Citation Nr: 21011745 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-03 865 DATE: March 2, 2021 ORDER A compensable disability rating for hypertension is denied. FINDING OF FACT At no point during the appeal period did the Veteran’s hypertension disability picture approximate diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more; and, the Veteran does not have a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. CONCLUSION OF LAW The criteria for entitlement to a compensable disability rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1967 to October 1970. This case is before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO granted service connection for hypertension and assigned a noncompensable rating effective from November 6, 2008. The Veteran timely appealed the July 2014 rating decision, and in November 2018 the Board remanded the case for further development and adjudicative action. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in VA’s Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Entitlement to a compensable disability rating for hypertension The Veteran contends that he is entitled to a compensable disability rating for service-connected hypertension. Specifically, he contends that in April 2015, blood pressure was tested at 166/109 (systolic/diastolic), with a second reading of 174/109. See February 2021 Written Brief Presentation. The Veteran’s hypertension is rated under 38 C.F.R. § 4.104, DC 7101. Under DC 7101, the following ratings apply: a 10 percent rating is warranted when diastolic pressure is predominantly 100 or more or when systolic pressure is 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 when diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more; a 40 percent rating is warranted when diastolic pressure is predominantly 120 or more; and a 60 percent rating is warranted when diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. Initially, the Veteran is correct concerning the assertion of April 2015 blood pressure readings: a March 2015 VA nursing note in fact shows blood pressure measured at 166/109; and again at 174/107. However, the record, including VA treatment records and two VA Hypertension examination Disability Benefits Questionnaires (DBQ), contains numerous blood pressure readings from throughout the appeal period which reflect that the Veteran’s (i) systolic blood pressure did not predominately measure to 160 or greater, and (ii) diastolic blood pressure did not predominately measure to 100 or more. Records prepared by various VA hospital departments reflect the following: blood pressure was 142/78 in February 2010; 143/69, and 140/90, in April 2010; and 154/78, then 143/69, in July 2010. See July 2010 VA primary care note. Blood pressure measured to 127/86 in January 2011; 134/65, and 119/72, in June 2011. Blood pressure measured to 148/72 in March 2014; 140/90, then again at 125/72, in June 2014; and 138/78 in July 2014. The Veteran had a VA Hypertension examination in April 2014. The examiner diagnosed hypertension based on average blood pressure readings of 140/80 from April 2013; but, noted that the Veteran did not have a history of diastolic blood pressure to predominantly 100 or more. The Veteran took medications for hypertension including atenolol and lisinopril. Blood pressure measured to 146/82 in January 2015, and 126/71 in February 2015. As noted above, blood pressure measured at 174/107, then 132/82, at a March 2015 VA nursing visit. Blood pressure measured at 132/82 in April 2015. Blood pressure was 132/80 in October 2015, and a VA physical therapy discharge note indicates systolic blood pressure “below 100” and diastolic blood pressure “greater than 120” [sic]. Blood pressure was 152/92 in April 2016; 137/81 in May 2016; 132/78, 162/90 in July 2016; and, a VA emergency department physical examination in July 2016 revealed blood pressure of 192/101. An August 2016 VA primary care note shows that the Veteran consistently took his blood pressure medication as prescribed, and blood pressure was “typically” under 140/90. His lisinopril prescription had been increased, and blood pressure was “controlled but not” at the time of the appointment. At the time, he was prescribed atenolol and lisinopril 40 mg. Blood pressure measured at 152/74, 146/79, 174/78, 164/87, 151/77, 164/80, 166/81, 152/81, and 142/80 in September 2016; 128/60, then 126/81, in October 2016; 170/92 in April 2017; 137/81, then 132/80, in May 2017; 142/82 in August 2017; 176/85 in October 2017; and 128/78 in November 2017. Blood pressure was 90/54 in July 2018; 140/68 in November 2018; and 116/56 in April 2019. A September 2018 VA primary care note shows that the Veteran’s highest systolic blood pressure reading was 138 when not taking his prescription of amlodipine. Blood pressure was 122/60 in October 2019, and 132/70 in December 2019. The Veteran had another VA Hypertension examination in September 2019. The examiner noted that the Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more. The examiner noted medications of atenolol and spironolactone, each taken daily. Blood pressure readings from September 2019 were 162/85, 157/82, and 155/93; resulting in an average blood pressure reading of 158/86. Based on the foregoing, the Veteran’s hypertension has not met or approximated the criteria for a compensable rating at any time during the appeal period. While the record shows (i) the Veteran has taken blood pressure medication throughout the appeal period; and (ii) diastolic blood pressure measured above 100 and systolic blood pressure measured above 160 in March 2015; the records also show that his blood pressure consistently measured below each of those thresholds on numerous occasions throughout the appeal period. See, e.g. supra (blood pressure readings from February 2010 through the remainder of the appeal period). Tellingly, in the months on either side of March 2015, the Veteran’s blood pressure measured significantly lower than was shown in the March 2015 nursing note. Id. Accordingly, the Board finds that the numerous blood pressure readings taken throughout the appeal period provide more insight into the level of severity of the hypertension than does the evidence that on a single date in March 2015, the Veteran’s blood pressure was high enough as would warrant assignment of a compensable rating. Simply put, the record shows that the Veteran’s blood pressure was below the levels which would warrant consideration of a compensable rating for the bulk of the appeal period; specifically, the weight of the evidence suggests that his (i) diastolic blood pressure was not predominantly 100 or more, and (ii) systolic blood pressure was not predominantly 160 or more, for the appeal period. For those reasons, assignment of a compensable rating for the service-connected hypertension is not warranted. The claim is denied. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. KAYS HUKILL 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.