Citation Nr: 0006951 Decision Date: 03/15/00 Archive Date: 03/23/00 DOCKET NO. 97-29 649 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to an evaluation greater than 10 percent for hypertension. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L. M. Rogers, Associate Counsel INTRODUCTION The veteran had active duty in the Navy from May 11, 1945 to January 18, 1946. This matter comes to the Board of Veterans' Appeals (Board) from an April 1997 rating decision of the Department of Veterans Affairs (VA) Los Angeles, California Regional Office (RO). In that decision the RO granted a disability rating of ten percent for arterial hypertension from April 1996. The veteran perfected an appeal of the April 1997 decision. The current award is less than the maximum evaluation available and consequently the issue remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The veteran claimed in his substantive appeal that the had a 20 percent rating for hypertension from service discharge to 1997, yet he received no compensation. However a RO decision in May 1949 decreased the disability evaluation for hypertension from 20 percent to zero percent. The veteran did not appeal this determination within one year of being notified and it is final. Veteran's Regulation No. 2(a), pt. II, par. III; Department of Veterans Affairs Regulation 1008, effective January 25, 1936 to December 31, 1957; currently 38 U.S.C.A. §§ 5108, 7105 (West 1991 & Supp. 1999). There being no claim of clear and unmistakable error in that determination, the only matter that has been fully developed for appellate review is the issue cited on the first page of this decision. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. The veteran's diastolic pressure is not predominantly 110 or more and his systolic pressure is not predominantly 200 or more. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for hypertension have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7101 (1997 & 1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background Service medical records indicate that in March 1945 the veteran had a diagnosis of arterial hypertension. In January 1946 the Medical Evaluation Board (MEB) determined that the veteran was unfit for service due to his arterial hypertension. From August 1993 to November 1993 the veteran received private medical treatment on numerous occasions. In August 1993 his blood pressure reading was 140/80. An August 1993 stress echocardiography revealed blood pressure readings at a resting rate of 148/80 and at a maximum rate of 180/80. In September 1993, the veteran's blood pressure reading was 130/70, in October 1993 it was 130/80 and in November 1993 it was 140/70. A February 1994 private medical report showed a blood pressure reading of 150/80 and no significant coronary disease was noted. A June 1994 private medical report showed a blood pressure reading of 155/80 and a December 1994 report showed a reading of 145/70. A May 1995 private medical report indicated a blood pressure reading of 110/60. The private physician noted that the veteran was a recovering alcoholic and his cardiac problems included a history of first-degree block, complex ventricular ectopy, and hypertension. It was also noted that the veteran had a syncope in 1991, which had not recurred. A July 1995 private hospital report showed that the veteran was hospitalized for a syncopal episode. Upon admittance the veteran's blood pressure reading was 180/97. An August 1995 private medical report showed blood pressure readings of 160/90 in the supine position and 160/85 in the standing position. It was also noted that the veteran had a syncopal episode in July 1995. During a September 1995 isoproterenol head up tilt test the veteran demonstrated no evidence of vasopressor or syncope. His blood pressure reading in the supine position at the baseline was 160/80 with a pulse of 50 beats per minute. During an infusion of 1 microgram (mcg)/minute of isoproterenol, his blood pressure in the supine position was 150/80 with a pulse of 68 beats per minute. During a 10 minute 80 degree tilt his blood pressure was 160/90, with a pulse of 90 beats a minute. As the infusion of isoproterenol was increased to 3 mcg/minute his blood pressure in the position was 164/64 with a pulse of 93 beats a minute. During the 80-degree tilt for ten minutes, his blood pressure was stable at 160/90 with a pulse of 115 beats a minute. It was noted that this physiologic response was normal and showed no evidence of vasopressor dysfunction. A February 1996 VA Medical Center (VAMC) hospital report indicated that the veteran was hospitalized from January 1996 to February 1996 for alcohol dependency and the veteran had high blood pressure throughout his hospital stay. A March 1996 private medical report indicated that the veteran was hospitalized in January 1996 for a sensation of sweating and dizziness during a period of detoxification. The private physician stated that looking back over the veteran's history, questions regarding consciousness have been during detoxification periods. It was also noted that the veteran does not have coronary artery disease. The report showed a blood pressure reading of 110/70 and it was noted that the veteran has had variable blood pressure. An April 1996 VA Medical Center (VAMC) treatment report showed a blood pressure reading of 148/82 and it was noted that the veteran's hypertension was well-controlled with medications. In June 1996 a private hospital report showed that the veteran had a blood pressure reading of 148/70. A June 1996 private medical report showed a blood pressure reading of 120/66. A July 1996 VAMC treatment report showed a blood pressure of 138/62. An October 1996 private medical report showed a blood pressure reading of 136/70. A stress echocardiography revealed a blood pressure reading of 136/70 while resting and 155/70 at a maximum rate. The veteran's echo wall motion score while at rest was 136/70 and at impost his blood pressure was 155/70. The report also indicated that the veteran had