Citation Nr: 0001233 Decision Date: 01/14/00 Archive Date: 01/27/00 DOCKET NO. 98-17 451 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to an increased evaluation for heart disease with hypertension, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States INTRODUCTION The veteran had active service from July 1955 to April 1968. This appeal arose from a March 1998 rating decision which, in pertinent part, expanded the veteran's service-connected cardiovascular disability to include hypertension and increased the disability evaluation for the veteran's heart disease with hypertension from non-compensable to 10 percent disabling. The Board of Veterans' Appeals (Board), in June 1999, remanded the veteran's claim for further development. The case was returned to the Board in December 1999. 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. Neither diastolic pressure of predominately 110 or more nor systolic pressure of predominately 200 or more has been demonstrated. CONCLUSION OF LAW An evaluation in excess in 10 percent for heart disease with hypertension is not for assignment. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § Part 4, Code 7101 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is seeking an increased evaluation for heart disease with hypertension. The Board finds that this claim is well-grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim that 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). In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41, and 4.42 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records as well as all other evidence of record pertaining to the history of the disability for which the veteran is now seeking a higher disability evaluation. The Board has identified nothing in the historical record which suggests that the current evidence of record is not adequate to fairly determine the rating to be assigned for this disability. Moreover, the Board has concluded that this case presents no evidentiary considerations which would warrant an exposition of the remote clinical history and findings pertaining to this disability. Factual Background In a rating action in February 1969 service connection was granted for heart disease and a non-compensable disability evaluation was assigned. In December 1997 the veteran initiated a request for an increased evaluation and at the time of a February 1998 Department of Veterans Affairs (VA) medical examination the veteran indicated that he had worked as an air traffic controller for a number of years and had to have an annual physical. The most recent was in 1996 and the veteran related that at that time he had had no health problems. He stated that he had had about fourteen teeth pulled about a year ago and that, at that time his blood pressure was quite high; he reported that it was thought that it was under the stress of pulling the teeth. He indicated that he had not seen a doctor since then and that he had no reason to. The veteran reported that the discomfort in his chest occurred approximately once a month and was not related to any activities or anything in particular. It was described as a mild discomfort of pressure and some belching. The veteran stated that he took an antacid and it went away within an hour or less. It was noted that physical activity did not seem to cause any problems of any type. His current employment required office work, including a lot of keyboard work. On examination, the veteran's blood pressure was 190/108 while seated, 190/108 while standing and 102/114 while reclining. His cardiac rate and rhythm were regular. No murmurs or friction rubs were heard, the peripheral pulses were normal and no bruits were heard. A chest X-ray was reported to demonstrate no evidence of cardiopulmonary abnormality. The diagnoses included hypertension. Following this examination, as noted above, the March 1998 rating decision expanded the veteran's service-connected cardiovascular disability to include hypertension and increased the disability evaluation for the veteran's heart disease with hypertension from non-compensable to 10 percent disabling, effective in December 1997. VA outpatient treatment records reflect that in March 1998 the veteran's blood pressure was reported to be 183/108 in the right arm and 196/108 in the left arm. The record shows that he had been started on Lopressor in February 1998 and it was indicated that his medication needed to be increased. A low salt and low cholesterol diet were recommended. Later the same month his blood pressure was reported to be 157/87. In April 1998 the veteran's blood pressure was reported to be 130/96. The following month his blood pressure was reported to be 140/98 and later that month his blood pressure was reported to be 140/78 in the left arm and 150/ 80 in the right arm. Additional VA outpatient treatment records reflect that in November 1998 the veteran's blood pressure was reported to be 160/90. In April 1999 the veteran's blood pressure was reported to be 150/88; an electrocardiogram (EKG) was interpreted to show sinus bradycardia and that the EKG was otherwise normal. In July 1999 the VA conducted heart and hypertension examinations of the veteran. At the time of the former examination it was noted that the veteran was taking Lopressor, hydrochlorothiazide and Metformin. It was indicated that there was no history of myocardial infarction or congestive heart failure. The veteran indicated that he was told that he had a cardiac arrhythmia when he applied for a job with the Federal Aviation Administration. He related that he did not have any chest pain and it was reported that he did not complain of any other problems with his heart. He did not have angina, syncope or any dyspnea. He stated that he did have fatigue on occasion. The examiner stated that exercise testing was not required as the veteran's metabolic equivalents (METs) levels was basically normal. The veteran did whatever he wanted to do and did not have any chest pain. He rode a lawn mower and also push mowed and did not have any problem. He was able to do whatever a normal person