Citation Nr: 19106959 Decision Date: 01/29/19 Archive Date: 01/29/19 DOCKET NO. 17-06 638 DATE: January 29, 2019 ORDER Entitlement to an initial compensable rating for hypertension is denied. FINDING OF FACT The Veteran's hypertension is not manifested by 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. CONCLUSION OF LAW The criteria for entitlement to an initial compensable disability rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Army from July 1965 to June 1967. The matter comes before the Board of Veterans' Appeals (Board) on appeal of a December 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed an appeals satisfaction notice in March 2017 and withdrew all issues on appeal before the Board except the increased rating appeal for hypertension. See March 2017 Appeals Satisfaction Notice. The Board acknowledges that the Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form that was received by VA on April 12, 2018. However, the appeal had already been activated by the Board and is therefore no longer eligible for the RAMP program. Accordingly, the Board will undertake appellate review of the case. The Board observes that the United States Court of Appeals for Veterans Claims (the Court) has held that a total disability rating indicating unemployability (TDIU) is “part and parcel” of a claim for an increased disability rating when raised by the Veteran or the evidence of record. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). A review of the record reveals TDIU has not been raised by the Veteran or the evidence of record. As such, entitlement to a TDIU is not in controversy in the instant appeal. Entitlement to a compensable rating for hypertension By way of introduction, the Veteran was denied service connection for hypertension in April 2014 and in December 2015. The Veteran filed a timely notice of disagreement (NOD) in December 2015 and a December 2016 rating decision granted service connection for hypertension with a noncompensable disability rating effective August 2013. The Veteran submitted a NOD for an increased rating for hypertension in January 2017. See January 2017 VA Form 21-0958. Initially, the Board notes that it has reviewed all of the relevant evidence in the Veteran's record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence, as deemed appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or does not show, as to the claims. Disability evaluations are determined by evaluating the extent to which a claimant's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. See 38 C.F.R. § 4.7. A claimant's entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Veteran filed an increased rating claim for his service-connected hypertension disability in January 2016. Where 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. Fenderson v. West, 12 Vet. App. 119 (1999). The Court has held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). That is to say, the Board must consider whether there have been times when his service-connected disability has been more severe than at others, and rate it accordingly. A Veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived or experienced, were directly through the senses. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, at 469-71 (1994). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). VA must consider the competency of the lay evidence and cannot outright reject such evidence on the basis that such evidence can never establish a medical diagnosis or nexus. However, this does not mean that lay evidence is necessarily always sufficient to identify a medical diagnosis, but rather only that it is sufficient in those cases where the lay person is competent and does not otherwise require specialized medical training and expertise to do so; i.e., the Board must determine whether the claimed disability is a type of disability for which a layperson is competent to provide etiology or nexus evidence. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board must give the Veteran the benefit of the doubt as to any issue material to the determination of a matter when there is an approximate balance of positive and negative evidence. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. For a claim to be denied on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In December 2016, the RO granted service connection for hypertension and assigned a noncompensable disability rating. In January 2017, the Veteran filed a notice of disagreement (NOD) for an increased evaluation which was denied and the Veteran timely appealed as to the assigned rating. See January 2017 VA Form 21-0958; February 2017 Statement of the Case; March 2017 Substantive Appeal (VA Form 9). The Veteran’s hypertension is rated as noncompensable under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101. DC 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, DC 7101. The Board notes that the record establishes that the Veteran has been prescribed medication for his high blood pressure. However, while the Veteran is on continuous medication, a higher, 10 percent rating requires a history of 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. Such has not been shown in this case. In August 2014, the Veteran was afforded a VA examination. The Veteran’s blood pressure was taken on three occasions and results revealed blood pressure readings of 148/82, 140/80, and 140/80. See August 2014 VA Medical Examination report. Additionally, in April 2015 at a VA outpatient treatment visit, the Veteran’s blood pressure was 168/91 and in a June 2016 private medical report, the Veteran’s blood pressure reading was noted as being 147/84. At no time during this appeal, has the Veteran’s blood pressure readings warranted a compensable or 10 percent rating. As such, the Board finds a compensable rating is not warranted. Having considered whether a staged rating is warranted, the Board finds that the Veteran’s hypertension has remained essentially the same during the period under appellate review and at no time meets the criteria for a higher evaluation. The Board finds that the competent credible medical evidence of record demonstrates that the Veteran's disability picture more nearly approximates the criteria for a non-compensable rating, and that a compensable initial, or staged, ratings are not warranted. (Continued on the next page)   A preponderance of the evidence is against finding that a compensable rating is warranted for the service-connected hypertension; therefore, the claim is denied. Under the circumstances, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Khan, Associate Counsel