood pressure was measured twice every other day over a ten-day period. All ten readings showed diastolic pressure less than 100. The Veteran’s blood pressure was again measured in May, June, and July 1999, all three of which readings showed diastolic pressure below 100. Thus, the evidence shows the Veteran’s diastolic pressure was predominantly below 100 prior to January 2000, when he started taking continuous medication to control his blood pressure. After the Veteran started taken blood pressure medication, his blood pressure was measured more than 50 times between January 2000 and November 2002. Every reading showed diastolic pressure of less than 100. Summarizing the foregoing, out of more than 80 blood pressure measurements between 1999 and 2013, the Veteran had diastolic pressure of 100 or more only six times. The readings are thus predominantly below 100 for diastolic pressure, both before and after the Veteran started taking continuous medication to control his blood pressure. The preponderance of the evidence is thus against finding the Veteran is entitled to the next higher rating of 10 percent based on the diastolic pressure criteria. The preponderance of the evidence shows the Veteran does not meet either the systolic criterion or the diastolic criteria for entitlement to the next higher rating of 10 percent for his hypertension disability. See 38 C.F.R. § 4.104, DC 7101. As such, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53. The Veteran’s claim for a compensable rating for hypertension at any time during the period under review is denied. REASONS FOR REMAND 1. Service connection for bilateral carpal tunnel syndrome is remanded. The Veteran initially contended his current diagnosis of bilateral carpal tunnel syndrome is secondary to his service-connected left thumb trigger finger and right-hand fingers strain disabilities. At the October 2017 hearing, the Veteran expanded his claim to assert his bilateral carpal tunnel syndrome is directly related to his in-service job activities, namely packing parachutes and emergency kits, and operating sewing machines to sew parachutes. The Veteran further testified he was diagnosed with carpal tunnel syndrome at Naval Medical Center (NMC) San Diego shortly after he left active service in August 2002, and that he was referred for and received carpal tunnel surgery at Scripps Hospital in San Diego. However, the Veteran could not provide a more specific timeframe for these events than sometime between 2003 and 2005. The Veteran had not previously identified Scripps Hospital as a potential custodian of medical records relating to his asserted carpal tunnel syndrome, nor submitted copies of any such records. Thus, when the Veteran underwent a VA examination for carpal tunnel syndrome in November 2013, the examiner did not have these records for review and consideration when he issued a negative nexus opinion that the Veteran’s claimed carpal tunnel syndrome is less likely than not proximately due to or the result of the Veteran’s service-connected hand and fingers conditions. An August 2005 entry on the Veteran’s medical records from NMC San Diego shows the Veteran reported a 2003 diagnosis of carpal tunnel syndrome for which he had received injections for pain, and then the claimed surgery. As the Veteran’s records from NMC San Diego begin in August 2005, it appears there may be additional NMC San Diego medical records for the period beginning with the Veteran’s discharge from active service in August 2002 through August 2005. Accordingly, this matter is REMANDED for the following action: 1. Obtain and associate with the electronic claims file the Veteran’s NMC San Diego medical records August 2002 through August 2005, inclusive. 2. Contact the Veteran and ask him to authorize VA to obtain all private treatment records from Scripps Hospital in San Diego and notify him that, in the alternative, he can obtain these records and submit them to VA. 3. DO NOT schedule the examination until all the above referenced records have been obtained or it is determined they do not exist. 4. Schedule the Veteran for an appropriate VA examination to determine the nature, extent, onset, and etiology of his claimed bilateral carpal tunnel syndrome. The claims file should be provided to the examiner for review. The examiner shall first identify any current unilateral or bilateral carpal tunnel syndrome disability, then address: • whether it is at least as likely as not (50 percent or better probability) that such disability was incurred as a result of a disease or injury sustained during active duty service. The examiner should specifically discuss the Veteran’s duties during service. See Board hearing transcript. • whether it is at least as likely as not (50 percent or better probability) that such disability was proximately caused by any of the Veteran’s service-connected disabilities, including his status post trigger finger surgery, left thumb and strain, bilateral fingers right hand disabilities. • whether it is at least as likely as not (50 percent or better probability) that such disability was aggravated (made chronically worse) by any of the Veteran’s service-connected disabilities, including his status post trigger finger surgery, left thumb and strain, bilateral fingers right hand disabilities. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Leamon, Associate Counsel