Citation Nr: 0005132 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 97-29 826 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to an evaluation in excess of 30 percent for chronic headaches with a history of trauma. 2. Entitlement to an evaluation in excess of 10 percent for hypertension. 3. Entitlement to service connection for a neck disability. 4. Entitlement to service connection for a low back disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD J. L. Prichard, Counsel INTRODUCTION The veteran had active service from January 1971 to July 1991. This matter comes before the Board of Veterans' (Board) on appeal of rating decisions of the Los Angeles, California, regional office (RO) of the Department of Veterans Appeals (VA). The Board notes that the issue of entitlement to service connection for a kidney disability, to include kidney stones, was originally included in those appealed to the Board. However, the veteran withdrew this issue from appeal at the March 1999 hearing. The issue of entitlement to service connection for a left knee disability was denied by the RO in May 1999, but no notice of disagreement has been received subsequent to the veteran being notified and the Board does not have jurisdiction of that matter at the present time. FINDINGS OF FACT 1. The veteran's headaches occur three to four times each month for three to five days on each occasion, but the headaches not completely prostrating, he is able to retain some functional ability during his attacks. 2. The veteran's diastolic pressures are predominately less than 110 and systolic pressures are predominately less than 200. 3. X-ray evidence of fusion of C6 to C7, failure of segmentation, and degenerative changes of the cervical spine were noted during active service; current X-ray evidence confirms the presence of this chronic disease. 4. The service medical records show a history of an injury to the low back in 1971, with treatment for low back pain, strain, and lumbar spasm on several occasions; the current medical evidence includes radiographic evidence of a Type II spondylolisthesis and mild degenerative disc disease at L1 to L2, and medical opinion has related this disability to the injury incurred during service. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent for chronic headaches with a history of trauma have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.124a, Code 8100 (1999). 2. The criteria for an evaluation in excess of 10 percent for hypertension have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1997); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1999). 3. Cervical spine degenerative disease with fusion of C6 to C7 was incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991 and Supp. 1999); 38 C.F.R. §§ 3.303 (1999). 4. Spondylolisthesis and mild degenerative disc disease at L1 to L2 was incurred during active service. 38 U.S.C.A. §§ 1110, 5107; 38 C.F.R. §§ 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Increased Evaluation The veteran contends that the evaluations for his service connected headaches and hypertension are inadequate to reflect their current level of severity. He states that he gets headaches several times a month lasting for days at a time, and that these headaches cause many problems with his normal functioning. In addition, he notes that he requires medication to control his hypertension. Initially, the Board finds that the veteran's claims for increased evaluations are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); that is, plausible claims have been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well-grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that the VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C.A. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Headaches Entitlement to service connection for chronic headaches with a history of head trauma was established in a July 1994 rating decision. A 10 percent evaluation was assigned for this disability. The veteran's disability was originally evaluated under 38 C.F.R. § 4.130, Code 9304, the rating code for dementia due to head trauma. However, the recent evidence is negative for a diagnosis of dementia. An April 1999 rating decision promulgated during the course of the current appeal evaluated the veteran's disability under the rating code for migraines, and increased the evaluation of the veteran's disability to the current 30 percent rating. Migraine headaches which are very frequent and completely prostrating, and include prolonged attacks productive of severe economic inadaptability are evaluated as 50 percent disabling. Characteristic prostrating attacks occurring on an average of once a month over the last several months are evaluated as 30 percent disabling. 38 C.F.R. § 4.124a, Code 8100. The evidence for consideration includes VA treatment records dated November 1995. These note that the veteran had been experiencing some headaches. The assessment was migraines. March 1996 VA treatment records state that the veteran had a history of a frontal lobe contusion as a child. He had experienced headaches since age 22. The headaches were described as a strong, pulsating pain. The inside of his head would feel light, and he would experience nausea, sonophobia, and photophobia. The headaches would last about three to four days, and he had one every week. Medication would help control his pain. The diagnosis was migraine headaches, without aura. The veteran came in for treatment and follow up care for complaints that included migraine headaches in April 1996. The headaches were described as flashing lights with nausea and vomiting, right temporal, lasting about three to four