Citation Nr: 21062935 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 20-28 972 DATE: October 12, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for a back disability is denied. Entitlement to a disability rating in excess of 10 percent for a right elbow disability is denied. Entitlement to a disability rating in excess of 10 percent for a left elbow disability is denied. Entitlement to a disability rating in excess of 10 percent for a right knee disability based on limitation of motion is denied. Entitlement to a disability rating in excess of 10 percent for a left knee disability based on limitation of motion is denied. Entitlement to a separate 10 percent rating, but no higher, for right knee instability is granted. Entitlement to a separate 10 percent rating, but no higher, for left knee instability is granted. Entitlement to a disability rating in excess of 10 percent for bilateral pes cavus is denied. Entitlement to a compensable disability rating for bilateral hearing loss is denied. Entitlement to a compensable disability rating for hypertension is denied. FINDINGS OF FACT 1. The Veteran's back disability was not manifested by forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or incapacitating episodes. 2. The Veteran's right elbow disability is manifested by pain and limitation of motion; there are no findings of ankylosis; flexion functionally limited to 90 degrees or less; extension functionally limited to 75 degrees or more; an elbow flail joint; impairment of the ulna; impairment of the radius; or significant limitation of 3. The Veteran's left elbow disability is manifested by pain and limitation of motion; there are no findings of ankylosis; flexion functionally limited to 90 degrees or less; extension functionally limited to 75 degrees or more; an elbow flail joint; impairment of the ulna; impairment of the radius; or significant limitation of 4. The Veteran's right knee disability was manifested by, at worst, flexion of 105 degrees, and normal extension. 5. The Veteran's left knee disability was manifested by, at worst, flexion of 95 degrees, and normal extension. 6. The Veteran's right knee disability was manifested by slight recurrent instability; it has not been manifested by moderate recurrent subluxation or lateral instability. 7. The Veteran's left knee disability was manifested by slight recurrent instability; it has not been manifested by moderate recurrent subluxation or lateral instability. 8. The Veteran's bilateral pes cavus has not been manifested by a unilateral foot disability that has all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads; the Veteran's bilateral pes cavus has not been manifested by moderately severe foot injury. 9. The Veteran's service-connected bilateral hearing loss was manifested, at its worst, by Level I hearing in both ears. 10. Although the Veteran's hypertension requires continuous medication for control, his blood pressure readings have not been predominantly 100 or more in the diastolic readings or predominantly 160 or more in the systolic readings during the appeal period. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for a back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for entitlement to a disability rating in excess of 10 percent for a right elbow disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5206, 5207. 3. The criteria for entitlement to a disability rating in excess of 10 percent for a left elbow disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5206, 5207. 4. The criteria for entitlement to a disability rating in excess of 10 percent for a right knee disability based on limitation of motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5260. 5. The criteria for entitlement to a disability rating in excess of 10 percent for a left knee disability based on limitation of motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.40, 4.45, 4.59, 4.71a, DC 5260. 6. The criteria for a separate 10 percent rating, but no higher, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257. 7. The criteria for a separate 10 percent rating, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257. 8. The criteria for entitlement to a disability rating in excess of 10 percent for bilateral pes cavus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.14, 4.31, 4.40, 4.45, 4.59, 4.71a, DC 5284-5278. 9. The criteria for entitlement to a compensable disability rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.85, 4.86, DC 6100. 10. The criteria for entitlement to a compensable rating for hypertension have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, DC 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1997 to March 1998, from November 2000 to July 2002, and from July 2010 to February 2018. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran attended a hearing before the undersigned Veterans Law Judge in February 2021. A transcript of the hearing is of record. This matter was previously remanded by the Board in April 2021. In consideration of the appeal, the Board is satisfied there was substantial compliance with the remand directives and will proceed with review. See Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that the issue of entitlement to service connection for a right ear hearing loss disability was granted by the Agency of Original Jurisdiction (AOJ) in an August 2021 rating decision. This represents a full grant of benefits. Furthermore, the issue of entitlement to a compensable disability rating for a left ear hearing loss disability has subsequently been recharacterized as entitlement to a compensable disability rating for bilateral hearing loss. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Court has held that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to 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. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. 