HYPERTENSION

Summary

The veteran, who served from June 1970 to June 1990, appeals the denial of an initial compensable rating for hypertension and an increased rating for tinea pedis. The veteran also sought service connection for a skin disorder separate from his service-connected tinea pedis. The Board denied the hypertension claim, finding that while the veteran's condition requires medication, his blood pressure readings did not meet the criteria for a compensable rating, specifically lacking a history of diastolic pressure predominantly 100 or more prior to medication or current readings reflecting the higher thresholds. For tinea pedis, the Board denied an increased rating, noting that the veteran's condition affected less than 20 percent of his body and did not require systemic therapy, thus not meeting the criteria for a higher evaluation. The Board also denied service connection for a separate skin disorder, finding no evidence of a current condition causally related to service or aggravated by his service-connected tinea pedis, and affording greater weight to VA examiner opinions over the veteran's lay statements regarding etiology. The Board acknowledged the applicability of the benefit of the doubt doctrine but found it inapplicable as the evidence weighed against the veteran's claims. The claim for unspecified iridocyclitis, ocular hypertension, presence of intraocular lens, and pupillary abnormality was remanded for the VA to obtain outstanding private treatment records from the Eye & Laser Center of Starkville.

Rationale

No history of diastolic pressure predominantly 100 or more prior to medication; Blood pressure readings did not meet criteria for compensable rating; VA examiner found no history of diastolic pressure elevation to predominantly 100 or more

Full Decision Text

Citation Nr: A26035975
Decision Date: 04/16/26	Archive Date: 04/16/26

DOCKET NO. 240212-417642
DATE: April 16, 2026

ORDER

An initial compensable rating for hypertension is denied.

A rating in excess of 10 percent for tinea pedis is denied.

Service connection for a skin disorder, separate and distinct from service-connected tinea pedis, is denied.

REMANDED

Entitlement to a compensable rating for unspecified iridocyclitis, ocular hypertension, presence of intraocular lens, and pupillary abnormality is remanded.

FINDINGS OF FACT

1. For the entire appeal period, the Veteran's hypertension has required continuous medication for control but has not been manifested by diastolic pressure predominantly 100 or more, or a history thereof, or systolic pressure predominantly 160 or more.

2. For the entire appeal period, the Veteran's tinea pedis does not affect at least 20 percent of the entire body or exposed areas and does not require systemic therapy.

3. A skin disorder, separate and distinct from service-connected tinea pedis, is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by service-connected tinea pedis.

CONCLUSIONS OF LAW

1. The criteria for an initial compensable rating for hypertension have not been met.  U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7101.

2. The criteria for a rating in excess of 10 percent for tinea pedis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7813.

3. The criteria for service connection for a skin disorder, separate and distinct from service-connected tinea pedis, have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1970 to June 1990.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in August 2023 (skin and eye disabilities) and October 2023 (hypertension) by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).  

In February 2024, the Veteran timely appealed such rating decisions by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and elected the evidence submission docket.  Therefore, the Board may only consider the evidence of record at the time of the August 2023 and October 2023 Agency of Original Jurisdiction (AOJ) decisions on appeal, respectively, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182.  38 C.F.R. § 20.303.  If evidence was submitted either (1) during the period after the AOJ issued the respective decisions on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.303, 20.801.

With respect to the claims adjudicated herein, if the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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 claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.  However, as the Board is remanding the remaining claim, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claim.  38 C.F.R. § 3.103(c)(2)(ii).

Increased Ratings

Disability ratings are determined by
 could not consider, he 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 claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.  However, as the Board is remanding the remaining claim, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claim.  38 C.F.R. § 3.103(c)(2)(ii).

Increased Ratings

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity.  Separate diagnostic codes identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R., Part 4.  Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized.  38 C.F.R. § 4.1.  Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work.  38 C.F.R. § 4.2.  All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3.  Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is to be assigned.  38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings.  Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings.  Id. 

1. Entitlement to an initial compensable rating for hypertension.

For the entire appeal period stemming from August 10, 2022, the date of service connection, the Veteran's hypertension has been rated as noncompensably disabling pursuant to DC 7101.  38 C.F.R. § 4.104. 

