Citation Nr: 22046641 Decision Date: 08/17/22 Archive Date: 08/17/22 DOCKET NO. 16-18 720 DATE: August 17, 2022 ORDER Effective October 1, 2014, entitlement to an initial rating of 10 percent (but no higher) for service-connected hypertension is granted. FINDING OF FACT Affording the Veteran the benefit of doubt, the evidence is approximately balanced (nearly equal) in favor of finding the Veteran's hypertension more closely approximates the rating criteria for a 10 percent rating. CONCLUSION OF LAW Effective October 1, 2014, the criteria have been met for an initial rating of 10 percent (but no higher) for hypertension. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from June 1993 to September 2014. By way of background, his service-connected hypertension has been noncompensable since October 1, 2014, which is the day after his discharge. He has continuously prosecuted a claim for a higher rating since the February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, September 2021, and February 2022, the Board remanded the Veteran's claim for additional development. 1. Effective October 1, 2014, entitlement to an initial rating of 10 percent (but no higher) for service-connected hypertension is granted. The Veteran seeks an increased rating for hypertension. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. If the evidence is not in approximate balance or nearly equal, the claim is to be denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001). Hypertension is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; it is 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 rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant. For the reasons that follow, the Veteran's hypertension warrants a 10 percent rating under DC 7101 because it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. For the purposes of rating hypertension, it has been determined that the ameliorative effects of medicine should be considered when rating the disability. See McCarroll v. McDonald, 28 Vet. App. 267 (2016) (holding that DC 7101 (for hypertension) explicitly contemplates the ameliorative effects of medication and the Board did not err when it considered the effects of the appellant's medication when evaluating his hypertension). VA treatment records show the Veteran takes and has taken multiple medications to control his blood pressure since before and since discharge from active duty. See December 2014 VA examination; May 2022 VA examination. VA treatment records show the Veteran's diastolic blood pressure readings range between 74 (lowest) and 114 (highest). See April 2020 VA treatment records; May 2022 VA examination. In the March 2022 addendum medical opinion, the examiner noted that the Veteran's hypertension gets worse when he discontinues his medicines. The opinion supports the proposition that the ameliorative effects of medication should be considered in rating the Veteran's hypertension. Unfortunately, little by way of rationale was provided by the examiner. While not all of the Veteran's diastolic blood pressure readings exceed 100, many of the blood pressure readings do exceed 100 even with the Veteran's persistent use of medication. Additionally, the March 2022 examiner indicated that if the Veteran was not taking medicine, his blood pressure would be higher. As noted above, where there is a question as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more nearly approximates the criteria for the higher rating. Here, the Board finds, after affording the Veteran the benefit of doubt, his hypertension symptoms, taken as a whole, more closely approximate a 10 percent rating. This is especially true when considering the ameliorative effects of the Veteran's blood pressure medications. See Kinley v. McDonough, No. 21-0211, 2022 U.S. App. Vet. Claims LEXIS 865, at *1 (Vet. App. June 2, 2022). Accordingly, the Board finds a 10 percent rating is warranted for the Veteran's service-connected hypertension. A higher rating is not warranted because the more probative evidence of record fails to show diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. 38 C.F.R. § 4.104; Diagnostic Code (DC) 7101. T. SHERRARD Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Williams, 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.