Citation Nr: 21072198 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-58 010 DATE: December 2, 2021 ORDER An initial 10 percent rating, but not higher, for service-connected hypertension is granted. FINDING OF FACT The most probative evidence dated during the appellate period demonstrates that the Veteran's service-connected hypertension was manifested by the need for continuous medication for control, with numerous readings of diastolic pressure of 100 or more. CONCLUSION OF LAW The criteria for an initial 10 percent rating, but not higher, for service-connected hypertension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1992 to January 1997. A video-conference hearing was held before the undersigned Veterans Law Judge (VLJ) of the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) in August 2021; a transcript of the hearing is associated with the claims file. Entitlement to an initial, compensable rating for service-connected hypertension. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disability. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. Id. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, 38 C.F.R. § 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran's favor. 38 C.F.R. § 4.3. If there is a question as to which disability rating to apply to the Veteran's disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. Where the appeal concerns the initial rating assigned a service-connected disability, as is the case herein, VA assesses the level of disability from the effective date of service connection. See Fenderson v. West, 12 Vet. App. 119, 125 (1999); 38 U.S.C. § 5110 ; 38 C.F.R. § 3.400. A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. See Fenderson, 12 Vet. App. 119; see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods based on the facts found, a practice known as "staged" ratings. The claimant bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107 (a). In making all determinations, the Board must fully consider all lay assertions of record. A layperson is competent to report on the onset and continuity of observable symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). In its evaluation, the Board considers all information and lay and medical evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id. The record before the Board contains voluminous post-service treatment records, which will be addressed as pertinent. Dela Cruz v. Principi, 15 Vet. App. 143, 148-49 (2001) (a discussion of all evidence by the Board is not required when the Board has supported its decision with thorough reasons and bases regarding the relevant evidence.) The Board has considered the Veteran's claim and decided entitlement based on the evidence. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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). Hypertension is rated pursuant to 38 C.F.R. § 4.104, DC 7110. By the May 2016 rating decision on appeal, service connection for hypertension associated with posttraumatic stress disorder (PTSD) was granted and initially assigned a noncompensable rating, effective October 7, 2015. Under DC 7101, for hypertension, evaluated separately from hypertensive heart disease and other types of heart disease, a 10 percent rating is assigned for diastolic pressure predominantly 100 or more; systolic pressure predominantly 160 or more; or, 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 appropriate for diastolic pressure predominantly 120 or more. A 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101, Note 3. During VA treatment in November 2015, the Veteran's blood pressure was recorded as 140/78. In March 2016, it was 128/82, 144/105, and 134/96. In an April 2016 Disability Benefits Questionnaire (DBQ), the examiner noted the Veteran's stable response to treatment, his prescribed medication. The Veteran reported being diagnosed as having hypertension and prescribed medication in 2010. The examiner reported that the Veteran did not have a history of diastolic elevation to predominantly 100 or more. The Veteran's blood pressure was 128/82, 158/98, 160/98; the average being 148/92. The Veteran reported that his hypertension did not impact his ability to work. During VA treatment in June 2016, the Veteran's blood pressure was 138/100 and 146/105. In January 2017, it was 148/98 and 152/109; the Veteran's prescribed medication dose was increased. In December 2017, it was 153/99. In January 2018, it was 165/100, and in July 2018, it was 179/110. In August 2018, VA treatment records indicate that a treatment provider telephoned the Veteran to inquire as to his daily at-home blood pressure readings; the Veteran reported that his average was 149/97. In response to the same telephonic inquiry in September 2018, the Veteran reported that his average was 140/95, and in October 2018, he reported that his average was 132/90-143/95. In January 2019, during VA treatment, the Veteran's blood pressure was 152/109. It appears that in September 2019, the Veteran's prescribed medication dose was increased. In September 2019, the Veteran's blood pressure was 148/98. In October 2019, it was 155/97. During VA treatment in December 2019, the Veteran's blood pressure was 140/80, 153/106, and 157/109. In January 2020, it was 153/99 and 148/98. During VA treatment in March 2020, the Veteran reported that while he did not measure his blood pressure at home on a consistent basis, his average was about 140s/90s. In July 2020, the Veteran's blood pressure was 155/100. In January 2021, it was 167/101. During the Veteran's August 2021 Board hearing, the VLJ and the Veteran's representative discussed that the portion of the regulation pertaining to hypertension providing that blood pressure should be measured two or three times on three different days referred to the diagnosis of hypertension and not the rating of the service-connected disability. The Veteran's representative asserted that VA should consider the Veteran's history of blood pressure readings including instances of diastolic pressure of 100 or more and systolic pressure of 160 or more and the Veteran asserted that his blood pressure medication had been increased since the 2016 DBQ. The Veteran's representative and the VLJ discussed considering the Veteran's blood pressure readings of record dated through January 2021 in lieu of affording the Veteran another VA examination in order to obtain additional blood pressure readings; the Veteran asserted that there were no blood pressure readings dated after January 2021. Based on the forgoing, the Board concludes that the Veteran's hypertension is manifested by the need for continuous medication for control, as is contemplated by the pertinent rating criteria for a 10 percent rating; however, the specific criteria contemplating the need for continuous medication also requires, in addition, diastolic pressure predominantly 100 or more. 38 C.F.R. § 4.104, DC 7101. The criteria also provides a 10 percent rating for systolic pressure predominantly 160 or more. Id. There are 25 instances of VA treatment or examination during which the Veteran's blood pressure was measured and recorded during the current appellate period, beginning on October 7, 2015. On four occasions, the Veteran's systolic pressure was 160 or more, on 11 occasions, his diastolic pressure was 100 or more, and on one occasion, his diastolic pressure was 110 or more. Given that the Veteran's blood pressure medication was increased on two occasions during the pendency of the appeal, and that 11 out of 25 readings showed diastolic pressure of 110 or more, the Board find that the criteria for a 10 percent rating have been more nearly approximated. See 38 C.F.R. § 4.7. However, the criteria for a 20 percent rating have not been met or more nearly approximated. The Veteran had only one diastolic reading of 110 or more, and there have been no systolic readings of 200. There is no lay or medical evidence, and no examiner has reported, that the Veteran demonstrated diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more, as is required for a 20 percent rating. Id. The Board has considered the Veteran's lay statements of record and notes that he has supplemented the record with cogent, detailed, and pertinent assertions and has supported such with medical evidence, specifically, his history of blood pressure readings. In the June 2016 statement, the Veteran referred to instances of private blood pressure measurement in 2010, years prior to the current appellate period and evidence that is not relevant to the current appeal. In that statement, he also asserted that his hypertension is being controlled by increased medication and that without such, his condition would be worse. However, VA is permitted to consider the ameliorative effect of medication because the plain language of DC 7101 contemplates the effects of medication. 38 C.F.R. § 4.104, DC 7101; McCarroll v. McDonald, 28 Vet. App. 267, 273 (2016). In sum, the Board finds that a 10 percent rating, but not higher, is warranted for the Veteran's service-connected hypertension. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.