1. Entitlement to a disability rating in excess of 10 percent for a back disability The Veteran's back disability is rated under DC 5242, Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome. Prior to the regulatory change, the criteria for evaluating disabilities of the spine are contained in a General Rating Formula for Diseases and Injuries of the Spine. The formula provides that with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, the following ratings are assigned: A rating of 10 percent is warranted when there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees, or there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of height. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. A rating of 20 percent is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm, or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A rating of 40 percent is warranted when there is forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Id. A rating of 50 percent is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a rating of 100 percent is warranted for unfavorable ankylosis of the entire spine. Id. There are several notes relevant to the rating criteria. 38 C.F.R. § 4.71a. Those pertinent to this appeal are included here. Note (1): Concerning disabilities affecting the spine, any associated objective neurologic abnormalities are evaluated separately under an appropriate DC. Note (2): Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. In addition to the General Rating Formula for Diseases and Injuries of the Spine, intervertebral disc syndrome may be evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation. See 38 C.F.R. § 4.71a, DC 5243. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that when intervertebral disc syndrome is productive of incapacitating episodes having a total duration of at least one week but less than two weeks during the past twelve months, a 10 percent rating is assigned. When incapacitating episodes have a total duration of at least two weeks but less than four weeks during the past twelve months, a 20 percent rating is assigned. When incapacitating episodes have a total duration of at least four weeks but less than six weeks during the past twelve months, a 40 percent rating is assigned. When incapacitating episodes have a total duration of at least six weeks during the past twelve months, a maximum 60 percent rating is assigned. Note (1) following 38 C.F.R. § 4.71a, DC 5243 provides that an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. As of February 7, 2021, under the amended criteria, DC 5243, intervertebral disc syndrome, is assigned "only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses." Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. Berkeley Springs, West Virginia 25411. The Veteran contends that his back disability symptoms are of the severity to warrant a disability rating exceeding 10 percent for the period on appeal. The Veteran had an examination for his back disability in July 2017, during which he reported instances of locking of the back and constant lower and mid back pain. The Veteran was found to have forward flexion to 90 degrees, extension to 30 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation were to 30 degrees. The Veteran was able to perform repetitive use testing with at least three repetitions without reduced range of motion. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. The Veteran denied experiencing flare-ups. There was no evidence of muscle spasm or guarding. There was no evidence of muscle atrophy. There was no evidence of radiculopathy or other neurological abnormalities. Straight leg raising testing was negative. There was no evidence of ankylosis. The Veteran did not report using assistive devices. The Veteran did not have a diagnosis of intervertebral disc syndrome (IVDS) and there was no evidence of incapacitating episodes. VA treatment records from September 2018 noted that the Veteran had degenerative back disease and arthritis of the spine. The Veteran reported consistent pain, which worsens with activity or movement. There was no evidence of weakness of extremities, and there was no evidence of numbness or tingling. At the February 2021 Board hearing, the Veteran testified that his back pain had gotten worse. The Veteran further testified that his pain radiates down to his lower extremities. The Veteran further testified that he has had bilateral lower extremity radiculopathy pain since separation from service. The Veteran had another examination for his back disability in July 2021. The Veteran was found to have forward flexion to 90 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 15 degrees, right lateral rotation to 15 degrees, and left lateral rotation were to 10 degrees. There was evidence of pain with active motion, which resulted in functional loss due to difficulty bending, stooping, and crawling. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions without reduced range of motion. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. The Veteran denied experiencing flare-ups. The examiner noted that the Veteran's range of motion was limited with repeated use over time to 90 degrees forward flexion; 10 degrees extension; 15 degrees right lateral flexion; and 10 degrees left lateral flexion, right lateral rotation, and left lateral rotation. There was evidence of localized tenderness not resulting in abnormal fait or abnormal spinal contour. There was no evidence of muscle spasm or guarding. There was no evidence of muscle atrophy. The Veteran was noted to mild intermittent pain of the bilateral lower extremities due to radiculopathy. There was no evidence of other neurological abnormalities. There was no evidence of ankylosis. The Veteran did not report using assistive devices. The Veteran did not have a diagnosis of IVDS and there was no evidence of incapacitating episodes. Based on the foregoing, the preponderance of the evidence is against a finding that an increased rating in excess of 10 percent is warranted. The objective evidence does not show that the Veteran's range of motion has been limited to 60 degrees or less of forward flexion or less than 120 degrees combined, nor is there any objective evidence of abnormal spinal contour due to guarding, spasms or other factors. Rather, the Veteran has had flexion to 90 degrees at worst. While the Board acknowledges the Veteran's statements concerning additional symptoms such as pain, these are outweighed by the objective evidence from this period which