Citation Nr: 20007352 Decision Date: 01/29/20 Archive Date: 01/28/20 DOCKET NO. 14-17 129 DATE: January 29, 2020 ORDER For the entire appeal period, entitlement to a 10 percent rating, and no higher, for service-connected hypertension is granted. FINDING OF FACT For the entire appeal period, the Veteran had a history of hypertension of diastolic pressure predominantly 100 or more and required continuous medication for control. CONCLUSION OF LAW The criteria for entitlement to a 10 percent rating, and no higher, for service-connected hypertension have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.10, 4.14, 4.104, Diagnostic Code 7101 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1976 to July 1979. The appeal comes before the Board from a September 2012 rating decision. Following an appeal of that decision, the Board remanded the claim in February 2018 to schedule a VA examination to adequately evaluate the current severity of the Veteran’s service-connected hypertension. On remand, the regional office (RO) issued a rating decision in September 2019 that increased the Veteran’s rating to 10 percent for his service-connected hypertension, effective September 20, 2019. For the entire appeal period, entitlement to a 10 percent rating, and no higher, for service-connected hypertension is granted. Disability evaluations are determined by comparing a veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), 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 applies under a particular diagnostic code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. 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 entire history is reviewed when making disability ratings. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The Veteran’s hypertension has been rated under the provisions of 38 C.F.R. § 4104, Diagnostic Code 7101. Under Diagnostic Code 7101, a 10 percent rating is assigned 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. 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. A 60 percent rating is assigned for diastolic pressure predominantly 130 or more. As an initial matter, the Veteran is currently in receipt of staged ratings. Specifically, the Veteran is currently assigned a 0 percent rating for his service-connected hypertension from February 1, 1983 to September 19, 2019 and a 10 percent rating from September 20, 2019. He contends higher ratings are warranted. The Board finds that a 10 percent rating, but no higher, is warranted for the entire period on appeal. The Veteran’s treatment records provide probative evidence as to the severity of his condition. The Veteran’s numerous blood pressure recordings showed occasions where his diastolic pressure was at or above 100 and the Veteran was mostly on medication for his hypertension during the appeal period. In 2011, blood pressure readings showed the Veteran’s worst reading as 153/99 in May, and his worst reading in 2012 showed 157/96. See March 2014 Medical Treatment Record – Non-Government Facility, pp. 61 & 69. In April 2013, the Veteran’s blood pressure was recorded as 151/105 and 128/85, less than one week apart (but the Veteran did not take his medications on either occasion). See February 2018 Medical Treatment Record – Non-Government Facility at p. 66. The worst blood pressure reading in 2016 was recorded as 154/100 in September, prior to the Veteran’s colonoscopy and esophagogastroduodenoscopy. See id. at p. 15. Furthermore, the Veteran’s blood pressure has been predominately above 100 for diastolic pressure or above 160 for systolic pressure since November 2017. See id. at pp. 69-76. For example, at a September 2019 VA examination, the Veteran’s blood pressure readings were 160/100, 180/100 and 160/102, uncontrolled. He reported that he has been on numerous medications combinations to treat his hypertension. The examiner noted that the Veteran’s treatment plan included taking continuous medication. The September 2019 examiner also noted that the Veteran had a history of a diastolic blood pressure elevation of predominantly 100 or more, but she was unable to identify the frequency over the past twelve months due to lack of blood pressure specific exams. In various written statements, the Veteran reported that his hypertension has continued to worsen and deserved to be rated at 10 percent as his diastolic pressure was above 100. He also reported that he took a number of medications for his hypertension, and his blood pressure would be out of control without his medications. While there are many documented blood pressure readings below the levels of a 10 percent rating, the Board resolves reasonable doubt in the Veteran’s favor and finds that a 10 percent rating is warranted for a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Post-service treatment records and the VA examination report document that the Veteran took medication daily for his hypertension. In addition, the Board notes that the records document a history of several blood pressure readings with diastolic pressure of 100 or more, as well as several instances where diastolic pressure was close to 100. The Veteran also reported a history of diastolic pressure over 100. Accordingly, the Board resolves reasonable doubt in the Veteran’s favor and finds that the criteria for a 10 percent rating under Diagnostic Code 7101 have been more nearly approximated. However, there is no documentation that diastolic blood pressure was ever predominantly 110 or more or that systolic blood pressure was ever predominantly 200 or more during the period pertinent to this appeal. Review of the Veteran’s treatment records and examination report documents blood pressure readings that were consistently well below these thresholds. While the Veteran has indicated that his blood pressure levels would probably be higher if left untreated, it is contradicted by the objective evidence of lower blood pressure readings shown at his VA examination and in treatment records during the appeal period. The Board acknowledges that the Veteran, in advancing this appeal, believes that the disability on appeal has been more severe than the assigned disability rating reflects. The Veteran is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). Notably, the Board’s award of a 10 percent rating is based, in part, on his description of his symptoms, particularly with regard to his report of his historical blood pressure readings. With respect to his entitlement to a higher rating than 10 percent, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal. The medical evidence also largely contemplates the Veteran’s descriptions of symptoms. The lay statements have been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The Board also acknowledges the Veteran’s representative’s assertion that using the Veteran’s three blood pressure readings taken on the same day from the September 2019 VA examination could not be deemed “predominant” to accurately determine his hypertension severity, as well as the Veteran’s contention that his condition has worsened. Diagnostic Code 7101 provides for blood pressure readings to be taken two or more times on at least three different days for the diagnosis of hypertension. However, this requirement is not required for increased ratings. The readings taken during the September 2019 examination, along with blood pressure readings contained in the Veteran’s treatment records, provide sufficient information regarding the Veteran’s blood pressure levels throughout the course of the appeal, and thus remand for an additional examination is not warranted. (Continued on the next page) As discussed above, the Board finds that the medical evidence demonstrated the Veteran’s hypertension warrants a 10 percent rating, but no higher, for the entire period on appeal. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.