Citation Nr: 21023242 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 15-15 770 DATE: April 20, 2021 ORDER Entitlement to a 10 percent rating, but no higher, for the Veteran’s service-connected hypertension is granted. FINDING OF FACT The Veteran’s service-connected hypertension is manifested by diastolic pressure predominantly 100 or more and systolic pressure predominately 160 or more, and required continuous medication for control; however, the objective and lay evidence fails to establish hypertension was manifested by a diastolic pressure 110 or more or systolic pressure of 200 or more. CONCLUSION OF LAW The criteria for a 10 percent disability rating, but not greater, for hypertension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.14, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the Air Force from July 1979 to July 1999. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) that denied a continued the noncompensable rating for the Veteran’s service-connected hypertension. A July 2019 Board decision remanded the above claim for Oklahoma City VA treatment records prior to July 2003, Asheville VA Treatment records prior to July 2003 and November 2016, and for a VA examination. The Board also remanded the above claim to allow the Veteran to resubmit to resubmit his May 2015 Form 9 as it was improperly scanned. In November 2019, Oklahoma City VA treatment records prior to July 2003 were uploaded. A November 2019 correspondence indicated that the Veteran’s first appointment with Asheville VA medical center (VAMC) was on July 28, 2003 and records before to July 28, 2003, would be unavailable. In November 2019, Asheville VA treatment records from September 2016 to October 2019 were uploaded. In July 2020, Asheville VA treatment records from October 2019 to May 2020 were uploaded. In November 2019, a subsequent development letter was sent requesting the Veteran to re-submit his May 2015 Form 9. In December 2019, the Veteran was afforded another VA examination for his hypertension. Based on the above, the Board finds substantial compliance with the Board’s remand directives, and the claim is ripe for adjudication. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to a 10 percent rating, but no higher, for the Veteran’s service-connected hypertension is granted. Disability ratings are determined by applying the criteria established in VA’s Schedule for Rating Disabilities, based on the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.20. Where there is a question as to which of two evaluations shall be applied under a particular Diagnostic Code, the higher evaluation is assigned if the disability more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the claimant. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increased rating claim when the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a competent source. Second, the Board must determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303 (2007). Third, the Board must weigh the probative value of the evidence considering the entirety of the record. The Veteran’s service-connected hypertension is currently evaluated under Diagnostic Code 7101. Under Diagnostic Code 7101, a 10 percent rating is assigned for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or as the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent evaluation is assigned for diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. A 40 percent evaluation is assigned for diastolic pressure predominantly 120 or more. A 60 percent evaluation is assigned for diastolic pressure predominantly 130 or more. Id. The Diagnostic Code requires that the readings must be confirmed by taking two or more readings on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). The Veteran contends that a compensable disability rating is warranted for his hypertensive disorder. Throughout the appeal period, VA treatment records show elevated blood pressure (BP) readings. For example, the following dated treatment records show his elevated BP readings: dated on note his BP readings: July 26, 2012, BP reading was 164/103 July 31, 2012, BP reading was 178/98; August 2, 2012, BP reading was 148/102; August 21, 2012, BP reading was 168/88; October 1, 2012, BP reading was 178/100; October 1, 2012, BP readings were 170/100 and 162/98; February 26, 2013, BP readings were 147/105, 158/100, and 160/98. January 9, 2018, Ashville VA treatment records show that his BP was 160/90. In April 2013, the Veteran was afforded a VA Hypertension Disability Benefits Questionnaire (DBQ). He reported that his condition had worsened. His blood pressure had been slowly going up and within the last year rose significantly. His medication was also increased, but the blood pressure was “still a little elevated.” The blood pressure is still a little elevated. He denied significant weight gain, change in his exercise pattern, and significant alcohol use over the last year. His wife reported that he snores and stops breathing at night. He denied stroke and myocardial infarction, and his creatinine was “in the upper range of acceptable.” He reported taking Atenolol and Chlorthalidone daily The VA medical examiner determined that the Veteran’s treatment plan included taking continuous medication for hypertension. The examiner recorded the BP readings of 160/98, 152/98, and 148/100. The average blood pressure reading was 153/98. In December 2019, the Veteran was afforded another Hypertension DBQ. He reported that he was still taking Chlorthalidone. He went back to Atenolol, which worked pretty well, but he had bradycardia, so in 2015, he was put on Losartan, which he was still taking. He denied shortness of breath, chest pain, and renal issues. He reported that his disability was asymptomatic (but still has elevated blood pressure). He reported taking Losartan every morning and Chlorthalidone daily. The VA medical examiner determined that the Veteran’s treatment plan included taking continuous medication for hypertension. The examiner recorded the BP readings of 120/85, 125/80, and 122/82. The average blood pressure reading was 122/82. Based on the above, the Board finds that the Veteran’s hypertension more nearly approximates the criteria for a 10 percent rating under Diagnostic Code 7101. Although both the April 2013 and December 2019 VA examiners reported the average diastolic pressure that was less than 100 and systolic blood pressure that was less than 160, they noted his daily use of Atenolol and Chlorthalidone, before 2015 and Losartan and Chlorthalidone, since 2015, to control his blood pressure. Therefore, a 10 percent rating is warranted. A higher rating is not warranted, for the evidence does not show that the Veteran’s diastolic pressure during the appeal period was predominantly 110 or more, or systolic pressure was predominantly 200 or more. Therefore, resolving any doubt in favor of the Veteran, the Board finds that his service-connected hypertension warrants a 10 percent rating, but no higher, for the entire period on appeal. (Continued on the next page)   There is no evidentiary basis to assign a rating greater than 10 percent for the Veteran’s hypertension. Since there is no basis for assigning an increased rating, there is no basis for assigning a staged rating. Hart, 21 Vet. App. at 505. Accordingly, the preponderance of the evidence is in favor of a 10 percent rating. 38 C.F.R. § 4.104, Diagnostic Code 7101. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). N. Stevens Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Smith, Associate 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.