Citation Nr: 20049966 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 18-03 999 DATE: July 28, 2020 ORDER An initial rating in excess of 10 percent for hypertension is denied prior to January 1, 2014. A 60 percent rating is granted for hypertension from January 1, 2014 to September 30, 2014, subject to the law and regulations governing the award of monetary benefits. A 20 percent rating is granted for hypertension from October 1, 2014 to February 28, 2015, subject to the law and regulations governing the award of monetary benefits. A 40 percent rating is granted for hypertension from March 1, 2015 to March 31, 2015, subject to the law and regulations governing the award of monetary benefits. A rating in excess of 10 percent for hypertension is denied from April 1, 2015. FINDINGS OF FACT 1. During the period on appeal prior to January 1, 2014, the Veteran’s hypertension was not manifested by diastolic pressure predominately 110 or more, or systolic pressure predominantly 200 or more. 2. In January 2014, the Veteran’s blood pressure was recorded as 217/171; there are no further blood pressure readings of record through September 2014. 3. From October 2014 to February 2015, the Veteran’s hypertension was manifested by diastolic pressure predominately 110 or more; but not by diastolic pressure predominantly 120 or more. 4. In March 2015, the Veteran had a blood pressure reading of 236/129; the only other reading from that period was 231/117. 5. Since April 2015, the Veteran’s hypertension has not been manifested by diastolic pressure predominately 110 or more, or systolic pressure predominantly 200 or more. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for hypertension prior to January 1, 2014 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 2. Resolving reasonable doubt in the Veteran’s favor, the criteria for a 60 percent rating for hypertension have been met from January 1, 2014 to September 30, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 3. Resolving reasonable doubt in the Veteran’s favor, the criteria for a 20 percent rating for hypertension have been met from October 1, 2014 to February 28, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 4. Resolving reasonable doubt in the Veteran’s favor, the criteria for a 40 percent rating for hypertension have been met from March 1, 2015 to March 31, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 5. Beginning April 1, 2015, 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. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1976 to November 1979. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision issued by the Department of Veterans Affairs Regional Office (RO) in Winston-Salem, North Carolina. The RO granted service connection and a 10 percent rating for hypertension, effective January 27, 2010. This case was previously before the Board in November 2018, when it was remanded to the agency of original jurisdiction for additional development, to include obtaining medical records from two private medical facilities. The record reflects that those records have been obtained. There has been at least substantial compliance with the Board’s remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to a higher rating for hypertension The Veteran seeks a higher rating for hypertension. His representative asserts that a staged 20 percent rating is warranted from January 2010 to March 2015. See June 2020 submission. Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. If 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. If different disability ratings are warranted for different periods of time over the life of a claim, “staged” ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). The Board has reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran’s hypertension is rated under 38 C.F.R. § 4.104, Diagnostic Code 7101. Under that diagnostic code, a 10 percent rating is assigned for hypertension manifested by 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. Finally, a maximum 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. In this case, the Board notes that the Veteran’s hypertension is treated with medication. That is consistent with the current 10 percent rating. As the rating criteria for hypertension specifically contemplate the use of medication to ameliorate symptoms, a higher rating may not be assigned based solely on the fact that medication is used. Cf. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012), (“[a]bsent a clear statement [in the diagnostic code] setting out whether or how the Board should address the effects of medication . . . the Board may not deny entitlement to a higher disability rating on the basis of relief provided by medication.”); McCarroll v. McDonald, 28 Vet. App. 267 (2016) (the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of Diagnostic Code 7101 contemplates the effects of medications). The Veteran’s blood pressure was recorded on many occasions during the period on appeal, as follows: February 2010: 154/97, 168/92, 195/103, 169/107 April 2010: 170/94 July 2010: 146/100, 166/104, 170/90 April 2011: 192/90 January 2014: 217/171 October 2014: 200/110 March 2015: 236/129, 231/117 April 2015: 130/72, 152/82, 161/93, 148/78, 147/87, 174/86, 166/87, 143/73, 163/94, 156/77, 160/85 May 2015: 86/62, 116/75, 101/57, 119/61, 154/73 December 2015: 187/83, 136/78 June 2016: 185/87, 182/90 February 2018: 132/78, 130/76 March 2017: 158/82, 158/86, 158/84 August 2019: 160/80 September 2019: 120/70 October 2019: 130/80 November 2019: 150/80 May 2020: 117/69 Following review of the relevant evidence in this case, and the applicable law and regulations, it is the Board’s conclusion that the evidence supports staged ratings for the Veteran’s hypertension. As set out above, the Veteran’s blood pressure was recorded as 217/171 in January 2014. No further blood pressure readings are thereafter of record until October 2014, when it was recorded as 200/110. In March 2015, his blood pressure was recorded twice. On one occasion, it was recorded as 236/129, and on the second occasion it was recorded as 231/117. Although the data is relatively sparse, the Board finds that it reasonably demonstrates diastolic pressure predominantly 130 or more from January 1, 2014 to September 30, 2014; diastolic pressure predominantly 110 or more, but not 120 or more, from October 1, 2014 to February 28, 2015; and diastolic pressure predominantly 120 or more, but not 130 or more, from March 1, 2015 to March 31, 2015. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 4.3. Accordingly, a 60 percent rating is granted from January 1, 2014 to September 30, 2014; a 20 percent rating is granted from October 1, 2014 to February 28, 2015; and a 40 percent rating is granted from March 1, 2015 to March 31, 2015. As to the period on appeal prior to January 1, 2014 and after March 31, 2015, the preponderance of the evidence is against the assignment of a rating in excess of 10 percent. As set out above, none of the blood pressure data from those periods demonstrates that the Veteran’s hypertension was manifested at those times by diastolic pressure predominately 110 or more, or systolic pressure predominantly 200 or more. To the contrary, all of the readings from those periods uniformly demonstrate diastolic pressures less than 110 and systolic pressures less than 200. To that extent, the appeal must be denied. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bradley Willis, 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.