Citation Nr: 21067241 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-45 435 DATE: November 3, 2021 ORDER Entitlement to an evaluation greater than 10 percent for hypertension is denied. REMANDED Entitlement to service connection for arthritis of the fingers (also claimed as gout) is remanded. FINDING OF FACT During the appeal period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Marines Corps from February 1982 to July 1982 and active service in the United States Air Force from August 1984 to March 1988. These matters are on appeal from a July 2015 rating decision. In March 2020 and May 2021, the Board remanded the appeal for additional evidentiary development. In a March 2020 rating decision, the Agency of Original Jurisdiction (AOJ) granted a total disability rating based upon individual unemployability for the entire appeal period. This issue is no longer on appeal before the Board. 1. Entitlement to an evaluation greater than 10 percent for hypertension In December 2018, the Veteran testified that his hypertension had worsened. During exacerbations he experienced head pain and dizziness. He indicated that during exacerbations his systolic blood pressure ranged from 165-175 and that his diastolic blood pressure ranged from 110-115. His blood pressure on average was 125/80. Hypertension is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or; it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant. For the reasons that follow, the Veteran's hypertension has been manifested by the need for continuous medication and diastolic pressure predominately less than 110 and systolic pressure predominately less than 200, corresponding to the criteria for a 10 percent rating under DC 7101. In July 2015, the Veteran was afforded a VA hypertension examination. The VA examiner diagnosed hypertension and indicated that the Veteran's condition required continuous medication. The Veteran's blood pressure readings were 122/76, 132/80, and 120/78. The Veteran did not have any complications related to his hypertension. Finally, in November 2020, the Veteran underwent his most recent VA hypertension examination. The VA examiner diagnosed hypertension and indicated that the Veteran's condition required continuous medication. The Veteran's blood pressure readings were 154/88, 152/90, and 150/94. The Veteran did not have any complications related to his hypertension. A December 2017, VA treatment note indicated that the Veteran's blood pressure was low with bradycardia, which could cause dizziness, headache, and passing out. The Veteran's VA treatment records do not disclose diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Accordingly, during the appeal period, the Veteran's hypertension has manifested by the need for continuous medication and diastolic pressure predominately less than 110 and systolic pressure predominately less than 200, corresponding to the criteria for a 10 percent rating under DC 7101. In reaching its conclusion, the Board has considered the Veteran's lay statements. To the extent that the Veteran has asserted his hypertension has caused headaches, the Board finds that the VA examinations and treatment records are more probative. The VA examiners have found that that the Veteran does not have any complications related to his hypertension. The effect of hypertension on the body is a medically complex issue. The VA examination findings were rendered by medical professionals and are more probative as the Veteran has not demonstrated the expertise necessary to make such an association. The Board notes that the Veteran has already been awarded service connection for chronic vascular headaches with dizziness, loss of equilibrium, head pain, and neck pain. Finally, the Veteran has only asserted that he has occasionally had systolic blood pressure ranged from 165-175 and diastolic blood pressure ranged from 110-115. He testified that his blood pressure on average was 125/80. Therefore, his lay statements accepted on their face do not establish diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A higher 20 percent rating under DC 7101 is not warranted unless diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more. During the appeal period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Accordingly, his hypertension does not more nearly approximate the criteria corresponding to a 20 percent rating. A higher 20 percent rating is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for arthritis of the fingers (also claimed as gout) is remanded. In December 2018, the Veteran testified that he injured his hand when he fell during an obstacle course training exercise. Pursuant to the Board's March 2020 remand, the Veteran was afforded a VA examination to determine the nature and etiology of his arthritis of the fingers. The VA arthritis examination report indicates that the Veteran does not have a current diagnosis related to his claim for arthritis of the fingers. The Veteran denied pain with or without joint movement. There was no limitation of motion or any joint deformities. The Veteran was also afforded a VA hand and finger examination. The VA examiner diagnosed degenerative calcification of the third metacarpal phalangeal joint of the right hand. Initial range of motion testing was normal. He was able to complete repetitive use testing without additional functional loss or range of motion after three repetitions. The VA examiner remarked that there were no findings, signs, or symptoms to support a diagnosis. The VA examiner provided a negative nexus opinion and elaborated that the Veteran denied chronic hand issues. This opinion is inadequate, because it offers no explanation as to why the Veteran's degenerative calcification of the third metacarpal phalangeal joint of the right hand was caused by his in-service fall. Furthermore, a secondary service connection opinion as not provided either. A remand is required to obtain an adequate VA medical opinion. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's degenerative calcification of the third metacarpal phalangeal joint of the right hand is at least as likely as not related to an in-service injury, event, or disease, including the Veteran's in-service fall and the physical toll of his training activities. The VA examiner must also opine as to whether it is at least as likely as not that the Veteran's degenerative calcification of the third metacarpal phalangeal joint of the right hand is at least as likely as not proximately due to or aggravated beyond its natural progression by his service-connected disabilities. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.R. Watkins, 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.