Citation Nr: 21013599 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 14-18 037 DATE: March 9, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for hypertension is denied. FINDING OF FACT Throughout the period on appeal, the Veteran’s hypertension has not been manifested by diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. CONCLUSION OF LAW The criteria for entitlement to an initial rating in excess of 10 percent for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1969 to June 1984. He appeals a November 2013 rating decision denying entitlement to service connection for hypertension with a noncompensable rating. The Board notes that the Veteran was granted an increased initial rating of 10 percent for his hypertension throughout the period on appeal in an April 2014 rating decision. Increased Rating Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran’s entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Further, “[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.” 38 C.F.R. § 4.7. In assigning a disability rating, the Board may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56 (2012). Conversely, if the rating criteria specifically contemplate the effects of medication, Jones is inapplicable. See McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016). 1. Entitlement to an initial rating in excess of 10 percent for hypertension. The Veteran contends that his hypertension is worse than is contemplated by a 10 percent rating. Specifically, he argues that is hypertension would be worse without medication. After review of the evidence, the Board finds that an initial rating in excess of 10 percent is not warranted. The Veteran’s hypertension is rated under 38 C.F.R. § 4.104, Diagnostic Code 7101. Under Diagnostic Code 7101, a 60 percent rating is warranted for diastolic pressure predominantly 130 or more. A 40 percent rating is warranted for diastolic pressure predominantly 120 or more. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Finally, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or 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. 38 C.F.R. § 4.104, Diagnostic Code 7101. In support of his appeal, the Veteran submitted private medical records from June and September 2013 showing blood pressure readings of 172/98 and 140/92 respectively. He also submitted private medical records from August 2013 showing blood pressure readings of 170/94, 158/104, 144/86, and 152/100. Upon examination in February 2020, the following blood pressure readings were noted: 189/102, 170/99, and 175/99. Importantly, a thorough review of the medical evidence of record does not show any diastolic pressure readings of 110 or more or any systolic pressure readings of 200 or more at any point during the period on appeal. The Board is sensitive to the veteran's claim that his blood pressure readings would be higher if it were not for continuous medication. However, the fact that he takes medication has already been considered in his current 10 percent rating, and the Board cannot speculate what his blood pressure would be if he were not taking medication. As such, the Board finds that the preponderance of the competent medical and lay evidence of record shows that a rating in excess of 10 percent for hypertension is not warranted and the claim is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel