Citation Nr: 19176620 Decision Date: 10/03/19 Archive Date: 10/03/19 DOCKET NO. 14-16 190 DATE: October 3, 2019 ORDER Entitlement to an initial compensable evaluation for Vitamin D deficiency is denied. REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected glomerulonephritis and systemic lupus erythematosus with Sjogren syndrome, is remanded. Entitlement to an initial compensable rating for glomerulonephritis is remanded. FINDING OF FACT The Veteran’s service-connected Vitamin D deficiency disability is asymptomatic. CONCLUSION OF LAW The criteria for an initial compensable evaluation for Vitamin D deficiency have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.88b, Diagnostic Code 6313. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1988 to February 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February and May 2013 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. Entitlement to an initial compensable evaluation for Vitamin D deficiency. Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1995). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s Vitamin D deficiency disability is rated under Diagnostic Code 6313, which relates to avitaminosis, a condition resulting from deficiency of one or more particular vitamins. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 184, 908 (32d ed. 2012). Under Diagnostic Code 6313, a 10 percent rating is assigned for a confirmed diagnosis with nonspecific symptoms such as decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate, and irritability. A 20 percent evaluation is assigned for stomatitis or achlorhydria or diarrhea. A 40 percent evaluation is assigned for stomatitis, diarrhea, and symmetrical dermatitis. A 60 percent evaluation is assigned for stomatitis, diarrhea, and symmetrical dermatitis with mental symptoms and impaired bodily vigor. A 100 percent evaluation is assigned for marked mental changes, moist dermatitis, inability to retain adequate nourishment, exhaustion, and cachexia. 38 C.F.R. § 4.88b, Diagnostic Code 6313. Upon review of the record, a compensable rating is not warranted for the Veteran’s disability. A June 2012 VA examination identified no symptoms related to Vitamin D deficiency. The examiner even remarked that the Veteran did not experience any functional impairment due to the disability. Similar findings were made during at January 2019 VA examination. At that examination, the Veteran did not present with any findings, signs, or symptoms attributable to her disability or the residuals thereof. Instead, the examiner noted, the Veteran is asymptomatic despite the fact she stopped taking her prescribed Vitamin D supplement. But for one report of decreased appetite in July 2010, VA treatment records support this understanding of the Veteran’s disability picture and do not establish a history of chronic or significant symptomatology. The Veteran stated she experienced decreased appetite and weight loss. VA medical records note that the Veteran denied decreased appetite, weight loss, abdominal pain, diarrhea, or constipation in August 2011, February and March 2012, March 2013, April 2014, and July 2015. This contemporaneous evidence has greater probative value than history as reported by the Veteran. Curry v. Brown, 7 Vet. App. 59, 68 (1994). Indeed, as addressed by the Court in Rucker v. Brown, 10 Vet. App. 67, 73 (1997), statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care. See also Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). Accordingly, the Veteran’s level of disability has most nearly approximated that contemplated by her current noncompensable evaluation. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable and the appeal seeking a compensable initial rating is denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as secondary to service-connected glomerulonephritis and SLE with Sjogren syndrome. The Veteran seeks service connection for hypertension which she asserts was caused or aggravated by her service connected glomerulonephritis or SLE with Sjogren syndrome. VA examinations were conducted in March 2014 and January 2019 VA examinations. Neither adequately addresses the question of aggravation. Indeed, the disability benefits questionnaire that was completed in January 2019 left the aggravation field/question (Section VI) blank. An addendum opinion is needed. 2. Entitlement to an initial compensable rating for glomerulonephritis. Glomerulonephritis is rated as renal dysfunction. 38 C.F.R. § 4.115b, Diagnostic Code 7536. Renal dysfunction will be assigned a noncompensable rating where it is manifested by albumin and casts with a history of acute nephritis. To warrant the minimum compensable evaluation of 30 percent, there must be constant or recurring albumin with hyaline and granular casts or red blood cells, transient or slight edema, or hypertension meeting the criteria for at least 10 percent evaluation under DC 7101. With regard to the Veteran’s claim for a compensable initial evaluation for her glomerulonephritis, she was most recently examined in January 2019. The examiner failed to state if granular casts and red blood cells were present in the Veteran’s urinalysis and whether this resulted in abnormal or normal findings. The examiner provided a separate opinion in which he states that the Veteran’s service-connected disability does not appear to be “worsening in severity” because the Veteran “is asymptomatic with intermittent proteinuria and normal renal function and normal renal ultrasound.” However, as noted, rating the Veteran’s service-connected disability pursuant to the rating schedule for renal dysfunction requires the application of specific findings. A new examination is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of any hypertension. The examiner must opine: (a.) Whether hypertension is at least as likely as not related to an in-service injury, event, or disease. (b.) Whether hypertension at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. (c.) Whether hypertension is at least as likely as not caused by glomerulonephritis and SLE with Sjogren syndrome. (d.) Whether hypertension is at least as likely as not aggravated (worsened) by glomerulonephritis and SLE with Sjogren syndrome. (e.) Rationale must be provided for each requested opinion. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected glomerulonephritis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Notably, the examiner should indicate whether there is evidence of constant or recurring albumin with hyaline and granular casts or red blood cells. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mahmoudi, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.