indicates that even with repetitive motion, the range did not go down. In evaluating the Veteran's current level of disability, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The Board notes that the Veteran specifically denied experiencing flare-ups at the July 2017 and July 2021 examinations. Additionally, the Board finds that an increased disability rating for the Veteran's back disability is not warranted on the basis of functional loss due to pain in this case as the Veteran's symptoms are supported by pathology consistent with the assigned 10 percent rating, and no higher. The Board recognizes that at points during the appeal period, there have been general statements about limited range of motion due to pain. However, there is no evidence that the Veteran's reported back pain amounted to functional loss resulting in forward flexion of 60 degrees or less than 120 degrees combined for the period on appeal. The Board finds that the Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish pain, weakened movement, excess fatigability, or incoordination that results in additional limitation of motion to the degree that would warrant an increased rating. Based on ranges of motion referenced above, ankylosis (defined as a fixation of the joint) has neither been alleged nor shown. Although the Veteran reported instances when his back would "lock" the objective medical evidence of record indicates that the Veteran retained some range of motion. Therefore, there is no basis for a higher rating due to favorable ankylosis of the entire thoracolumbar spine (40 percent), unfavorable ankylosis of the entire thoracolumbar spine (50 percent), or unfavorable ankylosis of the entire spine (100 percent) the General Rating Formula. In addition, consideration has been given as to whether a higher disability rating could be assigned under the General Rating Formula for IVDS Based on Incapacitating Episodes. Here, the Board finds that a higher rating is not appropriate under either the old or revised rating criteria. There is no evidence that the Veteran had a diagnosis of IVDS or had any incapacitating episodes at any time during the appeal period. Thus, the Board finds that a higher disability rating under the General Rating Formula for IVDS Based on Incapacitating Episodes is not appropriate under either the old or new rating criteria. When evaluating disabilities of the spine, any associated objective neurologic abnormalities are to be rated separately under an applicable DC. 38 C.F.R. § 4.71a, General Formula, Note 1. Here, service connection for the Veteran's left lower extremity and right lower extremity radiculopathy has already been granted for the period on appeal from July 22, 2021, and therefore is contemplated by that assigned rating. There is no objective medical evidence of record that a separate rating for right and left lower extremity radiculopathy is warranted for the period prior to July 22, 2021. Furthermore, no other neurologic abnormalities have been noted as being associated with the Veteran's back disability. As such, additional separate compensable ratings are not warranted at any point during the period on appeal. 38 C.F.R. § 4.71a, General Formula, Note 1. As such, the Board finds that a rating in excess of 10 percent for the Veteran's back disability is not warranted. 2. & 3. Entitlement to a disability rating in excess of 10 percent for right and left elbow disabilities The Veteran is currently in receipt of a 10 percent disability rating for his service-connected right and left elbow disabilities which are rated under DC 5206. With respect to disabilities of the elbow, 38 C.F.R. § 4.71a, DCs 5205 through 5213 set forth relevant provisions. Upper extremity ratings depend on whether the disabled extremity is the major or minor extremity. The major extremity is the one predominantly used by the Veteran. Only one extremity may be major. 38 C.F.R. § 4.69. The Veteran is right hand dominant. Therefore, his right elbow is considered his major extremity and his left elbow is his minor extremity. DC 5205 evaluates ankylosis of the elbow, DC 5254 evaluates elbow flail joint, DCs 5210, 5211, and 5212 evaluates impairments of the ulna and radius. The medical record does not document any of these conditions. Therefore, these DCs are not applicable and will not be discussed further. DC 5206 evaluates limitation of flexion. A 10 percent rating is assigned for flexion in either the major or minor extremity limited to 100 degrees. A 20 percent rating is assigned with flexion in either the major or minor extremity limited to 90 degrees. A 30 percent rating is assigned for flexion in the major extremity limited to 70 degrees and flexion in the minor extremity to 55 degrees. A 40 percent rating is assigned for flexion in the major extremity limited to 55 degrees and flexion in the minor extremity to 45 degrees. A 50 percent rating is assigned in the major extremity limited to 45 degrees. DC 5207 evaluates limitation of extension. A 10 percent rating is assigned for extension in either the major or minor extremity limited to 60 degrees. A 20 percent rating is assigned with extension in either the major or minor extremity limited to 75 degrees. A 30 percent rating is assigned for extension in the major extremity limited to 90 degrees and for extension in the minor extremity limited to 100 degrees. A 40 percent rating is assigned for extension in the major extremity limited to 100 degrees and extension in the minor extremity limited to 110 degrees. A 50 percent rating is assigned for extension in the major extremity limited to 110 degrees. DC 5208 evaluates limitation of flexion and extension. A 20 percent rating is assigned for flexion limited to 100 degrees and extension limited to 45 degrees. DC 5213 provides that limitation of supination to 30 degrees or less warrants a 10 percent rating. Pronation lost beyond the last quarter of the arc, where the hand does not approach full pronation, warrants a 20 percent rating. Pronation lost beyond the middle of the arc warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Moderate pronation or the hand fixed near the middle of the arc warrants a 20 percent rating. The hand fixed in full pronation warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. The hand fixed in supination or hyperpronation warrants a 30 percent rating for the minor extremity and a 40 percent rating for the major extremity. 