would do, including driving a car, taking care of himself and going to the grocery store. It was noted that his heart size, on an April chest X-ray, was normal and that there was no evidence of congestive heart failure. The diagnoses included normal examination and history of hypertension. At the time of the VA hypertension examination the veteran reported that he did not have any symptomatology or side effects from his hypertension medication other than he felt slowed down slightly and slightly sluggish. The veteran's blood pressure was 163/86 while sitting, 161/84 while standing and 166/92 while lying. He did not exhibit any discomfort, chest pain, shortness of breath or dyspnea. His carotid arteries sounded perfectly normal. There was no evidence of valvular disease and the heart revealed a regular rate and rhythm without murmur or gallop. The diagnoses included a basically normal examination of the cardiovascular system and history of hypertension. The examiner noted that METs were not indicated as the veteran did normal daily activities, including pushing a lawn mower, and did not have any chest pain. An EKG of the veteran was also conducted in July 1999. This was interpreted to show a normal sinus rhythm and a normal EKG. When compared to the April 1999 EKG, no significant change was found. The following month, when the veteran was seen in a VA outpatient clinic, his blood pressure was reported to be 122/86. His heart rate and rhythm were regular. Analysis In reaching its decision, the Board has considered the complete history of the disability in question as well as the 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, 4.10 (1999). Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The veteran has contended that his heart condition is growing worse with time, his blood pressure is being treated with medication and a restricted diet and that a rating in excess of the 10 percent disability evaluation assigned is warranted. The Board notes that, where an increase in an existing disability rating based on established entitlement to compensation is at issue, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). If two evaluations are potentially applicable, 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. As noted above, separate diagnostic codes identify the various disabilities. The veteran is currently being rated under 38 C.F.R. § 4.71a, Diagnostic Code 7101, for hypertension. In the Board's opinion, his cardiovascular disability is best rated under this Diagnostic Code. See Butts v. Brown, 5 Vet. App. 532, 539 (1993) (holding that the Board's choice of diagnostic code should be upheld so long as it is supported by explanation and evidence). The alternative diagnostic code which is for consideration is that for heart disease. Under Diagnostic Code 7005 for arteriosclerotic heart disease, in effect previous to January 12, 1998, a 30 percent disability evaluation was for assignment following typical coronary occlusion or thrombosis, or with history of substantiated anginal attack, ordinary manual labor feasible. As of January 12, 1998, Diagnostic Code 7005 was revised and a 30 percent disability evaluation is for assignment where a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram or X-ray. As the veteran is not shown to have experienced a coronary occlusion or thrombosis, does not have a history of substantiated anginal attack, is in no was restricted in his daily activities and has not demonstrated any evidence of cardiac hypertrophy or dilatation, the Board finds that the most appropriate Diagnostic Code is for hypertension. During the pendency of the veteran's appeal, the Diagnostic Code for hypertension was revised. Previous to January 12, 1998, under Diagnostic Code 7101, a 20 percent disability evaluation was for assignment where the diastolic pressure was predominantly 110 or more with definite symptoms and a 10 percent disability evaluation was for assignment where the diastolic pressure was predominantly 100 or more. Where continuous medication was shown necessary for control of hypertension with a history of diastolic blood pressure predominantly 100 or more, a minimum rating of 10 percent would be assigned. As of January 12, 1998, under Diagnostic Code 7101, a 20 percent disability evaluation will be assigned where the diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more. A 10 percent disability evaluation will be assigned where the diastolic pressure is predominantly 100 or more, or systolic pressure is predominantly 160 or more. This is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Pursuant to Karnas v. Derwinski, 1 Vet. App. 308 (1991) and Rhodan v. West, 12 Vet. App. 55 (1998), as of the date of the change in the regulation, both the old and new rating criteria are to be considered with the criteria more beneficial to the veteran to be applied. The record contains numerous blood pressure readings covering the last two years. A review of the blood pressure readings contained in VA examination reports and VA outpatient treatment records revealed no systolic readings of 200 or more and only one diastolic reading of 110 or more. Based upon the evidence of record, there is nothing to suggest that the veteran's systolic pressure was predominantly 200 or more or that his diastolic pressure was predominantly 110 or more. The Regional Office correctly found that the veteran did not meet the criteria in effect, previous to January 12, 1998, for a 20 percent rating for hypertension and that, whether the old rating criteria or the new rating criteria is applied subsequent to January 12, 1998, a 20 percent rating for hypertension is not for assignment. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4, Code 7101. The Board notes that the doctrine of reasonable doubt has been considered. However, the Board's review demonstrates that the evidence is not relative equipoise and that doctrine is not for application. 38 U.S.C.A. § 5107. ORDER Entitlement to an increased evaluation for heart disease with hypertension is denied. HILARY L. GOODMAN Acting Member, Board of Veterans' Appeals