HYPERTENSION

Summary

The veteran, an Army veteran who served from January 1981 to March 1983, appeals the denial of an initial compensable disability rating for hypertension. The veteran's hypertension was service-connected on a noncompensable basis, effective June 17, 2023, and is considered secondary to PTSD with insomnia disorder, though rated under its own diagnostic code. The veteran contends that her hypertension warrants a higher rating, citing the need for continuous medication and historical blood pressure readings. The Board reviewed evidence including a December 2023 emergency room visit where blood pressure was recorded as 127/70 and 130/75, and a May 2024 VA examination where readings were 137/75, 144/78, and 134/72. The Board found that these readings, even considering medication use, did not meet the criteria for a 10 percent rating under Diagnostic Code 7101, which requires predominantly 100 or more diastolic pressure or predominantly 160 or more systolic pressure. The highest recorded systolic pressure was 144. The Board concluded that the evidence did not support a compensable rating, and as the evidence was not in approximate balance, the benefit of the doubt doctrine was not applicable. Therefore, the appeal for a higher rating for hypertension was denied.

Rationale

Blood pressure readings did not meet criteria for 10% rating.; Highest recorded systolic pressure was 144.; Evidence persuasively against claim for compensable rating.

Full Decision Text

Citation Nr: A25063307
Decision Date: 07/24/25	Archive Date: 07/24/25

DOCKET NO. 241030-486745
DATE: July 24, 2025

ORDER

Entitlement to an initial compensable disability rating for hypertension is denied.

FINDING OF FACT

The Veteran's hypertension requires continuous medication for control but does not result in diastolic pressure of predominantly 100 or more (or a history thereof), or systolic pressure predominantly 160 or more.

CONCLUSION OF LAW

The criteria for an initial compensable disability rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7101.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran has active service in the United States Army from January 1981 to March 1983, with additional service in the Army Reserve. 

The August 2024 rating decision on appeal granted service connection for hypertension and assigned a noncompensable rating, effective June 17, 2023.  The August 2024 rating decision constitutes an initial decision

In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the August 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Preliminary Matter

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016).

Increased Rating Claim

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 resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating 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. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.                     

Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  

Under Diagnostic Code 7101, a 10 percent rating is assigned for hypertension when diastolic pressure is predominantly 100 or more, or when systolic pressure is predominantly 160 or more or as a 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 provided if diastolic pressure is predominantly 110 or more, or if systolic pressure is predominantly 200 or more.  A 40 percent rating is provided if diastolic pressure is predominantly 120 or more. A 60 percent rating is provided if diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101.

As to the 10 percent rating, "The
 when diastolic pressure is predominantly 100 or more, or when systolic pressure is predominantly 160 or more or as a 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 provided if diastolic pressure is predominantly 110 or more, or if systolic pressure is predominantly 200 or more.  A 40 percent rating is provided if diastolic pressure is predominantly 120 or more. A 60 percent rating is provided if diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101.

As to the 10 percent rating, "The plain text of DC 7101 directs VA to consider historical, rather than current, blood pressure readings and that the relevant 'historical blood pressure readings' are those taken before the veteran began medication." See Wilson v. McDonough, 35 Vet. App. 75, 76 (2021).

The term "predominant" is not defined in the rating criteria. Predominantly means "being most frequent or common." See Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/predominant (last accessed July 22, 2025). In the context of DC 7101, this means "above a certain level more often than it was below it." See Thompkins v. McDonald, No. 15-4128, 2016 U.S. App. Vet. Claims LEXIS 2013 (Dec. 29, 2016) (Greenberg, J.) (accepting this definition of predominant in the Board's decision and affirming based on the Board's application of the definition to the facts of that case); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4 th 776 (Fed. Cir. 2021) (en banc).

Hypertension - Evidence and Analysis

The Veteran's hypertension is currently rated as noncompensable under Diagnostic Code 7101 for hypertension for hypertensive vascular disease, effective June 17, 2023. See August 2024 Rating Decision, 38 C.F.R. § 4.104, DC 7101.

The Veteran contends that her service-connected hypertension warrants a compensable rating because it is secondary to other service-connected disabilities. See October 2024 VA Form 10182 Notice of Disagreement. 

As a point of clarification, the Veteran's hypertension, although service connected on a secondary basis to her posttraumatic stress disorder (PTSD) with insomnia disorder, is rated under its own diagnostic code. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Although the Veteran's hypertension is found to be etiologically related to her PTSD, it is its own separate disability, and the Board is bound by the rating criteria for the diagnostic code for hypertension. 38 C.F.R. § 4.7. 

For the reasons discussed below, the Board finds that the criteria for a higher (compensable) rating for the Veteran's hypertension are not met.

VA received the Veteran's claim for compensation in June 2023.  

In December 2023, the Veteran was seen in the emergency room for an unrelated matter and at intake, her blood pressure was 127/70. Upon discharge, her blood pressure was 130/75. See December 2023 Emergency Nursing Record - Medical Treatment Record - Non-Government Facility received by the Board March 2024.

In May 2024, the Veteran was afforded an in-person VA examination for hypertension. The Veteran's diagnosis of hypertension was confirmed. The Veteran reported that since the onset of her symptoms in 2016 her condition had improved with medication and weight loss. The Veteran took daily medication, Losartan 100 mg, to control her blood pressure. The Veteran underwent three blood pressure readings at the examination which were as follows: 137/75, 144/78, and 134/72. 

On review, the Board finds that a compensable rating for the Veteran's hypertension is not warranted.  The Board has reviewed the blood pressure readings during the period on appeal and finds that the criteria for a 10 percent rating under
4.

In May 2024, the Veteran was afforded an in-person VA examination for hypertension. The Veteran's diagnosis of hypertension was confirmed. The Veteran reported that since the onset of her symptoms in 2016 her condition had improved with medication and weight loss. The Veteran took daily medication, Losartan 100 mg, to control her blood pressure. The Veteran underwent three blood pressure readings at the examination which were as follows: 137/75, 144/78, and 134/72. 

On review, the Board finds that a compensable rating for the Veteran's hypertension is not warranted.  The Board has reviewed the blood pressure readings during the period on appeal and finds that the criteria for a 10 percent rating under DC 7101 are not met.  Although the Veteran's hypertension has required continuous medication for some time now, her current and historical blood pressure readings do not demonstrate diastolic pressure predominantly 100 or more.  Moreover, the Veteran's hypertension is not shown to result in systolic pressure predominantly 160 or more; the highest systolic pressure of record is 144 which was recorded during the May 2024 VA compensation examination.  The Board finds that the probative medical evidence does not support an initial compensable rating for the Veteran's hypertension.

The Board acknowledges the Veteran's assertion that her blood pressure readings would be higher if she did not take medication to control it. However, when rating hypertension under DC 7101, the Board may consider blood pressure readings taken while a veteran is using medication because the diagnostic code specifically contemplates the effects of medication. McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (holding that Diagnostic Code 7101 contemplates the effects of medication and, therefore, Jones v. Shinseki, 26 Vet. App. 56 (2012) does not apply). Accordingly, the recorded blood pressure readings considered herein are adequate for making an increased rating determination even considering the Veteran's use of medication to control her blood pressure.

In sum, the evidence is persuasively against the claim for an initial compensable rating for hypertension. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and an initial rating of 10 percent for hypertension is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 4.3.   

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Neither the Veteran nor her representative have raised any other issues, nor have any other issues been reasonably raised by the record, regarding the higher rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017).

 

 

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Elsbach, E. R.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.