Citation Nr: 21068702 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 18-18 273 DATE: November 12, 2021 ORDER Entitlement to a 10 percent rating, but no higher, for hypertension is granted. FINDING OF FACT During the appeal period, the Veteran's hypertension manifested in a history of diastolic pressure predominantly 100 or more and requiring continuous medication for control. 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 of 10 percent, but no higher, for service-connected hypertension have 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 served on active duty in the United States Army from April 1969 to December 1971. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Campaign Medal with the 1960 Device and the Army Commendation Medal with Oak Leaf Cluster. This matter comes before the Board of Veterans' Appeals (Board) from a November 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). This claim was most recently remanded by the Board in May 2021 for further development, to include providing VA examination and updating treatment records. The Board finds substantial compliance with the remand directives and therefore another remand is not necessary. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to a 10 percent rating, but no higher, for hypertension The Veteran contends that he is entitled to a higher rating for his hypertension. A March 2015 rating decision granted service connection for hypertension with an initial noncompensable rating, effective January 2007. The VA's Schedule for Rating Disabilities is used to determine disability ratings once a disability is service-connected. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In the Rating Schedule, Diagnostic Codes (DC) are assigned to specific disabilities. These DCs designate percentage ratings based on the average functional impairment of the Veteran due to a service-connected disability. 38 C.F.R. §§ 3.321, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may 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). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. 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 manifested in a history of diastolic pressure predominantly 100 or more requiring continuous medication for control, corresponding to the criteria for a 10 percent rating under DC 7101. VA and private treatment records from December 1993 to March 2003 show the Veteran's diastolic pressure was frequently measured at or greater than 100. His highest diastolic reading was 120 in November 1996. During this time his medicine was adjusted to reduce his diastolic pressure to under 100. The Veteran has remained on daily medication to control his blood pressure. VA and private treatment records from December 1993 to March 2003 also show that the Veteran's systolic pressure during this time was consistently under 160, with the highest systolic pressure reading of 158 in November 1996. VA treatment records from October 2004 forward reveal his systolic pressure was predominantly measured below 160. The highest systolic pressure readings were 162 in August 2014, 151 at the August 2015 VA examination, and 165 at the January 2021 VA examination. However, most systolic pressure readings were below 160 and ranged between 120 and 147. See, e.g., December 2013, August 2017, and March 2018 VA treatment records. At the August 2011 and August 2015 VA examinations the Veteran reported his systolic pressure can reach 160 at its highest. At the September 2021 VA examination the Veteran's highest systolic pressure reading was 139. VA treatment records from October 2004 forward also reveal his diastolic pressure was consistently measured at below 100. At the August 2015 VA examination the Veteran reported taking his blood pressure every day and intermittently having diastolic pressure as high as 95. The highest diastolic pressure reading in file during this time was 98 in March 2011, with most readings ranging between 69 and 91. See, e.g., September 2021 VA examination; May 2018 and January 2021 VA treatment records. At the September 2021 VA examination the Veteran's highest diastolic pressure reading was 82. In summary, the Veteran required continuous medication for control of his blood pressure throughout the appeal period. VA and private treatment records show a history of diastolic pressure predominantly greater than 100; however, diastolic readings after 2004 have consistently been measured at less than 100. Additionally, medical records reveal rare instances of systolic pressure measured at greater than 160; the predominant systolic measurements have ranged between 120 and 147. Accordingly, during the appeal period, the Veteran's hypertension has manifested in a history of diastolic pressure predominantly 100 or more requiring continuous medication for control, corresponding to the criteria for a 10 percent rating under DC 7101. 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. As above, diastolic pressure was predominantly measured below 100, and there are no systolic pressure readings of 200 or greater. Thus, 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 rating of 10 percent, but no higher, is warranted. To the extent that the Veteran contends entitlement to higher ratings, the preponderance of the evidence is against the claim; there is no reasonable doubt to be resolved; and any further increased rating is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Blevins, 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.