Citation Nr: 20038136 Decision Date: 06/03/20 Archive Date: 06/03/20 DOCKET NO. 14-33 976 DATE: June 3, 2020 ORDER Entitlement to a rating in excess of 10 percent for hypertension is denied. Resolving reasonable doubt in in the Veteran’s favor, service connection for right eye disability secondary to service-connected hypertension is granted. FINDINGS OF FACT 1. The Veteran’s service-connected hypertension has required continuous medication. He has a history of diastolic pressure that is predominantly below 110 and systolic pressure that is predominantly below 200. 2. The Veteran’s right eye disability is proximately due to his service-connected hypertension. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.104, Diagnostic Code 7101. 2. The criteria for entitlement to service connection for right eye disability secondary to service-connected hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1986 to June 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2010 and October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Board remanded the appeal for further development. Increased Rating Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 1. Entitlement to a rating in excess of 10 percent for hypertension The Veteran seeks a rating in excess of 10 percent for hypertension; it is rated under 38 C.F.R. § 4.104, Diagnostic Code 7101. The appeal period before the Board begins on February 25, 2008, one year prior to the date VA received the claim for an increased rating. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Diagnostic Code (DC) 7101 pertains to hypertensive vascular disease (hypertension and isolated systolic hypertension). Under that diagnostic code, the current 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. Lastly, a 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. The word “predominantly” is not defined in the rating schedule; however, the Board understands it to have its ordinary meaning of “most frequent or common.” Definition of Predominant, Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/predominant (last visited May 28, 2020). A March 2008 VA treatment record noted the Veteran’s blood pressure was 148/88. An October 2008 record noted a reading of 160/99. A February 2009 VA treatment record noted the Veteran’s blood pressure was 185/102. The May 2009 VA examination report showed blood pressure readings of 180/100, 150/90, and 160/90. A September 2010 self-report log noted the Veteran’s blood pressure was 153/95. The November 2010 VA examination report showed blood pressure readings of 130/79, 130/65, and 127/72. A January 2011 VA treatment record noted the Veteran’s blood pressure was 119/78. An August 2011 record noted a reading of 161/78. A May 2012 VA treatment record noted the Veteran’s blood pressure was 127/81. The September 2012 VA examination report showed blood pressure readings of 140/70, 148/80, 140/70. An April 2013 VA treatment record noted the Veteran’s blood pressure was 127/70. A November 2013 record noted a reading of 119/78. An April 2014 VA treatment record noted the Veteran’s blood pressure was 103/67. A November 2014 record noted a reading of 160/70. A February 2015 VA treatment record noted the Veteran’s blood pressure was 137/84, and a June 2016 VA treatment record noted a reading of 155/90. A few days later, the Veteran visited his primary care for blood pressure check. That morning, his blood pressure reading was: 178/95, 186/102, 195/101, 201/99, and manual 182/98. In July 2017, the Veteran’s blood pressure was 130/84 and 119/71 in June 2018. A January 2019 VA treatment record noted blood pressure readings of 201/86 and 199/90. The July 2019 VA examination report showed blood pressure readings of 158/82, 160/84, 158/84. In February 2020, the Veteran’s blood pressure was 176/95 and later that month, 133/81. In finding a higher rating is not warranted, the Board notes that blood pressure readings did not meet the criteria necessary for a 20 percent evaluation. Nearly all the systolic pressure readings are less than 200, and there also are no diastolic pressure readings at 110 or higher. There is no indication in the treatment records or VA examination reports that the Veteran’s hypertension worsened to a point where a 20 percent or higher rating would be warranted at any time during this appeal. The Board acknowledges the Veteran’s report of his condition worsening and managing it with four prescription drugs. See VA Form 9. However, DC 7101 already contemplates the effects of medication; any ameliorative effects of blood pressure medication are not discounted in the evaluation. See McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016). Based on this evidence, the Board does not find that there is a question between whether the Veteran’s disability picture more closely approximates a 20 percent rating for hypertension. Due to the absence of blood pressure readings equating to diastolic pressure predominately 110 or more, or systolic pressure predominately 200 or more, the Board concludes that an evaluation of 20 percent is not warranted even with consideration of 38 C.F.R. § 4.7. The Board has considered the application of staged ratings; however, at no point during the appeal period has the Veteran’s hypertension more nearly approximated the criteria corresponding to a rating in excess of 10 percent. Thus, the use of staged ratings is not warranted. Hart v. Mansfield, 21 Vet. App. 505 (2007); Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable, and a higher rating is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 – 67 (Fed. Cir. 2004).   Secondary service connection is warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a).  2. Entitlement to service connection for right eye disability as secondary to service-connected hypertension The Veteran seeks service connection for a right eye disability and contends that it is related to his service-connected hypertension. The Veteran was previously afforded a VA examination in September 2011. The Veteran reported that he suddenly went blind in 2007 due to retinal swelling that could not be treated with laser surgery or anything else by retina specialist. The examiner noted a .3 retinal pigment epithelium mottling right macula with no choroidal neovascular membrane or cystoid macular edema macula. The left eye macula was within normal limits. The examiner concluded that the Veteran had right eye age-related macular degeneration macular scarring that is not as likely related to hypertension and explained that he did not have private treatment records to suggest otherwise. As this examiner’s opinion did not specifically address whether the Veteran’s service-connected hypertension aggravated his right eye disability beyond its natural progress, it is incomplete and of lessened probative value. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). In November 2011, the Veteran’s private treatment record from the retina specialists was associated with his file. A December 2007 note reflects a final diagnosis of the Veteran’s right eye as CSR. A September 2019 VA examination report shows the Veteran has a current disability of central serous retinopathy (CSR), and the examiner opined that it is at least as likely as not proximately due to or the result of the Veteran’s service-connected hypertension. In his rationale, the examiner stated that if the Veteran’s right eye disability is being defined as a central serous retinopathy, there is evidence in literature that this condition can be triggered and/or enhanced by the presence of hypertension. Although the examiner was unable to establish a baseline because medical evidence prior to the Veteran’s vision loss in the right eye was not available or made available by the Veteran, he indicated that regardless of an established baseline, the Veteran’s diagnosis was at least as likely as not aggravated beyond its natural progression by his service-connected hypertension. The examiner again explained that if the claimed condition is considered CSR of the right eye, then the service-connected condition of hypertension can aggravate or be a contributing factor. This examiner also provided a nexus opinion for the Veteran’s right eye disability and his military service. As that negative opinion does not pertain to the Veteran’s assertion that his current right eye disability was caused by his hypertension, it will not be addressed. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current central serous retinopathy is proximately due his service-connected hypertension. The evidence of record reflects a December 2007 diagnosis of central serous retinopathy made by retinal specialists. While the September 2019 VA examiner appears to reluctantly affirm this diagnosis, he also does not reject it. Thus, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a right eye disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Telamour, 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.