days. The impression was migraine headaches. May 1996 records show that the veteran's headaches had been increasing over the past several months, and he had experienced sharp pains in the right frontal area for the past two weeks. They were relieved with extra strength Tylenol. A magnetic resonance imaging (MRI) study revealed a three centimeter region of encephalomalacia in the right frontal lobe consistent with an old infarct. September 1996 records reveal a history of migraines, but describe this disability as stable. The veteran was afforded a VA examination in November 1996. He was noted to have a history of a head injury in 1966 when he was a child. There was a diagnosis of a frontal contusion during service in 1980. The veteran had been complaining of recurrent headaches. He described them as a pounding sensation, and said that they made him highly sensitive to light. Currently, his headaches occurred once a month, and usually lasted two to three days. He was receiving medication to control his headaches and his anger. The veteran said that he found it hard to stay at work when he had his headaches. He added that his girlfriend had noticed some shaking of his legs during his sleep. The neurologic examination revealed mild to moderately slow alternate motion rate in the upper and lower extremities and tongue. There were symmetrical moderately decreased deep tendon reflexes in the upper extremities. He also had a few bursts of jocularity that were not called for by the situation. The diagnoses included status post concussion and contusion as a child, cognitive difficulties, mild with frontal lobe, migraines that occurred once a month, and periodic limb movements in his sleep. In VA treatment records from January 1997, the veteran stated that he felt fine, but that he had on and off headache episodes. Additional January 1997 records state that the headaches were unchanged in character and frequency. May 1997 records indicate that the veteran continued to be seen for several complaints, including headaches. The headaches were persistent, but did not interfere with daily activity. The assessment included right sided headaches. January 1998 VA treatment records show that the veteran's headaches were well controlled by medication. Additional January 1998 records indicate that the veteran had experienced headaches since childhood, which had been worsened by a trauma in service. His medication provided some relief, and his last migraine had been four days ago. However, March 1998 records show that the veteran had complained of off and on headaches for the past week. The headaches reportedly lasted 2-3 hours. The assessment included history of migraine headaches, and possible tension headaches. These were partially helped by medication. VA treatment records from August 1998 show that the veteran had experienced two migraines since his last visit. The veteran was afforded a hearing before a hearing officer at the RO in March 1999. He testified that he was taking two different dosages of his medication a total of three times each day. He stated that he now experienced his headaches at least three to four times each month, and that they would last from three to five days. His symptoms included blurred vision, nausea, and pounding of the head, and he would become more sensitive to sound and light. He was going to school on a full time basis, but his migraines sometimes caused him to miss class. The veteran said that he was able to function to a certain degree during his headaches, and that he would take hot showers or lay under a fan to help ease his pain. He would get some relief from that treatment, and the pain would come and go every few hours. The veteran stated that he was not totally incapacitated during headaches, but that he could function at a minimum. See Transcript. The Board finds that entitlement to an increased rating for the veteran's headaches is not merited. The veteran indicated at the November 1996 VA examination that he experienced headaches on a monthly basis, and January 1997 records indicate that this had not changed. The veteran testified at the March 1999 hearing that the frequency of his headaches had increased to the point where they now occurred three to four times each month, and that they lasted from three to five days. However, there is no evidence that the headaches are completely prostrating, and the veteran has denied that they are of such severity. While he has missed some school, he has noted that he retains some ability to function while having his headaches, and the treatment records show that his headaches are partially controlled by his medication. Therefore, the criteria for a 50 percent evaluation are not nearly approximated, and the Board finds that the veteran's symptomatology more nearly resembles that required for the 30 percent evaluation currently in effect. 38 C.F.R. § 4.124a, Code 8100. Hypertension Entitlement to service connection for hypertension was established in the July 1994 rating decision. A 10 percent evaluation was assigned for this disability, and this evaluation remains in effect. The Board notes that the Ratings Schedule has been revised with respect to the regulations applicable to cardiovascular disabilities, including hypertension, effective January 12, 1998. 62 Fed.Reg. 65207 (Dec. 11, 1997). When a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to the veteran will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). The RO considered the new criteria in the September 1998 supplemental statement of the case. The prior Rating Schedule criteria provided a 10 percent evaluation for hypertensive vascular disease for diastolic pressure predominantly 100 or more; a 20 percent evaluation was warranted for diastolic pressure predominantly 110 or more with definite symptoms; and a 40 percent rating was warranted when diastolic pressure was predominantly 120 or more and moderately severe symptoms were demonstrated. 38 C.F.R. § 4.104, Diagnostic Code 7101 (effective prior to January 12, 1998). It was noted that a minimum 10 percent rating was warranted when continuous medication was necessary for the control of hypertension with a history of diastolic blood pressure predominately 100 percent or more. Id. Under the amended criteria, a 10 percent evaluation is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure of 160 or more, or; 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 when diastolic pressure is predominantly 110 or more, or; systolic pressure is predominantly 200 or more, and a 40 percent evaluation requires diastolic pressure of predominantly 120 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101 (1999). The evidence includes VA treatment records dated February 1995. These records indicate that the veteran had not taken his blood pressure medication that day. His current blood pressure was 155/100. June 1995 records show a blood pressure reading of 136/78. August 1995 records include a blood pressure reading of 158/90. However, additional readings from this day were 172/116 and 184/114, and the veteran was noted to be experiencing anxiety concerning various health problems. October 1995 records show readings of 172/104, 172/106, and 112/63. November 1995 records show a reading of 150/90, and include an assessment of hypertension, well controlled. Additional VA treatment records show readings of 172/112, 148/90, 158/104 and 150/102 in April 1996, May 1996, June 1996, and September 1996 respectively. Additional records from October 1996 show a reading of 190/90. The veteran was afforded a VA examination for hypertension in October 1996. His hypertension was being treated with various medications. He complained of problems controlling his blood pressure. His blood pressure readings for the right arm were 142/92 sitting, 148/98 lying, and 148/98 standing. His blood pressure readings for the left arm were 148/88, 142/88, and 152/102 sitting, lying, and standing, respectively. The diagnoses included hypertension. January 1997 VA treatment records reflect that the veteran's blood pressure was 190/100. Additional records from January 1997 and February 1997 show readings of 136/91 and 136/84. April 1997 readings state that the hypertension was not well controlled, and show a reading of 162/104. However, additional records from April 1997, May 1997, and June 1997 show readings of 154/98, 158/98, and 134/88, respectively. The June 1997 records include an assessment of hypertension, good control. The reading was 144/100 in August 1997. October 1997 records show that the veteran had experienced three episodes of substernal chest pain the previous day, with associated shortness of breath, nausea, and vomiting. He also felt light headed and unsteady, and had problems with his left leg and arm. His history of a childhood trauma was noted, as were the risk factors of hypertension and obesity. The blood pressure was 160/100. The diagnostic impression included rule out myocardial infarction, and rule out transient ischemic attacks. January 1998 records describe the veteran's hypertension as well controlled, with a blood pressure reading of 132/90. He was also noted to have suffered a stroke in October 1997, with left hemiparesis. He had experienced similar symptoms in 1993, but had recovered. February 1998 records state that the veteran's hypertension was controlled with multiple medications. The veteran stated that he felt hypertensive, but that there was no chest pain or headaches, and just an occasional tingle. The veteran reported that his blood pressure had been checked at school that morning, and found to be 160/114. Subsequent readings reportedly showed systolic readings from 150 to 170, and diastolic readings from 100 to 139. Current readings were 172/106, and 142/103. The diagnostic impression was hypertensive episode, resolved. Records from August 1998 show a blood pressure reading of 154/94. December 1998 records note a history of stroke, and readings of 138/92, and 162/94. At the March 1999 hearing, the veteran testified that he took three different medications for his hypertension each day. He also took medication for chest pain. The veteran noted that he sustained his second stroke in 1997. He monitored his blood pressure at home. See Transcript. The Board finds that entitlement to an increased evaluation for hypertension is not warranted under either the regulations in effect before or after January 1998. Initially, the Board notes that the veteran recently had a stroke. Service connection for the residuals of this stroke has been established, and the symptoms associated with this disability are not for consideration in the evaluation of the veteran's hypertension. In order to receive a 20 percent evaluation under both the old and new regulations for the evaluation of hypertension, the diastolic readings that are predominately 110 or more are required. The new regulations also provide for a 20 percent evaluation when the systolic readings are predominately 200 or more. In this case, out of the numerous blood pressure readings obtained between February 1995 and December 1998 noted above, the veteran had diastolic pressures in excess of 110 on only 2 separate days, one in August 1995 and another in February 1998. These were attributed to a hypertensive episode which resolved during the day. All of the remaining diastolic readings obtained during this period were less than 110. Therefore, the veteran's diastolic pressure is not considered to be 110 or more, Finally, there is no record of a systolic reading of 200 or more. As the required criteria have not been met, a higher evaluation is not merited. 