38 C.F.R. § 4.71a, DC 5213. Normal range of motion of the elbow is from 0 degrees on extension to 145 degrees on flexion with pronation to 80 degrees and supination to 85 degrees. 38 C.F.R. § 4.71a, Plate I. The Veteran had an examination for his right and left elbow disabilities in July 2017. The Veteran was found to have normal range of motion for both the right and left elbows. There was noted pain with extension, however the examiner noted that the pain did not result in functional loss. There was no objective evidence of crepitus or pain with weight-bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing without reduced range or motion. The Veteran denied experiencing flare-ups. The examiner indicated that the Veteran did not have reduced range of motion with repetitive use over time. There were no additional symptoms contributing to the Veteran's disability. Additionally, the Veteran retained full muscle strength, did not experience muscle atrophy, or ankylosis. The Veteran denied the use of assistive devices. The Veteran did not have a flail joint, joint fracture and/or impairment of the supination or pronation. At the February 2021 Board hearing, the Veteran testified that he had sharp pain with the extension of his elbows. The Veteran had another examination for his bilateral elbow disabilities in July 2021. The Veteran was found to have normal range of motion for both the right and left elbows. There was noted pain with extension. As well as pain with passive motion, which resulted in functional loss due to difficulty performing repetitive motion such as lifting and carrying. There was no objective evidence of crepitus. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing without reduced range or motion. The Veteran denied experiencing flare-ups. The examiner indicated that the Veteran had reduced range of motion with repetitive use over time. Specifically, the Veteran's range of motion was reduced to 145 degrees of flexion, 0 degrees extension, 75 degrees forearm supination, and 70 degrees forearm pronation for both the right and left elbows. There were no additional symptoms contributing to the Veteran's disability. Additionally, there was no evidence of muscle atrophy or ankylosis. The Veteran denied the use of assistive devices. The Veteran did not have a flail joint, joint fracture, and/or impairment of the supination or pronation. Upon review of the evidence, the Board finds a rating in excess of 10 percent for the Veteran's right and left elbow disabilities is not warranted. This is because, even with consideration of complaints of pain on motion and some functional loss, including after repetitive use, he has retained normal range of motion for flexion and extension for both the right and left elbows. Thus, the 10 percent rating assigned for the entire period at issue has adequately compensated the Veteran for his service-connected right and left elbow disabilities. Without evidence that the disability has resulted in limitation of flexion to 90 degrees or limitation of extension to 75 degrees, an evaluation in excess of 10 percent is not warranted. See 38 C.F.R. § 4.71a, Diagnostic Codes 5206, 5207. The Board also finds that no other diagnostic code provides a basis for assignment of a higher rating for the service-connected right and left elbow disabilities. In this regard, the service-connected right and left elbow disabilities are not manifested by ankylosis, flail joint, nonunion of the radius and ulna, nonunion of the ulna, or nonunion of the radius. As such, Diagnostic Codes 5205, and 5208 to 5212 are not applicable. The disabilities are not shown to involve any other factor that would warrant consideration of any other provision of VA's rating schedule. The Board concludes that the preponderance of the evidence is against the assignment of a disability rating in excess of 10 percent for the right and left elbow disabilities. 4. & 5. Entitlement to disability ratings in excess of 10 percent for right and left knee disabilities based on limitation of motion The Veteran seeks a higher disability rating for his service-connected right and left knee disabilities. The Veteran's right and left knee disabilities are currently rated under 38 C.F.R. § 4.71a, DC 5260. Pursuant to DC 5260, a noncompensable rating is warranted when there is limitation of flexion of a leg to 60 degrees. A 10 percent disability rating is warranted if flexion is limited to 45 degrees. A 20 percent disability rating is warranted if flexion is limited to 30 degrees. A 30 percent disability rating is warranted if flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. Also, pursuant to DC 5261, a noncompensable rating is warranted when there is limitation of extension of a leg to 5 degrees. A 10 percent disability rating is warranted if extension is limited to 10 degrees. A 20 percent disability rating is warranted if extension is limited to 15 degrees. A 30 percent disability rating is warranted if extension is limited to 20 degrees. A 40 percent disability rating is warranted if extension is limited to 30 degrees. A 50 percent disability rating is warranted if extension is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. Where a claimant has both limitation of flexion and limitation of extension of the same leg, he or she must be rated separately under DC's 5260 and 5261 to be adequately compensated for functional loss associated with injury to the leg. VAOPGCPREC 9-2004 (September 17, 2004). Under certain circumstances, a separate disability evaluation may be assigned for arthritis of the knee under DC 5003 in addition to the rating for instability under DC 5257. VAOPGCPREC 9-98 and VAOPGCPREC 23-97. A number of other diagnostic codes also potentially apply to knee ratings. Under DC 5256, a 30 percent rating is warranted for ankylosis of the knee with favorable angle in full extension or slight flexion between 0 degrees and 10 degrees. Under DC 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability; a 20 