BVA9507733 DOCKET NO. 91-41 815 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Wichita, Kansas THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for a right leg disability. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Mark D. Hindin, Counsel INTRODUCTION The veteran had active service from August 1970 to August 1990. This appeal arises from a January 1991, rating decision in which the regional office (RO), in part, denied entitlement to service connection for hypertension, a right leg disability, a knee disability and a left shoulder disability. That decision granted service connection for residuals of the removal of a cyst from the left shoulder. In a September 1993 rating decision, service connection was granted for tendinitis of the left shoulder and chondromalacia of the left knee. The case was before the Board in December 1991, December 1992, and May 1994, when it was remanded for further development. In a statement dated in February 1994, the veteran expressed disagreement with the noncompensable evaluations assigned for tendonitis of the left shoulder and chondromalacia of the left knee. In briefs on appeal dated in October 1991 and March 1995, the veteran's representative raised the issue of entitlement to service connection for residuals of a fracture of the dorsal spine. These issues are not inextricably intertwined with those on appeal, and have not been developed for appellate consideration. They are referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for hypertension on the basis of elevated blood pressure readings reported in service, a diagnosis of hypertension reported on Department of Veterans Affairs (VA) examination in February 1992, and the opinion of the director of medical services for the veteran's representative. He also contends that a hypertension examination for VA in July 1993, was inadequate because the examiner did not review the claims folder. The veteran also contends that he has right leg pain as the result of a herniated nucleus pulposus incurred in service. He further implies that the case should again be remanded because the RO did not comply with the Board's remand instructions and precedents of the United States Court of Veterans Appeals. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims files. 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 preponderance of the evidence is against the grant of service connection for hypertension. The evidence is in favor of the grant of service connection for a right leg disability manifested by radiating pain from the low back, as part and parcel of a service connected low back disability. FINDINGS OF FACT 1. All evidence necessary for an equitable resolution of this case has been secured. 2. Chronic hypertension has not been demonstrated. 3. Right leg pain is part and parcel of the veteran's service connected lumbosacral spine disability. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1994). 2. A right leg disability, namely pain radiating from the low back, is proximately due to a service connected disability. 38 U.S.C.A. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303, 3.310 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran has presented well-grounded claims within the meaning of 38 U.S.C.A. § 5107. In this regard he has submitted evidence in support of his claims which renders them plausible. The Board also finds that the Department of Veterans Affairs (VA) has complied with its obligation to assist him with the development of those claims under the same code provision. The Board has considered the contentions regarding the inadequacy of the development undertaken by the RO. However, the Board finds that the evidence currently of record, as discussed below, is sufficient to render a decision as to the veteran's claims. I. Hypertension In order to establish the existence of hypertension for VA purposes, the evidence must show diastolic blood pressure readings predominantly of 100 or more. Rabidueau v. Derwinski, 2 Vet.App. 141, 143 (1992); Cox v. Brown, 5 Vet.App. 95, 99 (1993); 38 C.F.R. § 4.104, Diagnostic Code 7100 (1994). Under the provisions of Diagnostic Code 7100, disabling hypertension will be found to exist where there is a history of diastolic readings predominantly 100 or more and the current use of hypertensive medication. In addition, under the provisions of 38 C.F.R. 3.303, service connection could not be granted on the basis of elevated blood pressure which is not shown to be chronic. In this case the veteran's service medical records show that his diastolic blood pressure was recorded as 100 or more on several occasions. However, these readings were interspersed with numerous readings below 100. The veteran's blood pressure was checked several times on one date during hospitalization in April 1982. On that occasion, 4 of 8 diastolic readings were 100 or more. The veteran was given Inderal and nitroglycerin during an episode of chest pain in October 1983. However a 5 day blood pressure check in April 1984 revealed no readings of 100 or more. On examination for separation from service in September 1989, the veteran's blood pressure was 138/86. A similar pattern has been demonstrated since service. On VA examination the veteran's blood pressure was 134/88. Hypertension was not diagnosed. On VA examination in February 1992, blood pressure readings of 130/84, 140/100, 145/105, 138/102, 142/100 and 130/105 were reported. It does not appear that the examiner had reviewed the claims folder. Nonetheless, the diagnosis was hypertension. On examination for VA in July 1993, the veteran reported hypertension with occasional palpitations with several episodes of dizziness and syncope beginning in 1982. On the examination the veteran's blood pressure readings were 125/77, 134/80, 138/78, 134/76, and 132/70. The examiner concluded that there was no evidence of "substance" hypertension, and that the findings during service were apparently isolated, and that there was no present elevated blood pressure deemed necessary or sufficient for treatment. Additionally, it was concluded that there was no evidence of cardiovascular disease, except for palpitations of questionable origin. In a letter dated in February 1994, R. Henry Bodenbender, M.D., Director of Medical Services, for the Paralyzed Veterans of America, reported that he had found multiple hypertension readings in the veteran's service medical records, and