Citation Nr: 21064740 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-49 042 DATE: October 21, 2021 ORDER Service connection for an acquired psychiatric disorder, diagnosed as delusional disorder, is denied. Entitlement to a higher initial rating of 10 percent for the service-connected hypertension disability from June 8, 2016 is granted. Entitlement to special monthly compensation (SMC) based on the need for the aid and attendance (A&A) of another is denied. FINDINGS OF FACT 1. The Veteran has a current acquired psychiatric disability, diagnosed as delusional disorder. 2. The acquired psychiatric disability did not have its onset in service and is not otherwise etiologically related to service. 3. From June 8, 2016, the service-connected hypertension disability manifested in the need for continuous medication for control, without evidence of diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. 4. The Veteran's service-connected hypertension does not require the care or assistance of another on a regular basis. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder, diagnosed as delusional disorder, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. Resolving reasonable doubt in favor of the Veteran, the criteria for an initial rating of 10 percent for the service-connected hypertension from June 8, 2016 have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.104, DC 7101. 3. The criteria for special monthly compensation based on the need for the regular aid and attendance of another person are not met for any period. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1965 to August 1967, including in the Republic of Vietnam from February 13, 1967 to August 3, 1967. This appeal comes to the Board of Veterans' Appeals (Board) from a July 2017 rating decision. The Board has recharacterized an issue on appeal as service connection for an acquired psychiatric disorder, to include delusional disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that a claim for benefits of one psychiatric disability also encompassed benefits based on other psychiatric diagnoses and should be considered by the Board to be within the scope of the filed claim). These claims were before the Board in April 2019. The Board reopened the claim for service connection for an acquired psychiatric disorder, and remanded the issues of service connection for an acquired psychiatric disorder and service connection for hypertension for further development in order to obtain outstanding treatment records and conduct VA examinations. The issue of entitlement to SMC was remanded as it was inextricably intertwined with the two service connection appeals. VA examinations were conducted in November 2020. The issues were denied in a February 2021 supplemental statement of the case (SSOC). These claims came before the Board again in June 2021. The Board remanded the issues in order to obtain VA examination addendum opinions. VA examinations were conducted in August 2021. An August 2021 SSOC denied service connection for an acquired psychiatric disorder and entitlement to SMC. An August 2021 rating decision granted service connection for hypertension and assigned an initial disability rating of 0 percent from June 8, 2016. Duties to Notify and Assist The Board finds that the duties to notify and assist the Veteran in this case have been fulfilled. Neither the Veteran nor the representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). Legal Authority for Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). 1. Service Connection for an Acquired Psychiatric Disorder The Veteran generally contends that the acquired psychiatric disorder, diagnosed as delusional disorder, is related to service. The Veteran expressed that he had paranoid thinking related to his service in Vietnam. After a review of the record, the Board finds that the Veteran has a current acquired psychiatric disorder, diagnosed as delusional disorder. See November 2020 VA Examination. The weight of the evidence is against finding that the current acquired psychiatric disorder had its onset in service or is otherwise etiologically related to service. In an August 2021 VA examination, a VA examiner rendered a negative nexus opinion based on direct service connection. The VA examiner reasoned that there is no evidence that Veteran's diagnosed delusional disorder is associated with his military service. The VA examiner explained that the records provided clearly describe no diagnosis or treatment for a delusional disorder until 1977 (approximately nine years after service separation), and there is no evidence of mental health issues during military service. For these reasons, the Board finds that the preponderance of the evidence is against service connection for an acquired psychiatric disorder, diagnosed as delusional disorder; therefore, the claim for service connection must be denied. 2. Entitlement to a Higher (Compensable) Initial Rating for Hypertension from June 8, 2016 Under DC 7101, which governs ratings of hypertensive vascular disease (hypertension and isolated systolic hypertension), a 10 percent rating is assignable for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; 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 assignable for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent rating is assignable for diastolic pressure predominantly 120 or more. A 60 percent rating is assignable for diastolic pressure predominantly 130 or more. Note (1) states 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 is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. See 38 C.F.R. § 4.104, DC 7101. A noncompensable (0 percent) initial disability rating was assigned under DC 7101 for the service-connected hypertension from June 8, 2016 because of a finding that there were no compensable symptoms; however, compensable symptoms is only one means for obtaining a compensable rating for hypertension. As the service-connected hypertension disability manifested in the need for continuous medication for control from June 8, 2016, without evidence of diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more, the evidence is in equipoise as to whether the