percent rating is warranted for moderate recurrent subluxation or lateral instability; a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. Under DC 5258, dislocated semilunar cartilage, with frequent episodes of "locking," pain, and effusion into the joint, is rated as 20 percent disabling. Under DC 5259, a 10 percent disability rating is warranted for symptomatic removal of the semilunar cartilage. Under DC 5262, a malunion of the tibia and fibula of either lower extremity warrants a 20 percent evaluation if there is a marked knee or ankle disability. Notably, beginning February 7, 2021 DC 5257 clarifies the meaning of slight, moderate, and severe instability and requires that the condition be diagnosed based on objective medical findings. The Veteran had an examination for his knee disabilities in July 2017. Flexion of the Veteran's left and right knees was normal, to 140 degrees. The Veteran also exhibited normal range of motion for extension for both knees (0 degrees). The Veteran reported experiencing pain with running, jumping, squatting, going up and down steps, and anything that would require angulation of the knees. The Veteran denied experiencing flare-ups. There was evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the right knee, but not the left. There was objective evidence of crepitus. The examiner noted that there was pain noted on exam in the Veteran's knees, which resulted in functional loss. The Veteran was able to complete repetitive use testing without additional functional loss or reduction in range of motion. There was no evidence ankylosis. There was no muscle atrophy. Joint stability testing for the Veteran's knees was normal. There was no evidence of recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment. There was no evidence of a meniscal condition. The Veteran denied the use of any assistive device. The Veteran testified at the February 2021 hearing, that he has pretty significant instability. Specifically, the Veteran stated that stepping up or down causes sharp pain in his knees and that his knees are very unstable. The Veteran further testified that if he is on his knees for an extended period of time his knees will swell of lock. The Veteran had another examination for his bilateral knee disabilities in July 2021. Flexion of the Veteran's right knee was limited to 110 degrees and flexion of the Veteran's left knee was limited to 100 degrees. The Veteran exhibited normal range of motion for extension for both knees. There was evidence of pain on active and passive motion, which resulted in functional loss. Specifically, the examiner noted that the Veteran had difficulty with bending, stooping, and crawling. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue for both knees. There was objective evidence of crepitus for both knees. The Veteran was able to complete repetitive use testing without reduction in range of motion. The Veteran reported experiencing flare-ups, however, the examiner noted that the Veteran reported flares to be almost daily "which would suggest this is his baseline pain and not a true flare". The examiner indicated that there was reduction in range of motion with repeated use over time. Specifically, the examiner noted that the Veteran's right knee flexion was limited to 105 degrees, and left knee flexion was limited to 95 degrees. There was no evidence of muscle atrophy or ankylosis. There was no evidence of recurrent subluxation or persistent instability. The examiner indicated that there was no evidence of medial tibial stress syndrome or any other tibial and/or fibular impairment. The examiner indicated that the Veteran did not have a right knee meniscal condition. However, the examiner noted that the Veteran had a left knee meniscal tear with frequent episodes of joint "locking" and pain. The Veteran denied using assistive devices for his bilateral knee conditions. Given the evidence of record, the Board finds that a disability rating greater than 10 percent is not warranted for the Veteran's left and right knee disabilities based on limitation of motion. The Veteran had flexion to, at worst, 105 degrees for the right knee and 95 degrees for the left knee. Pursuant to DC 5260, a 20 percent evaluation is only warranted if flexion is limited to 30 degrees or less. As such a disability rating greater than 10 percent is not warranted for the Veteran's loss of flexion pursuant to DC 5260. Furthermore, a separate compensable rating is not warranted under DC 5261 as the Veteran had extension to 0 degrees (which is normal) during both the July 2017 and the July 2021 examinations. With regard to the potential for a higher rating for the left and right knees based additional loss of motion due to flare-ups of the left knee pursuant to Sharp, the Board notes that, even considering the Veteran's flare-ups during the July 2021 examination, the Veteran had flexion to, at worst, 105 degrees for the right knee and 95 degrees for the left knee. The examiner specifically noted that Veteran reported daily flare-ups, which the examiner suggested would be indicative of the Veteran's baseline pain and not a "true flare". As for the period of time prior to July 2021, there is no evidence of flare-ups. Significantly, during the July 2017 examination, the Veteran denied experiencing flare-ups. The Board accepts that the Veteran has functional impairment, pain, and pain on motion (see DeLuca) and finds the Veteran's own reports of symptomatology to be credible. However, neither the lay nor medical evidence reflects the functional equivalent of symptoms required for a higher rating. The more probative evidence consists of that prepared by neutral skilled professionals, and such evidence demonstrates that the currently assigned 10 percent rating is warranted and no more. The Board notes that there is no evidence of ankylosis, tibia and fibula impairment, or genu recurvatum. As a result, DCs 5256, 5262, and 5263 are not for application. There is no evidence of record that the Veteran has a right knee meniscal impairment. Although the July 2021 examiner noted that the Veteran had a left knee meniscal tear with frequent episodes of joint "locking" and pain, there is no evidence of effusion into the joint. Additionally, there is no evidence of removal of semilunar cartilage. Based on these findings, no additional separate rating is warranted under DCs 5258, or 5259. As such, a disability rating greater than 10 percent for the Veteran's left and right knee disabilities is not warranted. 6. & 7. Entitlement to separate 10 percent ratings for left and right knee instability The Board finds that the Veteran is entitled to separate 10 percent ratings for left and right knee instability. The Veteran has consistently reported issues with instability, trouble going up and down stairs or inclines, and that his left and right knee tend to "lock". Although the July 2017 and July 2021 examiners found no objective evidence of instability, objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). Objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See id. The Veteran has been consistent in his statements throughout the appeal about balance and feeling unstable. The Board finds him credible in so stating. As such, the Board finds that separate ratings for left and right knee instability are warranted for the period on appeal. Knee instability is rated under 38 C.F.R. § 4.71a, DC 5257. Prior to the regulatory change, slight impairment is assigned a 10 percent rating, moderate impairment a 20 percent rating, and severe impairment a 30 percent rating. The words "slight," "moderate," and "severe," as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just" decisions. 38 C.F.R. § 4.6. The Board finds that the Veteran's reports of his knee giving out are credible, and that they support a finding of mild instability under Diagnostic Code 5257; however, the preponderance of the evidence is against a rating in excess of 10 percent for left or right knee instability. The Board has carefully considered the Veteran's reports about instability, in particular the Veteran's reports of issues with balance and instances of "locking". English, 30 Vet. App. 347, 352-53. However, overall, the lay and medical evidence indicates that the instability symptoms have varied and do not suggest the presence of symptoms more nearly approximating moderate severity. The Veteran's statements do not indicate that his instability occurs on a frequent basis sufficient to rise to a moderate level. Moreover, there is no objective evidence of instability, subluxation, or laxity. Furthermore, a higher rating for instability is not warranted under the revised criteria because there is no evidence of a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace, cane, or walker. Additionally, there is no evidence of a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation; or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. Notably, the Veteran denied using an assistive device at the July 2021 examination. As such, the Board finds that separate 10 percent ratings, but no higher, are warranted for left and right knee instability. 8. Entitlement to a disability rating in excess of 10 percent for bilateral pes cavus The Veteran's bilateral pes cavus has been rated, under DC 5284-5278, as 10 percent disabling. In the assignment of diagnostic code numbers, hyphenated diagnostic codes may be used. Injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. Diseases will be identified by the number assigned to the disease itself, followed by a hyphen, with the residual condition listed last. 38 C.F.R. § 4.27. Therefore, the Veteran has been rated under other foot injuries (DC 5284) with residuals of acquired claw foot (pes cavus) (DC 5278). DC 5284 provides a 10 percent rating for impairment of moderate degree, a 20 percent rating for moderately severe impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a. Words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Under DC 5278, a 10 percent evaluation is warranted for bilateral or unilateral limitation of dorsiflexion at the ankle and definite tenderness under the metatarsal heads, with the great toe dorsiflexed. See 38 C.F.R. § 4.71a. A 20 percent rating is assigned for unilateral pes cavus where there is evidence of all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. A 30 percent rating is assigned for unilateral pes cavus where there is evidence of marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. 38 C.F.R. § 4.71a, DC 5278. The criteria under DC 5278 are conjunctive, not disjunctive. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive requirement must be met in order for an increased rating to be assigned). The Veteran had an examination for his bilateral foot disability in July 2017. The examiner noted that the Veteran experienced pain and tenderness due to bilateral pes cavus. There was no limitation of dorsiflexion. The Veteran denied experiencing flare-ups. There was no evidence of hallux valgus, metatarsalgia, Morton's neuroma, hammer toe, or hallux rigidus. The examiner noted that the Veteran experienced pain on movement and pain with weight-bearing. The Veteran reported bilateral arch pain when walking long distances. At the February 2021 Board hearing, the Veteran testified that if he stands or walks for a long period of time, he will have sharp pain in the arches of his feet. The Veteran had another examination for his bilateral foot disability in July 2021. The examiner noted that the Veteran experienced definite tenderness under metatarsal heads and shortened plantar fascia. There was no limitation of dorsiflexion. The Veteran described experiencing flare-ups, however, the examiner noted that the Veteran's lay description of functional impairment during flares was rejected because the Veteran reports flares too frequently, "indicating more likely, his natural baseline pain". There was no evidence of hallux valgus, metatarsalgia, Morton's neuroma, plantar fasciitis, hammer toe, or hallux rigidus. The examiner described the Veteran's bilateral foot disability as moderate. The examiner further noted that the Veteran's foot condition did not chronically compromise weight-bearing and did not require arch supports. The examiner noted that the Veteran experienced functional loss due to pain during flare-ups and/or after repeated use over time. Specifically, the examiner noted that the Veteran experienced difficulty standing and ambulating for long periods of time due to pain. There was evidence of pain with passive motion and weight-bearing. The Veteran denied using assistive devices. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of a rating in excess of 10 percent rating for a bilateral pes cavus disability. The evidence indicates that during this part of the appeal period the Veteran's bilateral foot disability is manifested with pain and functional loss but does not result in unilateral pes cavus where there is evidence of all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads, which is the criteria for a 20 percent rating under DC 5278. Examination results throughout this part of the appeal period indicate that the Veteran had bilateral pes cavus, resulting in pain, disturbance of locomotion, and interference with standing. Furthermore, while there was evidence of definite tenderness under metatarsal heads and shortened plantar fascia, there was no evidence of limitation of dorsiflexion and no effect on toes due to pes cavus. Furthermore, the evidence indicates that the Veteran's bilateral foot disability was not manifested by a moderately severe foot injury during this part of the appeal period, which is the criteria for a 20 percent rating under DC 5284. Notably, the Veteran does not have Morton's neuroma (Morton's disease) and metatarsalgia, hammer toe, hallux valgus, hallux rigidus, or malunion or nonunion of tarsal or metatarsal bones. Furthermore, the July 2021 examiner described the Veteran's bilateral foot disability as moderate. The Board has considered the effects of the Veteran's symptoms, including pain and functional loss, and the Board concludes that the preponderance of the evidence is against a finding of unilateral pes cavus where there is evidence of all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads, which is the criteria for a 20 percent rating under DC 5278. The Board also concludes that preponderance of the evidence is against a finding of moderately severe foot injury during the appeal period, which is the criterion for a 20 percent rating under DC 5284. Taking into account the evidence of record indicating the Veteran's regular complaints of pain and functional loss, the Board finds that the evidence does not reflect that such pain and symptoms resulted in a finding of unilateral pes cavus where there is evidence of all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads, or a finding of moderately severe foot injury, which would be required for a finding that the Veteran was entitled to a 20 percent disability rating under either DC 5278 or DC 5284. Thus, a higher rating under the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria is not approximated in the Veteran's disability picture for this appeal period. To the extent that the Board is denying entitlement to a disability rating in excess of 10 percent, the Board notes specifically that the Veteran's symptoms of pain, disturbance of locomotion, and interference with standing have been considered in evaluating the Veteran's disability picture. See 38 C.F.R. § 4.6 (Board must evaluate all of the evidence, to the end that its decisions are "equitable and just"). In sum, the evidence does not show that a 20 percent rating for the Veteran's bilateral pes cavus disability is warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran's claim for an increased rating is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 9. Entitlement to a compensable disability rating for bilateral hearing loss The Veteran contends that he should be awarded a compensable disability rating for his service-connected bilateral hearing loss. The assigned evaluation for hearing loss is determined by mechanically applying the rating criteria to certified test results under DC 6100 for hearing loss. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Under DC 6100, ratings for hearing loss are determined in accordance with the findings obtained on audiometric examination. Evaluations of hearing impairment range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies 1000; 2000; 3000; and 4000 Hertz (cycles per second). To evaluate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, DC 6100. As set forth in the regulations, Tables VI, VIa, and VII are used to calculate the rating to be assigned. See 38 C.F.R. § 4.85, DC 6100. Hearing tests will be conducted without hearing aids, and the results of above-described testing are charted on Table VI and Table VII. See 38 C.F.R. § 4.85. An August 2017 hearing loss examination revealed the following puretone thresholds, in decibels: HERTZ 1000 2000 3000 4000 Average RIGHT 10 10 20 35 19 LEFT 10 5 45 80 35 Speech recognition testing using the Maryland CNC Word List revealed speech recognition ability of 96 percent for both the right ear and the left ear. A July 2021 hearing loss examination revealed the following puretone thresholds, in decibels: HERTZ 1000 2000 3000 4000 Average RIGHT 10 15 20 45 23 LEFT 10 10 60 85 41 Speech recognition testing using the Maryland CNC Word List revealed speech recognition ability of 96 percent for both the right ear and the left ear. Concerning the functional impairment caused by his hearing loss, the Veteran testified at the February 2021 Board hearing that his hearing loss has gotten worse since separation from service. The Veteran further testified that he has difficulty understanding people, and that he has formed a habit of looking at lip movements to make sure that he understood what someone said. These audiometry test results equate to Level I in the right ear and Level I in the left ear using Table VI. 38 C.F.R. § 4.85. Applying the percentage ratings for hearing impairment found in Table VII, the August 2017 and July 2021 audiogram results do not warrant a compensable disability rating. 