38 C.F.R. § 4.104, Diagnostic Code 7101 (1997); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1999). II. Service Connection The veteran contends that he has developed disabilities of the neck and lower back as a result of active service. He states that he was injured during basic training when he was moving some wall lockers, and one of those lockers fell and struck him in the lower back. The veteran notes that he was found to have fusion of the cervical spine during active service, and believes that this is the same disability for which he currently seeks service connection. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131. If arthritis becomes manifest to a degree of 10 percent within one year of separation from active service, then it is presumed to have been incurred during active service, even though there is no evidence of arthritis during service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. A person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107. A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. The claim does not need to be conclusive, but only possible in order to be well grounded. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The veteran has the burden of submitting evidence to show that the claim is plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In order for a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Epps, 126 F.3d at 1468; Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). Where the determinative issue involves medical causation or etiology, or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. Epps, 126 F.3d at 1468. Further, in determining whether a claim is well-grounded, the supporting evidence is presumed to be true and is not subject to weighing. King v. Brown, 5 Vet. App. 19, 21 (1993). In the case of a disease only, service connection also may be established under section 3.303(b) by (1) evidence of the existence of a chronic disease in service or of a disease, eligible for presumptive service connection pursuant to statute or regulation, during the applicable presumption period; and (2) present disability from it. Savage v. Gober, 10 Vet. App. 488, 495. Either evidence contemporaneous with service or the presumption period or evidence that is post service or post presumption period may suffice. Id. A review of the service medical records reveals that a November 1976 X-ray study showed failure of segmentation and possible fusion of the 6th and 7th cervical vertebrae. A March 1977 X-ray study also showed an apparent anomaly in the posterior aspect of the lower cervical spine. The veteran was seen for complaints of headaches in July 1977. He was noted to have muscle tenderness of the posterior neck. February 1978 records state that the veteran had a history of low back pain. A history of an acute injury in 1971 was noted. The veteran continued to have pain off and on. On examination, there was increased tone of the paraspinal muscles. The assessment was low back strain. Additional February 1978 records show that the veteran continued to be seen for back pain. Undated service medical records noted the acute onset of low back pain. The assessment was lumbar muscle spasm. Service medical records dated November 1979 indicate that X- rays of the cervical spine revealed fusion of C7 and T1, as well as minimal spur formation. It was reported that he had a "pinched nerve" in the neck area 6 years earlier, with a short duration of neck stiffness. August 1984 records indicate that the veteran was seen for complaints of chronic lower back pain that radiated down his left leg. The assessment was chronic back pain. In April 1985, the veteran complained of pain in the middle of his lower back. The pain radiated into the legs below the knee. The assessment was a strained muscle. The veteran was seen for complaints of back pain at T1 to T3 in June 1985. This was associated with dysuria and/or frequency of urination. The veteran was afforded a retirement examination in November 1990. This examination found that the veteran's spine was normal. The veteran denied a history of arthritis and recurrent back pain on a Report of Medical History obtained at that time. A July 1991 examination for demobilization from Desert Storm also found that the veteran's spine was normal. The veteran answered "yes" to a history of recurrent back pain on a Report of Medical History obtained at this time. However, this was said to be remote. The post service records include the report of a VA examination of the spine conducted in September 1998. He gave a history of having fusion of C6 to C7 discovered during service. The veteran also said that he had sustained an injury to his low back during service when a wall locker had fallen and hit him in the back. The veteran said that he was treated at the time of his injury. X-ray studies obtained at this time reveal cervical spine degenerative disc disease throughout the cervical spine with associated hypertrophic changes and fusion of C6 to C7, with failure of segmentation, as well as spondylolisthesis Type II at the L5 to S1, with mild degenerative disc disease at L1 to L2. The diagnoses included degenerative disc disease throughout the entire cervical spine with a fusion of C6 to C7, and chronic lumbar spine pain with radiographic evidence of Type II spondylolisthesis and mild degenerative disc disease at L1 to L2. The examination report contains a handwritten addendum