Case A26020919

B.T. KNOPE · 2026 · Case ID: A26020919

DENIED

Summary

The Veteran served from June 1990 to February 1998. The Veteran appealed the denial of an increased rating for tension headaches, a compensable rating for right wrist scars, and service connection for hypertension. The Board dismissed the claim for an increased rating for residuals of a right distal radius fracture as the Veteran withdrew the appeal during the hearing. For tension headaches, the Board denied an increased rating, finding that while the Veteran experienced frequent headaches, they were not completely prostrating or prolonged, nor did they cause severe economic inadaptability. The Board afforded significant weight to a VA examination from August 2020, finding the Veteran's lay testimony regarding headache frequency and impact to be nonspecific and lacking in probative value. For right wrist scars, the Board denied a compensable rating, finding that the scars were small, not painful, and not unstable, based on multiple VA examinations. The Board afforded more weight to the VA examinations than the Veteran's testimony regarding scar sensation. For hypertension, the Board denied service connection, finding no evidence of continuous symptoms or onset within one year of service. The Board also found the Veteran's hypertension was not etiologically related to service, affording more weight to a VA examiner's opinion that it was less likely than not due to PTSD, over a private opinion that linked it to obesity and PTSD. The Board found the private opinion lacked probative value as it was not based on an examination and did not adequately relate medical studies to the Veteran's specific facts.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210127-136801

Full Decision Text

Citation Nr: A26020919
Decision Date: 03/09/26 Archive Date: 03/09/26

DOCKET NO. 210127-136801
DATE: March 9, 2026

ORDER

Entitlement to a rating in excess of 10 percent for residuals of right distal radius fracture is dismissed without prejudice.

Entitlement to an initial rating in excess of 30 percent for tension headaches is denied.

Entitlement to a compensable rating for residual scars status post closed-reduction fracture repair of the right wrist is denied.

Entitlement to service connection for hypertension is denied.

FINDINGS OF FACT

1. At the August 2024 hearing, prior to promulgation of a decision in the appeal, the Veteran knowingly and unambiguously withdrew the claim seeking an increased rating for residuals of right distal radius fracture.

2. The Veteran's tension headaches have not manifested as very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability.

3. The Veteran's right wrist scars have an area of less than 6 square inches or 39 square centimeters, and they are not unstable or painful.

4. The Veteran's hypertension is not etiologically related to service.

CONCLUSIONS OF LAW

1. The criteria for dismissal of entitlement to a rating in excess of 10 percent for residuals of right distal radius fracture have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for entitlement to an initial rating in excess of 30 percent for tension headaches have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.124a, Diagnostic Code (DC) 8100.

3. The criteria for entitlement to a compensable rating for residual scars status post closed reduction fracture repair of the right wrist have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.118, DCs 7801, 7802, 7804.

4. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310, 4.104, Diagnostic Code (DC) 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1990 to February 1998.

This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 2020 decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In the January 2021 Notice of Disagreement, the Veteran elected the Hearing docket. A Board hearing was held in August 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Withdrawal of Claims

An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by their authorized representative. 38 C.F.R. § 20.205.

1. Increased rating for right distal radius fracture

During his August 2024 hearing, with advice of counsel, the Veteran requested to withdraw his appeal regarding an increased rating for residuals of his right distal radius fracture. The Veteran was informed about the consequences
new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Withdrawal of Claims

1. Increased rating for right distal radius fracture

During his August 2024 hearing, with advice of counsel, the Veteran requested to withdraw his appeal regarding an increased rating for residuals of his right distal radius fracture. The Veteran was informed about the consequences by the presiding Veterans Law Judge at the hearing and, after being so informed, he confirmed his withdrawal of this issue. The Board finds that this withdrawal was knowing, unambiguous, and done with a full understanding of the consequences of such action on the part of the Veteran. Accordingly, this claim is dismissed without prejudice.

Increased Ratings

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability negatively affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptoms with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

2. Initial rating for tension headaches

The Veteran seeks an increased initial rating for his service-connected tension headaches. After reviewing the evidence, the Board finds an increased rating is not warranted.

The Veteran's tension headaches are currently rated at 30 percent under DC 8100 (migraines). This diagnostic code provides a 30 percent rating for characteristic prostrating attacks occurring on an average once a month over last several months. "Characteristic prostrating attacks" are those that "typically produce powerlessness or a lack of vitality." Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018).

To warrant an increased rating under this diagnostic code, the evidence must show very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, DC 8100. "Very frequent" is undefined by the regulations, but in the context of this successive diagnostic code, headaches must occur at least greater than once a month. "Completely" means entirely. "Prolonged" means lengthened in time, extended duration, drawn out, continued, protracted. Johnson v. Wilkie, 30 Vet. App. 245, 252-53 (2018).

Turning to the medical evidence, the Veteran's service treatment records do not show any complaints, symptoms, diagnosis, or treatment related to headaches. Post-service records show that, when establishing VA care in September 2015, he reported morning headaches in the context of potential untreated sleep apnea. A December 2017 primary care followup notes infrequent headaches. His problem list does not include any headache conditions, and his review of systems is routinely negative for headaches.

The Veteran's tension headaches were not diagnosed until an August 2020 VA examination. At this time, his headaches were described as constant pain on both sides of the head with sensitivity to light, typically lasting less than one day. There were no pertinent physical findings. He was assessed as having characteristic prostrating attacks more than once per month. However, he did not have very prostrating and prolonged attacks productive of severe economic inadaptability. His headaches were noted to impact his ability to work due to light sensitivity, irritability, and inability to focus.

Finally, the Board has considered the Veteran's lay statements. During his August 2020 VA examination, he reported intermittent, very random headaches that come in waves. He described having severe headaches two to three days a week lasting about two hours. He reported their severity had been about the same since their onset in 1994, and he treated them with over-the-counter medication three times weekly. During his August 2024 testimony, the Veteran described work accommodations due to headaches including having access to a quiet workspace with less light and teleworking. He reported taking time off from work or teleworking because of headaches.

Overall, the Board affords limited probative weight to the lay evidence. The Veteran's overall testimony was nonspecific and couched in vague qualifiers such as
has considered the Veteran's lay statements. During his August 2020 VA examination, he reported intermittent, very random headaches that come in waves. He described having severe headaches two to three days a week lasting about two hours. He reported their severity had been about the same since their onset in 1994, and he treated them with over-the-counter medication three times weekly. During his August 2024 testimony, the Veteran described work accommodations due to headaches including having access to a quiet workspace with less light and teleworking. He reported taking time off from work or teleworking because of headaches.

Overall, the Board affords limited probative weight to the lay evidence. The Veteran's overall testimony was nonspecific and couched in vague qualifiers such as "sometimes." He did not clearly distinguish between teleworking and using leave due to a total inability to work. Moreover, the Board cannot ignore the minimal headache complaints, lack of headache diagnosis, and negative reviews of systems within the VA records despite access to care and regular treatment for other conditions. See Kahana v. Shinseki, 24 Vet. App. 428, at 439-40 (2014).

On the other hand, the Board affords significant probative weight to the August 2020 VA examination, which was provided by a qualified medical professional after review of the claims file and application of the facts to current medical knowledge.

Considering this evidence, the Board finds that the Veteran's tension headaches have not manifested as very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. The evidence suggests that his headaches sometimes occur frequently, but they are not completely prostrating or prolonged duration. Moreover, while they cause some interference with work, the evidence does not suggest severe economic inadaptability.

Therefore, the Board finds that an increased initial rating is not warranted for tension headaches. The claim is denied.

3. Increased rating for right wrist scars

The Veteran seeks a compensable rating for his service-connected residual scars following closed reduction repair of a right wrist fracture. After reviewing the evidence, the Board finds that a compensable rating is not warranted.

The Veteran's right wrist scars are currently rated as noncompensable under DC 7802 which rates scars not of the head, face, or neck that are not associated with underlying soft tissue damage. To warrant a compensable rating under this diagnostic code, the evidence must show scarring of an area of at least 144 square inches or 929 square centimeters. 38 C.F.R. § 4.118, DC 7802. If the scars were associated with underlying soft tissue damage, a compensable rating would require an area of at least 6 square inches or 39 square centimeters. 38 C.F.R. § 4.118, DC 7801.

The Board has also considered DC 7804 pertaining to unstable or painful scars. To warrant a compensable rating under this diagnostic code, the evidence must show at least one scar that is unstable or painful. 38 C.F.R. § 4.118, DC 7804. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, DC 7804, Note 1.

Turning to the medical evidence, service treatment records show that the Veteran fractured his right distal radius in October 1995. He underwent a closed reduction with pinning and external fixation in November 1995 followed by hardware removal in or around December 1995.

VA treatment records do not show ongoing issues with right wrist scars. There are some notes regarding scar numbness and tingling, but these relate to surgical scars from a February 2020 foot surgery. There is no reference to right wrist postoperative scarring. Several exams in 2016 and 2017 state that he has no scars on his right upper extremity, although the focus of those exams was related to elbow pain.

The Veteran was afforded VA examinations in January 2019 and August 2020. Both examinations noted that he had three small right wrist scars. The largest measured 1 centimeter by 0.1 centimeter. Their combined total area was less than one square centimeter. None of the scars were painful or unstable.

Finally, the Board has considered the Veteran's lay statements, including his August 2024 testimony that his scars had a tingling sensation when touched and that one of the scars scabbed "every once in a while." Although asked, he could not testify more specifically about how often this occurs. The Board notes that this does not explicitly describe either pain or frequent loss of covering of skin over the scar. Moreover, two separate VA examinations indicate that his scars are not painful or unstable. The VA examinations are more persuasive than the Veteran's testimony, particularly given the
The largest measured 1 centimeter by 0.1 centimeter. Their combined total area was less than one square centimeter. None of the scars were painful or unstable.

Finally, the Board has considered the Veteran's lay statements, including his August 2024 testimony that his scars had a tingling sensation when touched and that one of the scars scabbed "every once in a while." Although asked, he could not testify more specifically about how often this occurs. The Board notes that this does not explicitly describe either pain or frequent loss of covering of skin over the scar. Moreover, two separate VA examinations indicate that his scars are not painful or unstable. The VA examinations are more persuasive than the Veteran's testimony, particularly given the lack of right wrist scar complaints over many years of treating records despite having reference to other issues with unrelated, non-service-connected scars.

Therefore, the persuasive weight of the evidence shows that the Veteran's right wrist scars have an area of less than 6 square inches or 39 square centimeters, and they are not unstable or painful. The Board finds that a compensable rating is not warranted under DCs 7801, 7802, or 7804. Therefore, the claim for an increased rating is denied.

For both of the Veteran's increased rating claims, the Board finds that referral for consideration of an extraschedular rating is not warranted. The evidence has not shown that the established schedular criteria are inadequate to describe the severity and symptoms of the Veteran's disabilities, nor does this case involve an exceptional or unusual disability picture. See Thun v. Peake, 22 Vet. App. 111 (2008).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Generally, the evidence must show the existence of a present disability, an in-service incurrence or aggravation of a disease or injury, and a causal relationship between the present disability and the disease or injury incurred or aggravated during service ("nexus"). Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). A showing of continuity of symptoms from separation to the present is a factor to be considered in assessing service connection claims.

Certain chronic diseases, including hypertension, may be presumed to have been incurred during service if they become manifested to a compensable degree within one year from separation from active service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. Id.

A disability may also be service connected on a secondary basis by demonstrating that the disability is either proximately due to or the result of an already service-connected disease or injury or aggravated by an already service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995).

A diagnosis of hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For these purposes, "hypertension" means that the diastolic blood pressure is predominantly 90 millimeters (mm) or greater, and "isolated systolic hypertension" means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, DC 7101, Note 1.

4. Service connection for hypertension

The Veteran seeks service connection for hypertension which he contends is secondary to his service-connected posttraumatic stress disorder (PTSD). In the alternative, he contends it is secondary to all of his service-connected disabilities with obesity as an intermediate step. The Board finds that service connection is not warranted.

As an initial matter, the September 2020 AOJ decision on appeal includes a favorable finding that the Veteran has a current disability of hypertension. The Board adopts this favorable finding. See 38 C.F.R. § 3.104.

The Board next considers whether the clinical evidence shows continuous symptoms since active service or an onset of compensable hypertension within one year of separation.

In this regard, the service treatment records do not show any complaints, symptoms, treatment, or diagnosis of hypertension or high blood pressure. His highest systolic blood pressure reading was 146 mm in October 1996. His highest diastolic blood pressure reading was 74 mm in or around August 1996.

VA treatment records show that the Veteran had no known history of hypertension when he established with VA primary care in September
includes a favorable finding that the Veteran has a current disability of hypertension. The Board adopts this favorable finding. See 38 C.F.R. § 3.104.

The Board next considers whether the clinical evidence shows continuous symptoms since active service or an onset of compensable hypertension within one year of separation.

VA treatment records show that the Veteran had no known history of hypertension when he established with VA primary care in September 2015. However, the condition was diagnosed during that visit based on blood pressure readings of 178/103 and 196/124. He was prescribed antihypertensive medication. His blood pressure has since been controlled with medication, most recently recorded as 116/66 in September 2020.

An August 2020 VA examination describes an onset of hypertension in September 2015 with improvement with medication since that time. At this appointment, his blood pressure readings were 107/64, 100/64, and 106/65. It was unknown whether his initial diagnosis was confirmed by blood pressure readings taken two or more times on at least three different days.

Considering the above, the clinical evidence does not show either continuous symptoms or an onset of hypertension during or within one year of service. The first indication of hypertension was in September 2015, more than a decade after active service.

Service connection can also be established through lay statements of continuity of symptoms. In this case, however, the Veteran does not contend that his hypertension arose during or within one year of active service.

Next, service connection may also be warranted if the evidence otherwise indicates a relationship or nexus between the Veteran's current disability and active-duty service. In this regard, there are competing medical opinions.

First, the August 2020 VA examiner concluded that the Veteran's hypertension was less likely than not proximately due to or a result of his PTSD. They noted that, according to the Mayo Clinic, there was no identifiable cause of primary or essential hypertension in most adults because this condition tends to develop gradually over many years. They also listed many causes of secondary hypertension, which included obstructive sleep apnea, one of the Veteran's non-service-connected conditions. Although the examiner did not explicitly address aggravation, there is no evidence that the Veteran's hypertension has undergone any worsening. It has been controlled with medication since it was diagnosed.

In contrast, after the Board hearing, the Veteran submitted a November 2024 private opinion from R.P., DO, an emergency medicine specialist. Dr. R.P. concluded that the Veteran's hypertension was at least as likely as not due to obesity and service-connected PTSD. They said that both PTSD and obesity-caused physical inactivity contributed to conditions that elevated his blood pressure ranging from persistent sympathetic nervous system activation to weight gain resulting from physical limitations due to service-connected knee and wrist injuries, collectively increasing his hypertension risk.

When reviewing conflicting medical opinions, the Board may favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). Relevant factors when evaluating medical opinions include the expert's knowledge and skill, their familiarity with the pertinent medical history, whether the patient was personally examined, whether the opinion is clear and thorough, and whether the expert provides a factually accurate, sound reasoning for their conclusion. See, e.g., McCray v. Wilkie, 31 Vet. App. 243, 257.

Here, the Board finds that the August 2020 VA medical opinion has the most probative value. The examiner met, interviewed, and examined the Veteran in person. They reviewed and summarized the available medical records. Their opinion is supported by a clear and factually accurate reasoning that is internally consistent. The examiner did not address obesity as an intermediate step, but this theory was not raised or reasonably inferable until the Board hearing.

On the other hand, the November 2024 private medical opinion is not accompanied by any interview or examination of the Veteran. It includes numerous references to medical studies showing prospective correlations, associations, and risk factors. However, the doctor did not relate those studies to the specific facts or evidence in this case beyond the Veteran's diagnoses. For example, they reference a study suggesting hypertension may develop early in young veterans with PTSD, yet the Veteran was middle-aged when diagnosed.

Moreover, the November 2024 private medical opinion presumes with minimal discussion that the Veteran's obesity was caused by physical inactivity due to service-connected knee and wrist injuries. However, while his treating records note a sedentary lifestyle, they do not suggest an inability to exercise. For example, they note that he walks on a treadmill, walks his dog, and works outside. His providers continue to encourage regular exercise while placing at least equal emphasis on dietary changes for weight loss. The only exercise restrictions noted were due to non-service-connected issues such as left foot surgery. The Board finds that the evidence does not support the presence of physical inactivity due to service-connected disabilities. As such, the November 2024 private medical opinion is not supported by the evidence or facts in this case, and it lacks significant probative weight.

Finally, the Board has considered the Veteran's belief that his service-connected disabilities have caused his hypertension. The Board acknowledges that he is competent to testify as to observed symptoms, and their onset and continuity. See Layno v. Brown, 6 Vet. App. 465 (1994). He has not been shown to have the medical training or skills needed to competently determine the cause of medical conditions, nor can he indicate when his hypertension became sufficiently severe to be considered a disability under VA regulations. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

For the above reasons, the Board finds that the Veteran's hypertension is not etiologically related to his active service. Therefore, service connection is not warranted, and the claim is denied.

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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Heger

Analyze in VA Law Explorer