38 C.F.R. § 4.85. The Board has considered the Veteran's symptomology and functional impact. The Veteran's complaints of hearing difficulty have been considered under the numerical criteria set forth in the rating schedule. In short, the rating criteria reasonably describe the Veteran's disability levels and symptomatology. The Board in no way discounts the difficulties that the Veteran experiences because of his hearing loss. The Veteran is competent to testify to facts or circumstances that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). However, it must be emphasized, as previously noted, that the disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Hence, the Board must base its determination on the results of the pertinent audiological evaluations of record. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). In other words, the Board is bound by law to apply VA's rating schedule based on the Veteran's audiometry results. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Furthermore, the regulations that designate decibel loss and speech discrimination for each level of hearing impairment in Table VI were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. In support of this finding, the Board points to the regulatory history of 38 C.F.R. §§ 4.85 and 4.86. In this regard, the rating criteria for hearing loss were last revised, effective June 10, 1999. See 64 Fed. Reg. 25206 (May 11, 1999). In forming these revisions, VA sought the assistance of the Veteran's Health Administration (VHA) in developing criteria that contemplated situations in which a veteran's hearing loss was of such a type that speech discrimination tests may not reflect the severity of communicative functioning these veterans experienced or that was otherwise an extreme handicap in the presence of any environmental noise, even with the use of hearing aids. VHA had found through clinical studies of veterans with hearing loss that when certain patterns of impairment are present, a speech discrimination test conducted in a quiet room with amplification of the sounds does not always reflect the extent of impairment experienced in the ordinary environment. Accordingly, a different table of decibel threshold requirements was established (i.e., Table VIA), with the intended effect being to fairly and accurately assess the hearing disabilities of veterans as reflected in a real-life industrial setting. 59 Fed. Reg. 17295 (April 12, 1994). Those certain patterns of impairment are specifically laid out in the schedule, and this Veteran's hearing thresholds do not qualify. See 38 C.F.R. §§ 4.85(c), 4.86(a). Accordingly, the Board finds that functional impairment due to hearing loss that is compounded by background or environmental noise, or otherwise requires assistive devices to overcome, is a disability picture that is considered in the current schedular rating criteria. Thus, the Board finds that the schedular rating criteria adequately contemplate the Veteran's symptomatology. Under these circumstances, the Board finds that throughout the period on appeal, the record has presented no basis for the assignment of a compensable disability rating for the Veteran's service-connected bilateral hearing loss. Accordingly, the claim is denied. Absent a relative balance of the evidence for and against the claim, the evidence is not in equipoise and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 10. Entitlement to a compensable disability rating for hypertension The Veteran contends that his service-connected hypertension warrants a compensable rating. Under Diagnostic Code 7101, a 10 percent rating is assigned for hypertension with diastolic pressure (bottom number) predominantly 100 or more, or systolic pressure (top number) predominantly 160 or more. A 10 percent rating also is the minimum rating 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 hypertension with diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for hypertension with diastolic pressure predominantly 120 or more. The maximum 60 percent rating is assigned for hypertension with diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104. There are three notes to 38 C.F.R. § 4.104, Diagnostic Code 7101. Note (1) provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure (i.e., bottom number) is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure (i.e., top number) is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Note (2) requires the evaluation of hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3) states that hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease. The Board notes that the use of medications is explicitly contemplated in Diagnostic Code 7101 and that the Court has held that 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. McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016). The Veteran had an examination for his hypertension in August 2017. The Veteran's treatment plan included taking continuous medication for his hypertension or isolated systolic hypertension. Blood pressure readings at the August 2017 examination were as follows: 127/87; 116/74; and 130/82. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner indicated that the Veteran did not have a history of a diastolic blood pressure elevation predominantly 100 or more. The Veteran had another examination for his hypertension in July 2021. The Veteran's treatment plan included taking continuous medication for his hypertension or isolated systolic hypertension. Blood pressure readings at the August 2017 examination were as follows: 132/87; 131/80; and 155/94. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner indicated that the Veteran did not have a history of a diastolic blood pressure elevation predominantly 100 or more. Based on the evidence above, the Board finds that, although the Veteran's hypertension requires continuous medication for control, his blood pressure readings have never been predominantly 100 or more in the diastolic readings or predominantly 160 or more in the systolic readings during the appeal period. Further, the Board does not discount the ameliorative effects of blood pressure medication because the plain language of DC 7101 contemplates the effects of medications. McCarroll v. McDonald, 28 Vet. App. 267 (2016). As blood pressure readings simply have not been elevated to the needed levels, the criteria for a compensable rating have not been met and the claim must be denied. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David M. Sebstead, 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.