no symptomatic arrhythmias and no inducible wall motion abnormalities. A November 1996 VAMC treatment report indicated that the veteran's hypertension was well-controlled with medications. During an August 1997 personal hearing the veteran complained of having extremely high blood pressure, continuous headaches and ringing in the ears. He also explained that he is limited in his activities and that when he exerts himself too strongly his blood pressure increases drastically. The veteran also stated that he feels lightheaded when his blood pressure increases and he takes medication to control his blood pressure. In March 1998 the veteran withdrew his request for a travel board hearing before a member of the Board of Veterans' Appeals. During a May 1998 VA examination the veteran complained that since 1945 he has continued to have an elevated blood pressure. The veteran stated that he has had occasional episodes of light-headedness and palpitations. He further stated that he occasionally has low heart rates, he has had two syncopal episodes in the past few years, and he has been told to keep his activities to a minimum because of hypertension and arrhythmia. Upon physical examination, the veteran's blood pressure lying was 134/72 with a pulse of 60, sitting was 133/66 with a pulse of 60, and standing was 128/70 with a pulse of 64. The veteran had a regular heart rate and rhythm with occasional premature beats. There was a 2/6 systolic ejection murmur heard best at the left lower sternal border and radiating to the auxiliary area. There were no thrills or heaves. Impression was history of hypertension and history of cardiac arrhythmia. II. Laws and Regulations The veteran's increased rating claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78 (1990). This finding is based on the veteran's contention regarding the increased severity of his service- connected hypertension. See Jones v. Brown, 7 Vet. App. 134 (1994); Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed and no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a) (West 1991). Disability ratings are based on the average impairment of earning capacity resulting from disability. The percentage ratings for each diagnostic code, as set forth in the VA's Schedule for Rating Disabilities, codified in 38 C.F.R Part 4, represent the average impairment of earning capacity resulting from disability. Generally, the degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The Board notes that the schedular criteria for evaluation of the cardiovascular system were changed effective January 12, 1998. Where 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 an appellant applies unless Congress provided otherwise or permitted the Secretary to do otherwise and the Secretary does so. Marcoux v. Brown, 9 Vet. App. 289 (1996); Karnas v. Derwinski, 1 Vet. App. 308 (1991); see also VAOGCPREC 11-97. Thus, the veteran's hypertension must be evaluated under both the old and the new rating criteria to determine which version is most favorable to the veteran. The rating criteria in effect for cardiovascular disorders prior to January 1998 provided for the assignment of 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. 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 (1997). Effective January 12, 1998, the rating schedule provides for a 10 percent evaluation 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. A 40 percent evaluation requires diastolic pressure of predominantly 120 or more. 38 C.F.R. § 4.104, Code 7101 (1999). Where there is a question as to which of two evaluations shall be applied, 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 (1998). 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, the regulations do not give past medical reports precedence over current findings. See 38 C.F.R. § 4.2 (1999); Francisco v. Brown, 7 Vet. App. 55 (1994). III. Analysis During a May 1998 VA examination, the veteran had complaints of elevated blood pressure, lightheadedness, lethargy, anxiety, depression, and insomnia. A physical examination revealed a blood pressure reading of 134/72 while lying, 133/66 while sitting, and 128/70 while standing. It was also noted that the veteran is currently taking medications to control blood pressure. The criteria for a 20 percent rating under 38 C.F.R. § 4.104, Diagnostic Code 7101, which requires diastolic pressure of predominantly 110 or more under both the new and the old criteria, or systolic pressure predominantly 200 or more, under the new criteria, are not met. As demonstrated above, diastolic blood pressure readings, particularly in the recent past, have been consistently in the area of 70 and clearly below 110. The veteran has not been found to have a systolic pressure of 200 or more on any VA examination or private medical examination. Although the veteran's argument as to the merits of an increased evaluation due to the severity of his hypertension is noted, it is not substantiated in view of the evidence of record and the applicable diagnostic criteria. The appellant, as a lay person without medical knowledge is not competent to offer opinions or to make such conclusions regarding the nature of his symptoms or the severity of the underlying disability. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992) (holding that lay persons are not competent to offer medical opinions). Based upon the competent evidence of record, the Board finds the veteran's hypertension under either the current or prior rating criteria warrants no more than a 10 percent disability rating. Medical evidence demonstrates that the disorder is presently controlled by medication. The preponderance of the evidence is against the veteran's claim. In denying the veteran's claim, the Board has considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the veteran's claim, the doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to an evaluation in excess of 10 percent for hypertension is denied. _____________________________________ THOMAS J. DANNAHER Member, Board of Veterans' Appeals