Citation Nr: 21066723 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 18-15 799 DATE: November 2, 2021 ORDER Entitlement to an initial 10 percent rating for hypertension (HTN) is granted. REMANDED Issue of entitlement to an initial rating higher than 10 percent for HTN is remanded. Issue of entitlement to an initial compensable rating for left ear hearing loss is remanded. FINDING OF FACT The evidence is in at least relative equipoise as to whether the Veteran's HTN has manifested with a diastolic pressure predominantly 100 or more; or with a history of diastolic pressure predominantly 100 or more and requires continuous medication for control. CONCLUSION OF LAW The criteria for entitlement to an initial 10 percent rating for HTN have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2000 to April 2015. This appeal to the Board of Veterans' Appeals (Board) arose from an April 2015 rating decision issued by the Department of Veterans Affairs (VA). See May 2015 Notice of Disagreement (NOD); January 2018 Statement of the Case (SOC); March 2018 Substantive Appeal (VA Form 9). The Veteran testified before the undersigned Veterans Law Judge in a June 2021 hearing. See June 2021 Hearing transcript. Entitlement to an initial 10 percent rating for HTN. The Veteran asserts that his medical treatment records support entitlement to a higher rating for HTN. May 2015 NOD. The Veteran testified that he has been on continuous medication for his HTN since 2005 and has had blood pressure readings with systolic values above 160 and diastolic values above 100. June 2021 Hearing Transcript. Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. See 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Board has considered the entire record, but only the evidence pertinent to the rating criteria and current disability will be discussed. See Gonzales v. West, 218 F. 3d 1378 (Fed. Cir. 2000). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran's HTN is currently evaluated under Diagnostic Code 7101 and rated as noncompensable, or zero percent disabling. April 2015 Rating Decision. Under Diagnostic Code 7101, a 10 percent rating is warranted for HTN with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. 38 C.F.R. § 4.104. The next higher rating of 20 percent is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. Id. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. After careful and thorough review of the evidence, the Board finds that the Veteran's HTN more nearly approximates the criteria for a 10 percent rating. Service treatment records show that the Veteran has had diastolic blood pressure readings over 100. See, e.g., January 2013 Service Treatment Records; May 2013 Service Treatment Records; April 2015 Naval Medical Center records. Medical treatment records since separation since shows that the Veteran has been on medication for his HTN but would still have occasional diastolic blood pressure readings above 100. See, e.g., July 2015 Naval Medical Center records; June 2016 Naval Medical Center records; August 2016 Naval Medical Center records; May 2021 Vital Signs History. This evidence supports that the Veteran had at least a history of diastolic blood pressure above 100 and takes continuous medication for control. The Board also considered the Veteran's testimony that his blood pressure readings taken at home normally showed a systolic value between 140 to 160 and diastolic value between 96 to 100. June 2021 Hearing Transcript. The Board finds the Veteran's testimony to be probative as he is competent to take his blood pressure at home and report the reading values. The Board recognizes that the medical treatment evidence also shows that the Veteran has had diastolic blood pressure readings below 100 during the period on appeal. See, e.g., July 2015 Naval Medical Center records; August 2016 Naval Medical Center records; December 2016 Naval Medical Center records; December 2017 Naval Medical Center records; May 2021 Vital Signs History. In addition, the Veteran testimony suggests his home blood pressure readings have shown diastolic values below 100. See June 2021 Hearing Transcript. This evidence raises a reasonable doubt as to whether the Veteran's diastolic blood pressure has been predominantly over 100 during the period on appeal. In resolving any reasonable doubt in favor of the Veteran, the Board finds that the medical and lay evidence support that the Veteran's HTN has manifested with diastolic pressure predominantly over 100 or more, or that he at least has had a history of diastolic blood pressure of 100 or more and requires continuous medication for control. The Board considered whether the current evidence supports that the Veteran's HTN has manifested with symptoms that warrant a 20 percent rating. However, the Board finds that the preponderance of the evidence is against finding that the Veteran's HTN has manifested with symptoms that more closely approximates a 20 percent rating. There is no medical or lay evidence that supports the Veteran has had a systolic blood pressure of 200 or more. While the medical evidence does show a few instances of diastolic blood pressure of 110 or more, the predominant readings during the period on appeal are less than 110. See, e.g., July 2015 Naval Medical Center records; June 2016 Naval Medical Center records; August 2016 Naval Medical Center records; December 2016 Naval Medical Center records; December 2017 Naval Medical Center records; May 2021 Vital Signs History. The Veteran testimony is also against finding that he has had a diastolic blood pressure predominantly 110 or more. June 2021 Hearing Transcript. Accordingly, the Board finds that entitlement to a 10 percent rating, but no higher, is warranted for the Veteran's HTN based on the current evidence. REASONS FOR REMAND 1. Issue of entitlement to an initial rating higher than 10 percent for HTN is remanded. The Board cannot make a fully informed decision on whether the Veteran's HTN warrants an initial rating higher than 10 percent because further development of the evidence is needed. The Veteran's May 2021 Vital Signs History from Portsmouth Naval Medical Center suggests that the Veteran has had treatment at the facility up through April 2021, but the most recent medical treatment records in the claims file from the Naval Medical Center is through 2017. The Board finds that an attempt to obtain any outstanding treatment records is needed. In addition, the Board finds that the Veteran should be afforded the opportunity for a VA examination to assess the current severity of his HTN. 2. Issue of entitlement to an initial compensable rating for left ear hearing loss is remanded. During the June 2021 Board hearing, the Veteran testified that his hearing loss has increased in severity since the Veteran was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his hearing loss. The matters are REMANDED for the following action: 1. Ask the Veteran to identify the provider(s) of any evaluations and/or treatment received for his HTN and left ear hearing loss, to specifically include treatment at the Portsmouth Naval Medical Center. Request that he provide authorizations for VA to obtain records of any private treatment that is not already part of the claims file and attempt to obtain the records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected HTN. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left ear hearing loss. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.