rating criteria for a 10 percent rating under DC 7101 are met. Upon review of private treatment records, the Veteran has been taking a prescription drug (Lisinopril) to control the hypertension symptoms throughout the entire period on appeal. See Private Treatment Records from June 2016 to September 2019; October 2020 VA Examination; August 2021 VA Examination. The weight of the evidence is against finding that a rating in excess of 10 percent is warranted for any period of the initial rating appeal. In this case, the evidence does not show that diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more, to warrant a higher 20 percent disability rating under DC 7101. See August 2016 Private Treatment Records (140/80); September 2016 Private Treatment Records (140/80); October 2016 Private Treatment Records (130/70); November 2016 Private Treatment Records (130/70); December 2016 Private Treatment Records (110/70); January 2017 Private Treatment Records (130/80); January 2017 Private Treatment Records (130/70); March 2017 Private Treatment Records (166/80); April 2017 Private Treatment Records (140/80); June 2017 Private Treatment Records (138/92); July 2017 Private Treatment Records (136/72); September 2017 Private Treatment Records (122/76); February 2018 Private Treatment Records (138/76); April 2018 Private Treatment Records (150/86); May 2018 Private Treatment Records (100/60); June 2018 Private Treatment Records (130/70); August 2018 Private Treatment Records (148/79); September 2018 Private Treatment Records (140/62); October 2018 Private Treatment Records (150/80); December 2018 Private Treatment Records (130/80 and 140/80); January 2019 Private Treatment Records (138/76); February 2019 Private Treatment Records (138/80); April 2019 Private Treatment Records (125/80); May 2019 Private Treatment Records (106/68); September 2019 Private Treatment Records (130/72); October 2020 VA Examination (150/90); August 2021 VA Examination (118/74). Based on the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for an initial rating of 10 percent, and no higher, for the service-connected hypertension disability from June 8, 2016 have been met. 38 C.F.R. §§ 4.3, 4.7. 3. SMC for Aid & Attendance Compensation at the aid and attendance rate is payable when the veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350 (b). Determinations as to the need for regular aid and attendance are factual and must be based upon the actual requirements for personal assistance from others. In making such determinations, consideration is given to such conditions as: the inability of the claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; the inability of the claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; or incapacity, either physical or mental, which requires care or assistance on a regular basis to protect a claimant from hazards or dangers incident to one's daily environment. It is not required that all of the disabling conditions enumerated be present before a favorable rating is made. The particular personal functions that the claimant is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the claimant be so helpless as to be in need of regular aid and attendance, not that there is a constant need. "Bedridden" constitutes a condition which, through its essential character, actually requires that an individual remain in bed. The fact that a claimant has voluntarily taken to bed, or that a physician has prescribed bed rest for a lesser or greater portion of the day will not suffice. 38 C.F.R. § 3.352(a). In Turco v. Brown, 9 Vet. App. 222, 224 (1996), the Court held that eligibility for special monthly compensation by reason of regular need for aid and attendance requires that at least one of the factors set forth in VA regulation is met. In addition, determinations that the claimant is so helpless as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. The regulations also provide additional compensation on the basis of being housebound where the veteran (1) has, in addition to a single, permanent service-connected disability rated 100 percent disabling, additional service-connected disability or disabilities independently evaluated as 60 percent or more disabling which are separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. A veteran will be considered housebound where the evidence shows that, as a direct result of his service-connected disability or disabilities, he is substantially confined to his dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350. In this case, the Veteran asserts that special monthly compensation based on aid and attendance is warranted due to "obstructive sleep apnea, paranoid ideation, cervical spondylosis, lumbar disc disorder with myelopathy, pain in the joints, acute chest syndrome, and a fall from slipping/tripping." See January 2017 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (VA Form 21-2680). Hypertension is the only service-connected disability. Neither the Veteran nor the Veteran's representative proffers any specific reason for entitlement to SMC for A&A based on the service-connected hypertension. See January 2017 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance; August 2017 Notice of Disagreement; September 2017 VA Form 9; May 2021 Appellate Brief; October 2021 Appellate Brief. After a review of the record, private treatment records and VA examinations indicate that, while the Veteran is taking medication to control the hypertension, there is no indication that the hypertension necessitates the care or assistance of another on a regular basis. See Private Treatment Records from June 2016 to September 2019; October 2020 VA Examination; August 2021 VA Examination. For these reasons, the Board finds that the weight of the evidence demonstrates that the Veteran does not have a factual need for the regular aid and attendance of another person due to the service-connected hypertension; therefore, the criteria for a special monthly compensation based on the need for the regular aid and attendance of another person have not been met. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Costantino, 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.