which states that it is likely the lower back disability is related to the injury in service. At the March 1999 hearing, the veteran testified that there was no injury to his neck or back prior to entering active service. He stated that he had sustained an injury in 1971 when a wall locker fell from a truck and hit him in the lower part of his back. He was not currently receiving any treatment for his back complaints. He noted that he had reported his problem during treatment at a VA facility in 1996, but was told that the priority should be to get his blood pressure under control, and that this was the first problem that should be addressed. The veteran stated that his back problems prevented him from walking for more than a short distance without having to stop and rest. He would experience pain in his neck and back when he did physical activities such as working in the yard. He had not sustained any additional injuries to his neck or back since discharge from service. See Transcript. The Board finds that the veteran has submitted evidence of a well grounded claim for entitlement to service connection for a neck disability. Moreover, the Board finds that entitlement to service connection for degenerative disease of the cervical spine, with fusion of C6 to C7 is warranted. The veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). Although the veteran's entrance examination is not contained in the claims folder, the veteran has testified that he did not have a neck problem prior to service and there is no evidence to show that a neck disability preexisted service. The veteran is therefore presumed to have been in sound condition upon entering active service. A neck disability was not noted until four years after the veteran entered service, when the November 1976 X-ray study revealed failure of segmentation and possible fusion in the cervical spine. An X-ray study conducted in November 1979 confirmed fusion of C7 and T1, as well as minimal spur formation. The current evidence of record includes the September 1998 VA X-ray examination, which noted severe degenerative disc disease throughout the entire cervical spine with a fusion of C6 to C7. Although the separation examinations did not detect a neck disability, and although the post service medical records are negative for a neck disability until September 1998, the provisions of 38 C.F.R. § 3.303(b) state that when a chronic disease is shown in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. Arthritis that is confirmed by X-ray studies is considered to be a chronic disease. 38 C.F.R. § 3.309(a). The spurring found on the November 1979 examination-rays can not be dissociated from the hypertrophic changes exhibited on VA x-rays in September 1998. Therefore, service connection for degenerative disease of the cervical spine, with fusion of C6 to C7 is established. The Board also finds that the veteran has submitted evidence of a well grounded claim for entitlement to service connection for a low back disability. The service medical records show that the veteran was treated for low back pain or low back strain on several occasions between 1978 and 1985, and that a history of low back pain was noted at discharge in July 1991. The September 1998 VA examination included a diagnosis of chronic lumbar spine pain with X-ray evidence of spondylolisthesis and mild degenerative disc disease, and the examiner stated that it was likely that the low back condition was related to the veteran's injury during service. Therefore, as there is evidence of the disability in service, evidence of a current disability, and competent medical evidence of a nexus between the current disability and active service, the veteran's claim is well grounded. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The Board further finds that the evidence supports entitlement to service connection for chronic lumbar spine pain with spondylolisthesis and mild degenerative disc disease at L1 and L2. There is no evidence that a low back disability existed prior to active service, and the veteran has testified that he did not have a back problem prior to service. Therefore, he is presumed to have been sound upon entrance into service. 38 C.F.R. § 3.304(b). The service medical records contain a history of an injury to the back in 1971, which is consistent with the veteran's contentions of an injury during basic training. They also show that the veteran was treated for complaints that concerned his low back on several occasions between 1978 and 1985, and that the diagnoses included chronic back pain, back strain, and lumbar muscle spasm. The September 1998 VA examination notes the veteran's report of an injury in service, and reached a diagnosis of chronic lumbar spine pain with radiographic evidence of a Type II spondylolisthesis and mild degenerative disc disease at L1 to L2. The examiner opined that it was likely this was related to the veteran's injury during service. Therefore, the Board finds that entitlement to service connection for chronic lumbar spine pain with radiographic evidence of spondylolisthesis and mild degenerative disc disease at L1 to L2 is merited. ORDER Entitlement to an evaluation in excess of 30 percent for chronic headaches with a history of trauma is denied. Entitlement to an evaluation in excess of 10 percent for hypertension is denied. Entitlement to service connection for degenerative disease of the cervical spine with fusion of C6 to C7 is granted. Entitlement to service connection for chronic lumbar spine pain with radiographic evidence of spondylolisthesis and mild degenerative disc disease at L1 to L2 is granted. THOMAS J. DANNAHER Member, Board of Veterans' Appeals