Citation Nr: 20006760 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 14-33 039 DATE: January 28, 2020 ORDER Entitlement to an initial compensable evaluation for hypertension is denied. FINDING OF FACT For the entire appeal period, the Veteran's hypertension required continuous use of medication for control, but is not manifested by a history of diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. CONCLUSION OF LAW The criteria for an initial compensable evaluation for hypertension are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1986 to January 1994 and from July 2000 to February 2008. He is in receipt of several medals, including 3 Bronze Stars. In April 2018, the Board remanded the issue on appeal for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to an initial compensable evaluation for hypertension Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In a June 2013 rating decision, the Veteran was awarded service connection for hypertension with an initial noncompensable rating from December 13, 2011. He disagreed with this determination, therefore the issue before the Board is whether the Veteran’s hypertension warrants an initial compensable rating. Based on the following evidence of record, the Board finds a compensable evaluation throughout the appeal period is not warranted. The Veteran’s hypertension disability is rated under 38 C.F.R. § 4.130, DC 7101, which pertains to hypertensive vascular disease (hypertension and isolated systolic hypertension). Under that diagnostic code, a 10 percent rating is assigned for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or where an individual with a history of diastolic pressure predominantly 100 or more requires continuous medication for control. A 20 percent rating is assigned for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for diastolic pressure predominantly 120 or more. The highest rating, 60 percent, is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101 (2018). Private treatment records received in July 2012 from Family Health Clinic Grenada and Dr. J.B.W. indicate normal blood pressure readings for the Veteran as well as prescribed medication for his hypertension. A May 2013 VA Hypertension Disability Benefits Questionnaire (DBQ) examination indicates that the several blood pressure readings taken that day were all lower than a systolic pressure of 160 and diastolic pressure of 100. This examination also indicates that the Veteran takes continuous medication for his hypertension. The Veteran submitted several copies of an undated letter from L.P. PA-C., indicating the Veteran had been a patient of the Fox Army Health Center since 2012. Further, the examiner noted that his blood pressure readings for the past 14 months had been “136-154/76-96”, and that off medication, he would be in the “180-200/110/120” range. In October 2017, the Veteran attended a Board hearing where he testified to shortness of breath and headaches for which he took Lotrel daily to prevent flare-ups. In January 2019, as required by the April 2018 Board remand, the Veteran attended a VA Hypertension DBQ examination. The examiner indicated that the Veteran’s treatment plan included taking continuous medication for hypertension. Further, the exam indicates that the several blood pressure readings taken that day were all lower than a systolic pressure of 160 and diastolic pressure of 100. Finally, the examiner noted: Review of medical records indicates that Veteran’s blood pressure on 8/26/2011 was initially 170/117 and with sitting dropped to 140/100. Other than that one incident, available medical records from that date until today, indicate that diastolic blood pressure has been well controlled and not above 160 systolic or 100 diastolic. A letter from PA [L.P.] indicates blood pressures of 136-154/76-96 during period under her care. Veteran has noted that when he gets a headache or feels short-winded, often his blood pressure is somewhat elevated. This happen recently and with increase in his anti-hypertensive medications and better control of his blood pressure, he has not had headaches or such shortness of breath. Elevated blood pressure can cause transient headaches, transient shortness of breath, other symptoms or it can be asymptomatic. In addition, both shortness of breath and headaches can occur in the absence of poorly controlled hypertension. However, in the absence of specific documentation of episodes of headaches or shortness of breath and documentation of blood pressure at those and asymptomatic periods, it is not possible to provide an opinion as to etiology of headache or shortness of breath. Finally, numerous blood pressure readings in the Veteran’s VA treatment records throughout the appeal period are all lower than a systolic pressure of 160 and diastolic pressure of 100. The evidence of record throughout the entire appeal period is silent for any blood pressure readings indicating systolic pressure of 160 and/or diastolic pressure of 100. In addition, the Board finds the January 2019 VA opinion the most probative evidence of record regarding the Veteran’s contentions relating to headaches and shortness of breath. It also notes that the Veteran has failed to provide any evidence to the contrary. Furthermore, while the Veteran and his private physician essentially contend that his blood pressure would be higher, but for the medication he was currently prescribed, the Board notes the rating criteria for hypertension take into account the ameliorative effects of medication. As such, the Board is not required to discount the ameliorative effects of the medications when evaluating the Veteran's hypertension. McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (holding that Diagnostic Code 7101 (for hypertension) explicitly contemplates the ameliorative effects of medication and the Board did not err when it considered the effects of the appellant’s medication when evaluating his hypertension); See Jones v. Shinseki, 26 Vet. App. 56 (2012). In making its determinations in this case, the Board has also carefully considered the Veteran's contentions with respect to the nature of his service-connected hypertension and notes that his lay testimony is competent to describe observable symptoms. The Veteran's history and symptom reports have been considered, including as presented in the medical evidence discussed above, and have been contemplated by the disability rating that has been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of his service-connected hypertension. As such, while the Board accepts the Veteran's testimony with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of his service-connected hypertension. In sum, the Board finds that the Veteran is not entitled to an initial compensable rating for his hypertension. In denying such claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against a higher initial rating, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.A. Elliott II, 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.