Citation Nr: 21026676 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 16-31 036 DATE: May 3, 2021 ORDER A rating greater than 10 percent for service-connected hypertension is denied. FINDING OF FACT During the appeal period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. CONCLUSION OF LAW The criteria for a disability rating greater than 10 percent for service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the United States Air Force from September 1970 to September 1981 and from April 1983 to March 1998. His awards, among others, include the Vietnam Service Medal. This matter comes before the Board of Veterans' Appeals (Board) from a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which denied a rating greater than 10 percent for service-connected hypertension. The Veteran submitted a Notice of Disagreement (NOD) in August 2012 and a Statement of the Case (SOC) was issued in May 2016. The Veteran perfected an appeal by submitting a timely VA Form 9 in July 2016. The issue was previously before the Board. In December 2019, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to ask the Veteran to complete a VA Form 21-4142 for Dr. A who treated the Veteran for hypertension and to schedule him for a VA examination. In a January 2020 letter, the AOJ requested that the Veteran complete a VA Form 21-4142, and the Veteran returned the completed form in the same month. The Veteran was also afforded a VA examination for his hypertension in January 2020. In February 2020, treatment records from Dr. A were added to the Veteran's VA claims file. Thus, the Board finds that the AOJ substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998). Following evidentiary development, a supplemental statement of the case (SSOC) was issued in August 2020. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. INCREASED RATING Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where 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. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. It is not expected that every case will show every criterion for a particular rating. 38 C.F.R. § 4.21. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). A rating greater than 10 percent for service-connected hypertension The Veteran contends that his hypertension warrants a rating greater than 10 percent. Under 38 C.F.R. § 4.104, DC 7101, Hypertensive vascular disease (hypertension and isolated systolic hypertension) requires diastolic pressure predominantly 110 or more; or, systolic pressure predominantly 200 or more for a 20 percent rating. Diastolic pressure predominantly 120 or more is required for a 40 percent rating, and diastolic pressure predominantly 130 or more for a 60 percent rating. After reviewing the Veteran's medical records, the Board finds that the Veteran's diastolic pressure was not predominantly 110 or more, and his systolic pressure was not predominantly 200 or more during the appeal period. VA Medical Center treatment records from June 2011 show that the Veteran's systolic pressure was between 128 to 150 mmHg and that his diastolic pressure was between 80 to 88 mmHg. For the sake of brevity and clarity, the Veteran's blood pressure will be noted in the form of "systolic pressure/diastolic pressure mmHg," just as noted in the medical evidence of record. In April 2016, during a VA examination, the Veteran's average blood pressure was 189/107 mmHg. The Veteran reported that, since October 2015, he has had elevated systolic and diastolic blood pressure and has been closely followed by his civilian physician, Dr. A. He stated that as his diastolic blood pressure has been persistently in the high 90's and over 100 in the last six months. The Veteran indicated that, two months ago, Dr. A. increased his Coreg from 25mg twice daily to 80mg one tablet daily. Since that time, the Veteran reported that his home systolic blood pressure readings have averaged in the 140's with a couple times in the 180's and the diastolic in the mid-high 80's with a couple times in the 90's. The VA examiner stated that the Veteran's hypertension does not impact his ability to work. Private treatment records from Dr. A, from whom the Veteran received treatment for his service-connected hypertension, show the Veteran's blood pressure readings from December 2014 to December 2019. Specifically, the records show that the Veteran's blood pressure was 152/90 and 140/80 mmHg in December 2014, 136/80 mmHg in January 2015, 136/80 mmHg in February 2015, 136/80 mmHg in April 2015, 140/80 mmHg in July 2015, 170/100 mmHg and 170/108 mmHg in September 2015, 158/90 and 130/80 mmHg in October 2015, 130/80 mmHg in December 2015, 158/94 in January 2016, 148/90 in February 2016, 126/80 in April 2016, 158/90 in June 2016, 138/82 and 128/82 mmHg in July 2016, 142/98 mmHg in August 2016, 130/90 mmHg in September 2016, 120/80 mmHg in October 2016, 164/90 mmHg in January 2017, 150/80 mmHg in April 2017, 144/86 mmHg in July 2017, 140/80 and 146/80 mmHg in October 2017, 150/88 mmHg in November 2017, 158/84 mmHg in December 2017, 158/80 mmHg and 160/90 mmHg in February 2018, 128/80 mmHg in May 2018, 130/82 and 138/70 mmHg in June 2018, 150/90 mmHg in August 2018, 142/72 mmHg in October 2018, 140/80 mmHg in November 2018, 146/80 mmHg in February 2019, 150/100 mmHg in March 2019, 120/80 and 130/88 mmHg in April 2019, 150/90 mmHg in May 2019, 172/100 mmHg in September 2019, and 130/80 mmHg in December 2019. In sum, between December 2014 and December 2019, the highest systolic pressure recorded by the private practitioner was 172 mmHg in September 2019, and the highest diastolic pressure was 108 mmHg in September 2015. Including the measurements from the April 2016 VA examination, the highest systolic pressure during this time was 189 mmHg. None of the readings showed systolic pressure greater than 200 mmHg or diastolic pressure greater than 110 mmHg. In January 2020, the Veteran received a VA examination for his hypertension. His blood pressure readings were 131/76, 143/80, and 124/64 mmHg. Again, none of the readings showed systolic pressure greater than 200 mmHg or diastolic pressure greater than 110 mmHg. The Veteran told the VA examiner that he was being treated by a private practitioner for his hypertension and that his blood pressure increased in March 2018. The Veteran also stated that the examination was complete, accurate, and contained "all of the information" that the Veteran requested to have in the examination. The VA examiner indicated that the Veteran's service-connected hypertension does impact his ability to work. The examiner noted the Veteran's report that he would miss up to 10 days of work per year due to hypertension if he were working in human resources. The Board notes that there are no VA Medical Center (VAMC) treatment records from April 2016 to January 2021. Although there is a gap of nearly 5-years in the Veteran's VA Medical Center records, the private treatment records during this time sufficiently describes the Veteran's disability picture as discussed above. These private treatment records are also the records the Board directed the AOJ to obtain in the December 2019 remand. Moreover, the Veteran himself stated that his hypertension was being treated by the private practitioner above and he has not contended that his hypertension disability has been treated at the VAMC. Thus, the Board finds that the gap in the VAMC treatment records is not material to the present case, that the private medical treatment records are sufficient, and that, even if VAMC treatment records existed for the period above, said records would not outweigh the probative value of blood pressure measurements recorded by the private practitioner who specifically treated the Veteran's hypertension. For the foregoing reasons, the preponderance of the evidence reflects that the criteria for a rating greater than 10 percent for the Veteran's service-connected hypertension have not been met or more nearly approximated. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yun 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.