Citation Nr: A25035481 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 241107-491340 DATE: April 17, 2025 ORDER Entitlement to a compensable rating for hypertension (HTN) is denied. FINDING OF FACT 1. Throughout the period on appeal, the Veteran's hypertension manifested by diastolic pressure predominantly 100 or less, systolic pressure predominantly 160 or less, and the Veteran does not have a history of diastolic blood pressure predominantly 100 or more that requires continuous medication for control. CONCLUSION OF LAW The criteria for entitlement to a compensable rating for hypertension (HTN) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1969 to February 1981 and from August 1982 to September 30, 1994. The Appeals Modernization Act (AMA) creates a new framework for Veterans dissatisfied with Department of Veterans Affairs' (VA) decision on their claim to seek review. The AMA became effective on February 19, 2019. 38 C.F.R. §?3.2400(a)(1). The AMA applies to all initial decisions issued after February 19, 2019. The present matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2024 rating decision issued by VA Agency of Original Jurisdiction (AOJ). Accordingly, this decision is subject to the AMA.? In July 2023, the Veteran's service connection claim for a HTN was granted with a noncompensable evaluation effective August 10, 2022. In July 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR). In October 2024, the AOJ issued the HLR decision, continuing the noncompensable rating evaluation for the Veteran's HTN. Next, the Veteran timely appealed the October 2024 rating decision to the Board in a November 2024, VA Form 10182 Notice of Disagreement. Based on the Veteran's selection of the evidence docket, the Board can only consider evidence received up to the date of the October 2024 rating decision on appeal and evidence received within 90 days of receipt of the VA Form 10182 Notice of Disagreement. 38 C.F.R. § 20.303. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. If two disability ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances, it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. 38 C.F.R. § 4.21. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. §§ 3.102, 4.3. When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods as to the pending claim. In all cases, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr at 308 (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). 1. Entitlement to a compensable rating for hypertension (HTN) In the July 2023 rating decision, the AOJ granted service connection for the Veteran's hypertension and awarded a noncompensable rating effective August 10, 2022. Therefore, the period on appeal begins on August 10, 2022. 38 C.F.R. § 3.400(o). The Veteran's hypertension has been assigned a noncompensable evaluation under 38 C.F.R. § 4.104, DC 7101. Under that DC, a 10 percent evaluation is warranted where diastolic blood pressure is predominantly 100 or more, or systolic blood pressure is predominantly 160 or more, or when an individual with a history of diastolic blood pressure predominantly 100 or more requires continuous medication for control. A 20 percent evaluation is warranted where diastolic blood pressure is predominantly 110 or more, or systolic blood pressure is predominantly 200 or more. A 40 percent evaluation is warranted where diastolic pressure is predominantly 120 or more, and a 60 percent evaluation is warranted where diastolic blood pressure is predominantly 130 or more. 38 C.F.R. § 4.104. See Webster's New World Dictionary, 1062 (3d college ed. 1988) (defining "predominantly" as "most frequent, noticeable, etc.; prevailing, preponderant"). For the reasons set forth below, the Board finds that a compensable disability rating is not warranted. The Veteran was afforded a VA examination in July 2023, at which time the examiner indicated that the Veteran was diagnosed with hypertension in 2016. The examiner reported that the Veteran had been prescribed Losartan and Toprol to manage his hypertension symptoms. The examiner reported that the Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more. Blood pressure readings taken at the July 2023 examination were: 136/81, 138/89, and 131/80. The examiner noted that the Veteran's hypertension does not impact his ability to work. The Board finds this examination adequate and highly probative. Other medical evidence of record, prior to the July 2023 rating decision, demonstrates that the Veteran's documented blood pressure readings show that his diastolic pressure was predominantly below 100, and his systolic pressure was predominantly below 160. See June 2023 Medical Treatment Record - Government Facility. Review of medical records throughout the course of the appeal confirms the use of medication to control the Veteran's hypertension. However, the Board notes that the rating criteria for hypertension specifically contemplate the use of medication to ameliorate symptoms and that a higher rating may not be assigned based solely on the fact that the Veteran uses medication to treat his symptoms. McCarroll v. McDonald, 28 Vet. App. 267 (2016). The Board acknowledges the Veteran's evidence filed with his VA Form 10182, which emphasizes blood pressure readings from September 2014 through March 2020. On one occasion, the Veteran had a systolic reading of greater than 160, and on one occasion, the Veteran had a diastolic reading of 100 or more. However, these readings do not demonstrate diastolic pressure predominately 100 or more or systolic pressure predominately 160 or more nor were these readings obtained within the period on appeal. Furthermore, the emphasized readings do not show a history of diastolic pressure predominantly 100 or more. The evidence of record further demonstrates that the Veteran's blood pressure readings do not more nearly approximate a history of diastolic pressure predominantly 100 or more that requires continuous medication for control. In this regard, the evidence demonstrates that the Veteran's hypertension requires continuous medication; however, the evidence does not demonstrate a history of diastolic pressure predominantly 100 or more. Throughout the period on appeal, all of the diastolic pressure readings are below 100. See June 2023 Medical Treatment Record - Government Facility. The Board has no reason to doubt the validity of this medical evidence and finds it highly probative. On appeal, the Veteran contends that the AOJ did not properly weigh the evidence, apply the appropriate standard of proof, and did not follow its M21 directives. The Board finds that the evidence was weighed properly, and the most probative evidence is against the claim for an increased initial rating. As such, the benefit-of-doubt-rule is not applicable. 38 U.S.C. § 5107(b). While VA's Adjudication Procedures Manual (M21) provides guidance, the Board is not bound by it. Although the Board is not bound by the M-21, it is "required to discuss any relevant provisions as part of the duty to provide adequate reasons or bases if the Board chooses to rely on an M21 provision as a factor to support its decision." See Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). Here, the Board is not relying on an M21 provision as a factor to support its decision. The Board's decision is solely based on application of 38 C.F.R. § 4.104 for Diagnostic Code 7101 to the relevant evidence. The Board further notes that consideration of another Diagnostic Code is not permissible here as the Veteran is being rated under the Diagnostic Code applicable specifically to hypertension. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015) (held that where there is a diagnostic code that addresses the particular service-connected disability, to evaluate that disability under another code would constitute impermissible rating by analogy). For the foregoing reasons, the Board finds that the Veteran's hypertension symptoms have not more nearly approximated the criteria for a compensable disability rating. While the Veteran's hypertension requires continuous medication for control, the weight of the evidence reflects that the Veteran's diastolic pressure is predominantly 100 or less, his systolic pressure is predominantly 160 or less, and the Veteran does not have a history of diastolic blood pressure predominantly 100 or more that requires continuous medication for control. Accordingly, the claim for a compensable rating for hypertension is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeffreys, J. 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.