that these readings could not be "disassociated" from the "confirmed" diagnosis of hypertension supported by 5 elevated diastolic readings over 100 on the VA examination in February 1992. Dr. Bodenbender further commented that these findings met a definition of hypertension contained in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 1002 (Jean D. Wilson, et al., eds., 12th ed. 1991), and noted that hypertension, by VA regulation, is a chronic condition. In a statement dated in May 1994, the veteran reported that he was not using hypertensive medication. The Board must conclude that the evidence does not demonstrate that the veteran has chronic hypertension for VA purposes. Neither during service or since, has the veteran been shown to have diastolic readings of predominantly 100 or more. The veteran has pointed to the findings on the February 1992, VA examination to support his assertion that he currently has hypertension for VA purposes. However, the examiner diagnosed hypertension without looking at the veteran's claims folder. Instead the examiner relied on an incomplete history supplied by the veteran. That history suggested, incorrectly, that since 1981 his blood pressure had always been found to be at least "borderline high." Dr. Bodenbender's opinion is also based on an incomplete and hence inaccurate history. Dr. Bodenbender ignored the many diastolic blood pressure readings during service which were below 100. He also ignored the normal reading on the February 1992 examination and the normal readings on the July 1993 examination. Contrary to what Dr. Bodenbender wrote, findings on the February 1992, examination do not meet a definition contained in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 1002 (Jean D. Wilson, et al., eds., 12th ed. 1991). That text recommends that where hypertension is suspected, blood pressures should be measured at least twice on 2 separate occasions. The February 1992, examination contained a number of blood pressure readings taken on a single occasion. It is also noted in that text that there is no dividing line between normal and high blood pressure, but arbitrary levels have been established. The text does contain its own arbitrary definition, which the veteran has not been shown to meet. However, even if the veteran did meet this definition, service connection could not be granted unless he met VA criteria. As noted above, the veteran does not. Medical opinions based on incomplete and inaccurate history are of no probative weight. See Reonal v. Brown, 5 Vet.App. 458 (1993). In this case Dr. Bodenbender relied on an incomplete and hence inaccurate record in concluding that the veteran had hypertension. The examiner conducting the February 1992, examination relied on an inaccurate history supplied by the veteran. The accredited representative has asserted that the examiner conducting the July 1993 examination also did not have the claims folder for review and that the 1993 examination is also inadequate. It is not apparent from a review of the examination report that the examiner did not comply with the remand instructions to conduct such a review. Moreover, pursuant to instructions in the Board's remand, the physician was informed of the veteran's history. Additionally, the blood pressure readings reported on that examination were within normal limits. The examiner would be qualified to measure the veteran's blood pressure and report accurate results and advance the opinions he did advance. The examiner's opinion that the veteran does not have hypertension is, as discussed above, supported by the record. II. Right Leg Disability The veteran essentially contends that his right leg disability consists of radiating pain secondary to a herniated nucleus pulposus identified during service. The service medical records do show that in May 1987, he had low back pain which radiated to the right calf. In July 1987, he was reported to have a herniated nucleus pulposus at the level of the fifth lumbar vertebra and first sacral segment on CT scan. In December 1987, a lumbar myelographic examination reportedly revealed an enlarged disc. In a report of medical history completed for separation from service in September 1989, it was reported only that the veteran had been treated for mechanical low back pain. On VA examination in November 1990, the veteran complained of a "right leg condition." He reported that he continued to have episodes of low back pain. Straight leg raising was negative. There were no reported findings referable to a right leg disability or disc disease. In the January 1991 rating decision the RO granted service connection for traumatic arthritis of the lumbar spine which it evaluated under 38 C.F.R. § 4.71(a); Diagnostic Code 5010 (1994) pertaining to traumatic arthritis, and 38 C.F.R. 4.71(a); Diagnostic Code 5293, pertaining to intervertebral disc syndrome. The latter diagnostic code provides for evaluating disability on the basis of symptoms in the lower extremities. In the May 1994 remand, the Board requested that the RO determine whether service connection was warranted for a herniated disc and explain its use of Diagnostic Code 5293. The RO responded in a supplemental statement of the case dated in September 1994. The RO responded as follows: The arthritis of the lumbar spine has been rated analogous to Disc Disease (DC 5293) because of complaints of radiating pain and past history of possible disc problems. A herniated disc is not shown and not service connected. Despite the RO's statement that a herniated disc was not service connected, clearly the RO has granted service connection for a disability manifested by "complaints of radiating pain." As such complaints of pain radiating to the right leg are part and parcel of the service connected low back disability. A right leg disability, consisting of radiating pain, is service connected. The veteran has not at this point claimed service connection for any other right leg disability. ORDER Service connection for hypertension is denied. Service connection for a right leg disability, consisting of radiating pain from the low back, is granted as part and parcel of the service connected low back disability. JEFFREY MARTIN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (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), 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 (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.