Under DC 7101, a 60 percent rating is warranted for hypertension if the diastolic pressure is predominantly 130 or more; a 40 percent rating is assigned if the diastolic pressure is predominantly 120 or more; a 20 percent rating is warranted when the diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more; and a 10 percent rating is assigned if the diastolic pressure is predominantly 100 or more or systolic pressure is predominantly 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. 

The United States Court of Appeals for Veterans Claims (Court) has held that, under DC 7101, "a history of diastolic pressure predominantly 100 or more [that] requires continuous medication for control" refers to blood pressure readings taken before a veteran began medication to control hypertension.  Wilson v. McDonough, 35 Vet. App. 75 (2021).

Based upon a review of the evidence, the Board finds that a compensable rating for hypertension is not warranted.  In this regard, a review of the record fails to show a history of diastolic pressure predominantly 100 or more prior to the prescription of medication to control the Veteran's hypertension.  Here, the Veteran's post-service treatment records first reflect that he was prescribed Hydrochlorothiazide (25mg per day) in September 2014.  Prior to the prescription of such medication, blood pressure readings were 150/76, 130/72, 150/94, 137/91, 134/74, 127/78, 125/83, 129/79, 128/81, 139/90, 140/91, 127/82, 126/83, 131/71, 120/78, 130/77, 139/93, 130/87, 132/82, 140/90, 147/82, 170/85, 118/81, and 151/90.  No reading reflects diagnostic pressure of 100 or more prior to the prescription of medication.  Further, the October 2023 VA examiner
 were 150/76, 130/72, 150/94, 137/91, 134/74, 127/78, 125/83, 129/79, 128/81, 139/90, 140/91, 127/82, 126/83, 131/71, 120/78, 130/77, 139/93, 130/87, 132/82, 140/90, 147/82, 170/85, 118/81, and 151/90.  No reading reflects diagnostic pressure of 100 or more prior to the prescription of medication.  Further, the October 2023 VA examiner found that the Veteran did not have a history of diastolic blood pressure elevation to predominantly 100 or more. 

Moreover, while the Veteran's hypertension has required continuous medication for control, the blood pressure readings taken throughout the appeal period fail to reflect that such is manifested by diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more.  Specifically, VA and private treatment records reflect that his blood pressure was 120/68 in August 2022; 120/67, 126/75, and 150/75 in December 2022; 110/70 in January 2023; 128/74 in February 2023; 122/72, 128/78, 121/81, 126/78, 127/84, 138/89, 116/110, 149/89, 145/76, and 130/86 in May 2023; and 177/80, 184/88, 151/92, and 144/69 in April 2024.  Additionally, at the October 2023 VA examination, it was noted that the Veteran was on Hydrochlorothiazide to control his blood pressure; however, his contemporaneous blood pressure readings were 125/71, 127/79, and 121/75.  

Based on the foregoing, the Board finds that an initial compensable rating for the Veteran's hypertension is not warranted as the evidence shows that, while such requires continuous medication for control, such has not been manifested by diastolic pressure predominantly 100 or more, or a history thereof, or systolic pressure predominantly 160 or more.  Rather, the evidence shows that the vast majority of his blood pressure readings during the appeal period have reflected that his systolic blood pressure was under 160 (with only two occasions of 160 or more) and his diastolic pressure was under 100 (with only one occasion of 100 or more).  Further, the aforementioned VA examiner found that he did not have a history of a diastolic pressure elevation to predominantly 100 or more.  Therefore, an initial compensable rating for the Veteran's hypertension is not warranted pursuant to DC 7101.

In reaching such decision, the Board acknowledges that the Veteran takes medications for his hypertension, which assists in controlling such disease; however, the use of medications is explicitly contemplated in DC 7107.  In this regard, the Court has held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of DC 7101 contemplates the effects of medications.  McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016).  

2. Entitlement to rating in excess of 10 percent for tinea pedis.

The appeal period stems from May 27, 2023, the date VA received the Veteran's increased rating claim for his tinea pedis, plus the one-year look-back period.  Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).  For the entire appeal period, such disability is rated as 10 percent rating pursuant to DC 7813. 

DC 7813 provides that dermatophytosis is rated under the General Rating Formula for the Skin.  In this regard, such provides for a 10 percent rating where there is characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12 month period.  

A 30 percent rating is assigned where there is characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of
.  In this regard, such provides for a 10 percent rating where there is characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12 month period.  

A 30 percent rating is assigned where there is characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12 month period.  

A 60 percent rating is warranted where there are characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period.  Id.

A note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."  

In order to warrant the assignment of the next higher rating of 30 percent pursuant to DC 7813, the evidence must show that the Veteran's skin disability involves 20 to 40 percent of the entire body or exposed areas affected, or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.  However, as set forth below, the evidence of record does not show that the Veteran's skin disability affects a requisite portion of his body, or requires systemic therapy, so as to warrant the assignment of a higher rating.  

Specifically, at a March 2023 VA examination, the Veteran's skin disability was assessed as affecting at least 5 percent but less than 20 percent of his entire body and none of his exposed areas.  It was noted that he had not been treated with medication in the previous 12 months.  Additionally, at a June 2023 VA examination, the Veteran's skin disability was assessed as affecting less than 5 percent of his entire body and none of his exposed areas.  It was noted that he had not been treated with medication in the previous 12 months.  

Based on the foregoing, the Board finds that, for the entire appeal period, the Veteran's skin disability affected less than 20 percent of his entire body and exposed areas and has not required systemic therapy.  Thus, a rating in excess of 10 percent for his skin disability is not warranted under DC 7813.

In this regard, the Board has considered whether a higher or separate rating is warranted under any other potentially applicable diagnostic code.  Here, as discussed in further detail below, the March 2023 VA examiner, who provided current diagnoses of tinea pedis and tinea unguium (onychomycosis), determined that the Veteran's onychomycosis was a progression of his service-connected tinea pedis.  However, onychomycosis is also rated under DC 7813.  Thus, assigning a separate rating for the Veteran's onychomycosis would be tantamount to pyramiding and is prohibited by law.  38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).  

Other Considerations 

In reaching its conclusion in the instant case, the Board acknowledges the Veteran's belief that his hypertension and tinea pedis are more severe than as reflected by the current assigned disability ratings.  In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule.  While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria.  Woehlaert v.
.  38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).  

Other Considerations 

In reaching its conclusion in the instant case, the Board acknowledges the Veteran's belief that his hypertension and tinea pedis are more severe than as reflected by the current assigned disability ratings.  In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule.  While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria.  Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).  Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities.

The Board has considered whether staged ratings are appropriate for the Veteran's service-connected hypertension and tinea pedis; however, the Board finds that his symptomatology has been stable throughout the period on appeal.  Therefore, assigning staged ratings is not warranted.  Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the increased and initial rating claims adjudicated herein.  Doucette v. Shulkin, 28 Vet. App. 366 (2017).

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the weight of the probative evidence is against the Veteran's claims for increased ratings for his hypertension and tinea pedis, that doctrine is not applicable in the instant appeal and his claims must be denied.  38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 

3. Entitlement to service connection for a skin disorder, separate and distinct from service-connected tinea pedis.

The Veteran asserts he has a skin disorder (namely onychomycosis), separate and distinct from his service-connected tinea pedis.  

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.  Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).  

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.  38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).  Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability.  38 C.F.R. § 3.310(b).

