Citation NR: 9702374 Decision Date: 01/27/97 Archive Date: 02/07/97 DOCKET NO. 95-05 071 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased disability evaluation for postural hypotension, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michelle D. Doses, Associate Counsel INTRODUCTION The veteran had active service from September 1970 to September 1974. This appeal arises from a January 1994 rating decision granting a 10 percent disability evaluation for the veteran’s postural hypotension. It is herein noted that the veteran filed a claim received in April 1996 for service connection for a disability related to his teeth and for an increased disability evaluation for the disability related to his jaw. There is no indication in the record that these claims have yet been adjudicated. Thus, they are referred back for appropriate consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the diagnostic code under which his disability is rated is an inappropriate code. He asserts that he experiences blackout spells which would be more appropriately rated under the diagnostic code for Addison’s Disease. He further asserts that, under that diagnostic code, a higher evaluation is warranted for his postural hypotension. DECISION OF THE BOARD The Board of Veterans Appeals (Board), in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports a 20 percent evaluation for postural hypotension. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran’s appeal has been obtained by the originating agency. 2. The current manifestations of the veteran’s postural hypotension include dizziness and headaches and associated fatigue. CONCLUSION OF LAW A 20 percent disability evaluation is for assignment for postural hypotension. 38 U.S.C.A. §§ 1155, 5107 (West 1991 & Supp. 1995); 38 C.F.R. §§ 4.20, Part 4, Code 7911 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is seeking an increased evaluation for postural hypotension. The veteran’s claim is “well-grounded” within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). The service medical records reflect that the veteran had an episode of syncope. The impression was probably postural hypotension associated with low blood sugar. They further reflect that he complained of headaches. A Department of Veterans Affairs (VA) examination report dated in September 1978 discloses that the veteran reported attacks of syncope or dizziness on and off since his separation from service. He had blacked out on occasions. Blood pressure was within normal limits. The diagnosis was history of blackout spells possibly related to postural hypotension. There was moderate drop in systolic pressure from change of position from lying to standing if done rapidly, but asymptomatic at the time of examination. A VA examination report for hypothyroidism dated in December 1993 reflects that the veteran reported that his last blackout spell was two months previously and that his blackout spells generally lasted from two to three minutes. The veteran denied any history of fatigability or tiredness. It was noted that there was a history of hypothyroidism that, at the present time, showed little evidence of active disease. However, the veteran did have some evidence of “black-out spells.” The diagnosis was hypothyroidism, by history, and blackout spells, syncope, cause unknown. A January 1995 magnetic resonance imaging (MRI) report shows that the veteran reported syncope for 20 years and headaches for ten years. The impression was normal MRI of the brain with contrast. VA outpatient treatment notes dated in October 1995 and November 1995 show blood pressure readings of 132/79 and 130/60. The veteran reported headaches. A VA examination report dated in February 1996 reflects that the veteran denied ever having had hypertension, and knew of no history of thyroid disease. He stated that his blood pressure was fine and denied chest pain or dyspnea. He reported a history of headaches, dizziness, and blackouts. The frequency of the blackouts was two or three times a week, and was preceded by dizziness. On further questioning, it was clarified that he had not had an actual blackout or syncopal episode since military service. When the symptoms occurred he sat and put his head between his knees until they went away. The episodes occurred while standing and sometimes while sitting. He noted that his headaches began around 1991 or 1992 and occurred every day or night. He denied associated symptoms. It was noted that the veteran was seen in the neurology clinic the previous week, when his blood pressure was 148/67 and the impression was chronic caput headaches, probably tension, presyncopal symptoms, fairly rare now. On examination, his blood pressure was 120/70 sitting, 110/84 standing after three minutes, and 120/80 after ten minutes. It was 110/70 lying for five minutes. The veteran did not have any dizziness or headache. The assessment was no syncope since the military, but dizziness, usually postural, and headaches of muscular origin. A VA outpatient treatment record dated in June 1996 discloses that the veteran complained of headaches and dizziness for five to ten minutes. His blood pressure was 144/75. The assessment was syncope, etiology unknown, and headaches. At a June 1996 hearing, the veteran testified that he complained mainly of headaches and blackouts. He stated that his blackouts had increased about 50 or 100 percent since 1994. He noted that he went through a long period where they just seemed to have stopped and then all of a sudden, in the last few years, the dizziness and headaches had become constant. He described the blackouts as everything went dark for about five to ten minutes. He knew enough in advance when they were coming and could usually sit or lie down. The headaches were along the frontal lobe and were a constant throbbing all over. Sometimes the blackouts came with the headaches. Many times he had to decline doing something socially because of his headaches, dizziness, or fatigue. He kept his symptoms a secret from his employer. He noted that he could not handle a full time job because of the blackouts and headaches. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology, are closely analogous. 38 C.F.R. § 4.20. Diagnostic Code 7911 provides for a 20 percent disability evaluation for Addison’s disease if there are one or two crises during the past year, or two to four episodes during the past year, or weakness and fatigability, or corticosteroid therapy required for control. A 40 percent disability evaluation is for assignment for Addison’s disease if there are three crises during the past year, or five or more episodes during the past year. An Addisonian “crisis” consists of the rapid onset of peripheral vascular collapse with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in the abdomen, legs, and back; fever; apathy; and depressed mentation with possible progression to coma, renal shutdown and death. An Addisonian “episode” is a less acute and less severe event than a crisis and may consist of anorexia; nausea; vomiting; dehydration; weakness, malaise, orthostatic hypoptension, or hypoglycemia, but no peripheral vascular collapse. Code 7911, Notes 1 and 2. While the veteran’s blood pressure readings were within normal limits, a history of headaches, dizziness, and blackouts was noted, and, the assessment on recent VA examination was dizziness, usually postural, and headaches of muscular origin. In addition, the veteran stated that, in the last few years, the dizziness and headaches had become constant, accompanied by fatigue. In fact, as recently as June 1996, the veteran complained of headaches and dizziness for five to ten minutes. After reviewing the history of the veteran’s postural hypotension, as well as the current symptoms as reported by the veteran and the findings made on the VA examination, the Board concludes that, based upon the findings of dizziness and headaches on a regular basis, and the extent and severity of the veteran’s symptoms as well as their associated functional impairment, the manifestations of the service-connected disability more nearly approximate the criteria for a 20 percent evaluation. Accordingly, in the Board’s judgment, a 20 percent disability evaluation is for assignment for the veteran’s postural hypotension. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4, Code 7911. The evidence does not demonstrate that factors such as three crises during the past year, or five or more episodes during the past year, among the criteria for a 40 percent rating under Code 7911, have been met or approximated. The benefit of the doubt is resolved in the veteran’s favor. 38 U.S.C.A. § 5107. In reaching its decision on this issue, the Board has considered the complete history of the disability in question as well as any current clinical manifestations and the effect the disability may have on the earning capacity of the veteran 38 C.F.R. §§ 4.1, 4.2, 4.41 (1995). ORDER An evaluation of 20 percent for postural hypotension is granted, subject to the law and regulations governing the payment of monetary benefits. WAYNE M. BRAEUER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1996), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -