Citation Nr: 21013022 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 16-00 810 DATE: March 8, 2021 ORDER Entitlement to a 10 percent rating prior to December 23, 2015, for hypertension is granted. Entitlement to a disability rating greater than 10 percent prior to June 28, 2019, and greater than 20 percent thereafter, for hypertension is denied. FINDINGS OF FACT 1. The record evidence shows that, prior to December 23, 2015, the Veteran’s service-connected hypertension required continuous medication for control. 2. The record evidence does not show that, prior to June 28, 2019, the Veteran’s service-connected hypertension was manifested by diastolic pressure predominantly 110 or more. 3. The record evidence shows that, effective June 28, 2019, the Veteran’s service-connected hypertension is manifested by, at worst, diastolic pressure predominantly 110 or more. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 10 percent rating prior to December 23, 2015, for hypertension have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.104, Diagnostic Code (DC) 7101 (2019). 2. The criteria for a disability rating greater than 10 percent prior to June 28, 2019, and greater than 20 percent thereafter, for hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.104, DC 7101 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1996 to January 2005, including in combat in Afghanistan. In August 2018, the Board remanded the currently appealed claims to the Agency of Original Jurisdiction (AOJ) for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. The Board directed that the AOJ obtain updated treatment records for the Veteran and schedule her for updated examination to determine the current severity of her service-connected hypertension. Additional records subsequently were associated with the claims file. And the requested examination occurred in June 2019. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). In an August 2020 rating decision, the AOJ assigned a 10 percent rating effective December 23, 2015, and a 20 percent rating effective June 28, 2019, for the Veteran’s service-connected hypertension. Thus, the issues on appeal have been recharacterized as stated above. The Board finds that the evidence supports assigning a 10 percent rating prior to December 23, 2015, for the Veteran’s service-connected hypertension. The Veteran essentially contends that her service-connected hypertension is more disabling than currently evaluated throughout both periods of time in this appeal. The Board notes initially that the AOJ assigned a 10 percent rating effective December 23, 2015, for the Veteran’s service-connected hypertension in the August 2020 rating decision (as discussed above). The record evidence supports assigning a 10 percent rating effective prior to December 23, 2015, for the Veteran’s service-connected hypertension under DC 7101. See 38 C.F.R. § 4.104, DC 7101 (2019). For example, on private outpatient treatment in March 2014, the Veteran’s blood pressure was 175/95. On VA hypertension Disability Benefits Questionnaire (DBQ) in August 2014, the Veteran’s complaints included worsening hypertension. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. The Veteran reported that her hypertension was worsening because she was on 3 different medications and her blood pressure readings “have been as high as 200/100.” Her hypertension required continuous medications (atenolol, verapamil, and lisinopril) for control. Her current blood pressure readings were 150/87, 156/89, and 160/90 with an average blood pressure reading of 155/88. The diagnosis was hypertension. In an undated letter from A. M., CMA, a private treating clinician date-stamped as received by VA on September 9, 2014, this clinician stated that the Veteran “has uncontrolled hypertension and is still on four agents to help lower her blood pressure. Her goal blood pressure readings should be less than 130/85 which she has not met at this time.” Consistent with the Veteran’s lay assertions, the record evidence shows that she is entitled to a 10 percent rating effective prior to December 23, 2015, for her service-connected hypertension. Id. This disability required continuous medication for control as documented in VA and private outpatient records and examination reports. The September 9, 2014, letter from a private clinician persuasively suggests that, despite being prescribed multiple medications, the Veteran’s service-connected hypertension still was uncontrolled. These findings support the assignment of a 10 percent rating for service-connected hypertension prior to December 23, 2015, under DC 7101. Id. There is no indication that, prior to December 23, 2015, the service-connected hypertension is manifested by diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more as is required for a disability rating greater than 10 percent during this time period under DC 7101, however. Id. The Board recognizes that the Veteran reported at her August 2014 VA examination that her blood pressure readings “have been as high as 200/100.” This isolated report of systolic pressure “as high as” 200 is not matched by the findings on physical examination in August 2014 when her blood pressure readings were 150/87, 156/89, and 160/90 with an average blood pressure reading of 155/88. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 10 percent rating prior to December 23, 2015, for hypertension have been met. The Veteran also is not entitled to a disability rating greater than 10 percent prior to June 28, 2019, and greater than 20 percent thereafter, for service-connected hypertension. Id. The record evidence does not show that, prior to June 28, 2019, this disability is manifested by diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more as is required for a 20 percent rating under DC 7101. Id. The Board also recognizes that, on VA hypertension DBQ on June 28, 2019, the symptomatology attributable to the service-connected hypertension worsened and supported the assignment of a higher 20 percent rating effective on that date under DC 7101. Id. At this examination, the Veteran’s complaints included dizziness and lightheadedness, mild chest pain which she rated as 1/10 on a pain scale, numbness and tingling in her bottom lip, and daily mild blurry vision. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. The Veteran reported that her blood pressure was “constantly increasing along with medication.” Her treatment plan included taking continuous medication for control of her hypertension. She had a history of diastolic blood pressure elevation to predominantly 100 or more. Her blood pressure readings were 187/118, 190/107, and 195/116 with an average 190/114. The diagnosis was hypertension. On private outpatient treatment in January 2020, the Veteran reported that her home blood pressure readings were always less than 140/90. Her current blood pressure was 112/74. In July 2020, the Veteran’s blood pressure was 120/84. The Board recognizes that the symptomatology attributable to the service-connected hypertension worsened effective June 28, 2019, supporting the assignment of a 20 percent rating for this disability effective on that date under DC 7101. Id. Contrary to the Veteran’s lay assertions, however, the record evidence shows that, effective June 28, 2019, her service-connected hypertension is manifested by, at worst, diastolic pressure predominantly 110 or more (i.e., a 20 percent rating under DC 7101). Id. Blood pressure readings taken on VA examination on June 28, 2019, were 187/118, 190/107, and 195/116 with an average 190/114. There is no indication that her blood pressure readings since June 28, 2019, reflected diastolic pressure predominantly 120 or more or 130 or more (i.e., a 40 or 60 percent rating under DC 7101) such that a disability rating greater than 20 percent is warranted for service-connected hypertension during this time period. Id. Following the June 2019 VA examination, subsequent private outpatient treatment visits documented blood pressure of 112/74 and 120/84. The Veteran herself reported in January 2020 that her home blood pressure readings were always less than 140/90. She otherwise has not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 10 percent prior to June 28, 2019, and greater than 20 percent thereafter, for her service-connected hypertension. Thus, the Board finds that the criteria for a disability rating greater than 10 percent prior to June 28, 2019, and greater than 20 percent thereafter, for hypertension have not been met. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael T. Osborne, 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.