The Veteran's service treatment records (STRs) reflect that he had right foot cellulitis in August 1977.  STRs dated in May and June 1979, and May 1984 reveal that he was treated for athlete's foot.  A June 1979 STR reflects that the Veteran had warts/corns/calluses on his right foot (4-5 interdigital area), and it was noted that he had chronic tinea.  STRs dated in October and November 1981, October 1982, and April 1985 reveal that he was treated for plantar warts.  In June 1985, the Veteran complained of burning, itching feet.  In July 1987, it was noted that he complained of cracking skin between his toes, and an assessment of
 cellulitis in August 1977.  STRs dated in May and June 1979, and May 1984 reveal that he was treated for athlete's foot.  A June 1979 STR reflects that the Veteran had warts/corns/calluses on his right foot (4-5 interdigital area), and it was noted that he had chronic tinea.  STRs dated in October and November 1981, October 1982, and April 1985 reveal that he was treated for plantar warts.  In June 1985, the Veteran complained of burning, itching feet.  In July 1987, it was noted that he complained of cracking skin between his toes, and an assessment of tinea was rendered.  His October 1989 separation examination reflects a finding of fungal infection of toenails on both feet. 

VA treatment records dated in February and April 2023 reveal assessments of onychomycosis bilaterally.  Additionally, the March 2023 VA examination reflects diagnoses of tinea pedis and tinea unguium (onychomycosis).  Here, the examiner specifically found that the Veteran's onychomycosis was the progression of his tinea pedis - to all ten toenails.  In a June 2023 VA medical opinion, an additional VA examiner indicated that the Veteran's bilateral onychomycosis was less likely than not incurred in or caused by his in-service treatment for toe fungus as his STRs revealed no formal diagnosis of such disability that was noted by a healthcare provider.  

Upon review, the Board affords great probative weight to the VA examiners' opinions provided in March and June 2023 in the collective.  In this regard, such considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed.  Moreover, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").  Here, the March 2023 VA examiner clearly found there was no current skin disorder separate and distinct from the Veteran's service-connected tinea pedis.  The Veteran has not submitted any medical opinions to the contrary, and there is no evidence, other than his own lay statements, that indicates a relationship between a separate and distinct skin disorder and his in-service treatment, or tinea pedis.

Thus, the Board has considered the Veteran's assertions as to the nature and etiology of his current skin disorders; however, as a lay person, he does not have the requisite training and experience necessary to address such complex medical matters.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).  In this regard, the etiology of such disorders involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship.  Therefore, such matters may not be competently addressed by lay statements.  See Woehlaert, supra.  Accordingly, the Veteran's opinions as to the etiology of his skin disorders are not competent evidence and, consequently, are afforded no probative weight.

In conclusion, a skin disorder, separate and distinct from service-connected tinea pedis, is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by service-connected tinea pedis.  Consequently, service connection for such disorder is not warranted.  In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the weight of the probative evidence is against the Veteran's claim for service connection, such doctrine is inapplicable and his claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

REASONS FOR REMAND

4. Entitlement to a compensable rating for unspecified iridocyclitis, ocular hypertension, presence of intraocular lens, and pupillary abnormality.

The Veteran's VA treatment records reveal that he received non-VA treatment (care consult) related to his eyes on December 5, 2022, with Eye &
 decision, the Board has considered the applicability of the benefit of the doubt doctrine.  However, as the weight of the probative evidence is against the Veteran's claim for service connection, such doctrine is inapplicable and his claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

REASONS FOR REMAND

4. Entitlement to a compensable rating for unspecified iridocyclitis, ocular hypertension, presence of intraocular lens, and pupillary abnormality.

The Veteran's VA treatment records reveal that he received non-VA treatment (care consult) related to his eyes on December 5, 2022, with Eye & Laser Center of Starkville.  In this regard, such records reflect that scanned documents pertaining to such treatment were available to view through VistA Imaging.  Although private treatment records from Eye & Laser Center of Starkville were subsequently associated with the record, such were received outside of an evidentiary window relevant to the instant appeal and, thus, may not be considered by the Board.  

As the private treatment records may contain information relevant to the claim on appeal, and such were identified prior to the rating decision on appeal, the Board finds the failure to attempt to associate such with the claims file for review constitutes a pre-decisional duty to assist error that must be cured on remand.  

The matter is REMANDED for the following action:

Obtain all outstanding private treatment records identified prior to the rating decision on appeal, to include those from Eye & Laser Center of Starkville dated December 5, 2022, and associate such with the claims file.  

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Koria B. Stanton, Associate Counsel

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.