Citation Nr: 21069967 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 16-38 530 DATE: November 22, 2021 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to an initial compensable rating for hypertension is denied. FINDINGS OF FACT 1. Resolving any reasonable doubt in the Veteran's favor, his currently diagnosed tinnitus had its onset during active military service 2. The Veteran's hypertension requires continuous medication for control but has not been productive of diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more during the appellate period. CONCLUSIONS OF LAW 1. The criteria to establish service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303 3.307, 3.309. 2. The criteria for an initial compensable rating for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1994 to February 2014. This appeal stems from September 2014 and February 2015 rating decisions of a Department of Veterans Affairs Regional Office. The Veteran requested a Board hearing, and such was scheduled for May 2019; however, he failed to report to the scheduled hearing. There is no request to reschedule the hearing and no good cause is shown. Therefore, the Board considers the hearing request to be withdrawn and finds it may proceed with adjudication. Service Connection for Tinnitus Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Tinnitus (as an organic disease of nervous system) is considered a "chronic" disease under 38 C.F.R. § 3.309(a). Therefore, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic diseases in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). If not manifest during service, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the 'chronic' disease became manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307. The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record. See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012); Kahana, 24 Vet. App. at 433-34. A claimant bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). In making its ultimate determination, the Board must give an appellant the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. Id. at 1287 (quoting 38 U.S.C. § 5107 (b)). Here, the Veteran asserts that his tinnitus had its onset during active duty service. He is currently diagnosed with tinnitus, a disability capable of lay observation and diagnosis. The Board next concedes exposure to hazardous noise during service because the Veteran's military occupational specialty (MOS) was a helicopter repairman, which carries with it a high probability of noise exposure. As to the etiology, during the February 2015 VA audiology examination, despite the Veteran's reports that his tinnitus began during service, the examiner opined that the tinnitus was less likely than not related to service. The examiner reasoned that the Veteran's hearing was normal during service and that there were no documented complaints of tinnitus. In the August 2016 substantive appeal, the Veteran again indicated that he was a helicopter mechanic for seventeen years and routinely exposed to acoustic trauma. He added that he began having tinnitus during active duty service and that he continues to have tinnitus. On review, the Board resolves all doubt in the Veteran's favor in finding that the Veteran's current tinnitus had its onset during active duty service. Although the Board acknowledges the negative medical opinion, it relied on the fact that service treatment records did not mention tinnitus and that the Veteran's hearing was normal, factors that are not necessarily unfavorable to the claim. As reported by the Veteran, he experienced tinnitus in service and ever since service. He is competent to report such statement and the Board has no reason to doubt the credibility of that statement. Based on this body of evidence, the Board finds that, at the very least, the evidence is in equipoise on the question of whether the Veteran's current tinnitus was incurred in service. Resolving any reasonable doubt in the Veteran's favor, the Board finds that, based on competent and credible evidence of in-service incurrence and continuous post-service symptoms, presumptive service connection for tinnitus is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Initial Rating Claim for Hypertension For the entire initial rating period on appeal, the Veteran's hypertension is rated as noncompensably disabling pursuant to Diagnostic Code 7101. Under Diagnostic Code 7101, a 10 percent rating is warranted for 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. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more or; systolic pressure predominantly 200 or more. A 40 percent rating is warranted for diastolic pressure predominantly 120 or more. A 60 percent rating is warranted for diastolic pressure predominantly 130 or more. The Board may not discount the effects of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 62-63 (2012). However, VA has contemplated the effects of medication as a factor to be considered when rating hypertension under DC 7101. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (holding that Jones does not apply to DC 7101). For the reasons expressed below, the Board finds that a compensable rating for hypertension is not warranted. During a January 2014 VA examination, it was noted that the Veteran was prescribed Metoprolol. The examiner noted that the Veteran was followed by routine care, and that although he had high blood pressure for several years, he was not started on medications until November 2010. The Veteran had no history of a diastolic blood pressure elevation to predominantly 100 or more. Upon physical examination, blood pressure was 122/81, 125/79, and 127/85. The average blood pressure reading was 124/81. A review of the Veteran's treatment records from 2014 to the present revealed the following blood pressure readings in chronological order: 122/81, 128/76, 126/85, 117/73, 118/76, 121/68, 111/60, 112/69, 116/63, 103/69, and 112/71. On review, the Board finds that the preponderance of the evidence is against the Veteran's claim for an initial compensable rating for service-connected hypertension under DC 7101. The medical evidence shows that the Veteran takes prescribed medication for his hypertension, but it does not show that the Veteran's hypertension has been productive of diastolic pressure (or a history thereof) predominantly 100 or more, or systolic pressure predominantly 160 or more, to award a compensable rating. Indeed, his diastolic pressure readings during the appeal period have ranged from 68 and 81, and his systolic pressure readings have ranged from 103 to 128. Although it is the Veteran's belief that without medication his blood pressure readings would be higher, his blood pressure readings considered in this appeal are sufficient for making an increased rating determination even considering the Veteran's use of medication to control his blood pressure. See McCarroll, supra. Accordingly, the Board finds that a preponderance of the evidence is against the claim for an initial compensable rating for hypertension. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.