Citation Nr: 21025183 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-32 492 DATE: April 27, 2021 REMANDED Entitlement to a compensable rating for hypertension is remanded. REASONS FOR REMAND The Veteran served in the United States Army from August 1985 to May 1988. This appeal comes to the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) March 2016 rating decision of the Agency of Original Jurisdiction (AOJ). In February 2021 the Veteran appeared before the undersigned Veterans Law Judge at a virtual Board hearing. A transcript of the hearing has been reviewed by the Board, and has been associated with the claims file. 1. Entitlement to a compensable rating for hypertension is remanded. Hypertension is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.104, Diagnostic Code 7101. A 10 percent rating is warranted if hypertension is manifested by diastolic blood pressure predominantly 100 or more; or if the systolic pressure is predominantly 160 or more; or if the condition requires continuous medication for control and there is a history of diastolic pressure predominantly 100 or more. A 20 percent rating is warranted if the diastolic blood pressure is predominantly 110 or more; or if the systolic pressure is predominantly 200 or more. Ratings of 40 and 60 percent, respectively, are assigned for diastolic blood pressures predominantly 120 or more, or 130 or more. The Veteran contends that his hypertension warrants at least a 10 percent disability rating. See Notice of Disagreement, September 2016. The Veteran maintains that his medical history of blood pressure readings warrants a higher evaluation, and that without medication, his blood pressure readings would meet that the thresholds required for a compensable rating. Also, at his February 2021 Board hearing, the Veteran testified that while his hypertension is under control with his medication, it has worsened over time and his doctors have told him that he will likely have to alter his medication regimen in the future. The Veteran stated that he takes his blood pressure readings at home, and testified that they range from 180/110 to 120/80, and that the average is around 140/100. He has also testified that he has periods several times per month where he feels he will black out, and has chest pains, heart palpitations, headaches, and hot flashes which he attributes to either periodic spikes in his blood pressure and/or to the side effects of his blood pressure medication. The Board notes that the Veteran was last examined for VA purposes in September 2015. At that time, the examiner noted that the Veteran’s service treatment records included the following blood pressure readings between January 1988 and May 1988: 126/84; 148/104; 176/92; 165/98. The examiner also noted a notation of questionable essential high blood pressure in the STRs. On examination the examiner noted that the Veteran reported that he had been diagnosed with hypertension 15 years earlier and had started Atenolol initially with other medications added later. The Veteran reported that his blood pressure was often high in service, but when re-taken it would decrease. On examination, the Veteran’s blood pressure was 120/76 and 118/78. The examiner stated that the Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more. The Board notes, however, that additional relevant medical evidence has been added to the record since the last VA examination. Private medical records have been added to the record including an October 2015 letter from Dr. M., a non-VA physician who had been treating the Veteran. According to Dr. M., the Veteran first started taking medication to treat his hypertension in November 2007. According to Dr. M., the last reading prior to beginning medication was 168/98. Private treatment records of Dr. M. dated between December 2007 and January 2021 do not appear show diastolic blood pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. However, based on the testimony provided by the Veteran at the recent Board hearing, it is unclear whether the symptoms reported by the Veteran are due to a worsening of his hypertension or are as a result of the medication taken for his hypertension, or are unrelated to either. As it appears that the Veteran’s hypertension may have increased in severity and the last VA compensation examination was over five years ago, the Board finds that a current examination must be afforded the Veteran to accurately assess the current level of disability. Accordingly, the appeal is REMANDED for the following action: 1. Ask the Veteran to identify all providers of evaluations and treatment he has received for hypertension, and to provide authorizations for VA to obtain updated, to the present, records of any private evaluations or treatment. Secure for the record complete clinical records of the evaluations and treatment identified (i.e., any not already associated with the record). If any private records identified are not received pursuant to the request, the Veteran should be so notified and advised that ultimately it is his responsibility to ensure that private records are received. 2. Schedule the Veteran for a VA examination (in person or through other appropriate means) to ascertain the severity and manifestations of his service-connected hypertension. The examiner is requested to review all pertinent records associated with the claims file. Any and all studies and tests deemed necessary by the examiner should be performed. The examiner must identify all symptoms and functional impairment due to the Veteran’s hypertension or medication prescribed for the disability. With attention to the documented medical history, the examiner should opine as to whether the Veteran's hypertension has manifested in diastolic blood pressure predominantly 100 or more, or systolic blood pressure predominantly 160 or more throughout the period on appeal/or any portion of it. The examiner must specifically acknowledge and consider the lay evidence of the Veteran regarding his symptoms and must address the Veteran’s reports that several times per month he feels he will black out, and has chest pains, heart palpitations, headaches, and hot flashes, and indicate the relationship/significance, if any, of these symptoms to the Veteran’s hypertension and/or medication taken for hypertension. A complete rationale should accompany all opinions. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.