HYPERTENSION

Summary

The veteran, who served in the U.S. Navy from April 1975 to March 1983 and again from March 1985 to April 1993, appealed the denial of increased disability ratings for hypertension, trigeminal neuropathy (TN), and temporomandibular joint dysfunction (TMD). The Board of Veterans' Appeals reviewed the evidence, including private medical examinations, independent medical evaluations, and VA treatment records, to determine if the veteran met the criteria for ratings higher than those already awarded. For hypertension, the Board found that while the veteran's blood pressure readings occasionally exceeded 160/100, they did not consistently meet the criteria for a 20 percent rating, which requires diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. Therefore, the 10 percent rating was upheld. For TN, the Board reviewed VA examinations that noted moderate numbness and decreased sensation, but concluded these symptoms did not rise to the level of severe, incomplete paralysis required for a higher rating. The Board found the symptoms described were consistent with moderate, incomplete paralysis, warranting the existing 10 percent rating. For TMD, the Board considered the veteran's reported pain, clicking, difficulty chewing, and numbness, along with measurements of inter-incisal range and lateral excursion. While some flare-up estimates suggested limitations, the Board found the evidence did not support a rating higher than the existing 20 percent, as the criteria for higher ratings, particularly regarding dietary restrictions or more severe jaw opening limitations, were not met. The Board denied increased ratings for all three conditions.

Rationale

Highest recorded blood pressure did not meet criteria for 20% rating; Diastolic pressure not predominantly 110 or more; Systolic pressure not predominantly 200 or more

Full Decision Text

Citation Nr: A26038721
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 210727-175427
DATE: April 24, 2026

ORDER

Entitlement to a rating in excess of 10 percent for hypertension is denied.

Entitlement to a rating in excess of 10 percent for trigeminal neuropathy (TN) is denied.

Entitlement to a rating in excess of 20 percent for temporomandibular joint dysfunction (TMD) is denied.

FINDINGS OF FACT

1. The evidence of record does not indicate that the Veteran's diastolic blood pressure is predominantly 110 or more or that his systolic blood pressure is predominantly 200 or more.

2. The evidence of record does not indicate severe, incomplete paralysis of the trigeminal cranial nerve.

3. The evidence of record does not indicate dietary restrictions to soft and semi-solid foods, full liquid or pureed foods, or 11 to 20mm of maximum unassisted vertical opening.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 10 percent for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101.

2. The criteria for a rating in excess of 10 percent for trigeminal neuropathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.124a, Diagnostic Code 8205.

3. The criteria for a rating in excess of 20 percent for temporomandibular joint dysfunction (TMD) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.150, Diagnostic Code 9905.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from April 1975 to March 1983 and from March 1985 to April 1993. 

These matters come before the Board of Veterans' Appeals (Board) from a January 2021 rating decision issued by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA).

In July 2021, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal, electing the Hearing docket. On April 7, 2025, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the January 2021 rating decision, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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 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. 

The Board also notes a number of other issues were listed on the July 2021 VA Form 10182. However, these issues were also listed in a preceding January 2021 VA Form 10182 and were recently addressed in a March 2026 Board decision. Thus, these issues will not be addressed in this decision.

Increased Rating Legal Criteria

Disability ratings are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations should be applied, the higher evaluation
 VA Form 10182 and were recently addressed in a March 2026 Board decision. Thus, these issues will not be addressed in this decision.

Increased Rating Legal Criteria

Disability ratings are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. 

The veteran's entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 

The effective date provisions for awards of increased disability compensation include a general rule - an award based on a claim for increase of compensation "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore." 38 U.S.C. § 5110(a). The corresponding VA regulation expresses this rule as the "date of receipt of claim or date entitlement arose, whichever is later." 38 C.F.R. § 3.400(o)(1).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (the claimant is entitled to the benefit-of-the-doubt when competing evidence is in "approximate balance" or "nearly equal"; exact equipoise is not required to trigger the favorable benefit-of-the-doubt rule).

1. Entitlement to a rating in excess of 10 percent for hypertension.

The Veteran was awarded service connection for hypertension in a January 2021 rating decision with a noncompensable rating effective February 16, 2018, and a 10 percent rating from December 1, 2020.

Upon review, the Board finds that the evidence of record does not support a rating in excess of 10 percent for the Veteran's hypertension. 

Hypertension is rated pursuant to 38?C.F.R. §?4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; it is the 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 for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

For the reasons that follow, the Veteran's hypertension has manifested in diastolic pressure predominantly 100 or more and systolic pressure predominantly 160 or more corresponding to the criteria for a
 diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

For the reasons that follow, the Veteran's hypertension has manifested in diastolic pressure predominantly 100 or more and systolic pressure predominantly 160 or more corresponding to the criteria for a 10 percent rating under DC 7101.

A private medical examination dated September 11, 2019, noted the Veteran's blood pressure history. "The [Veteran] had documented his blood pressure over the years from 20 February 1977 to 14 March 1993 and throughout this time, his blood pressure ranged in the 130s to 140s systolically and from the high 60s to low 90s diastolically. Eventually, he was placed on blood pressure medications and treated." His blood pressure during that appointment measured 142/82. The record also noted an exercise stress test report dated April 17, 2018, when he had a resting blood pressure of 156/96. See Correspondence received July 6, 2020.

The Veteran submitted an independent medical evaluation (IME) dated August 6, 2020. The IME noted the following blood pressure readings and dates: 140/70 on February 24, 1977; 140/68 on April 20, 1977; 148/68 on April 30, 1985; 140/70 on November 21, 1986; 142/98 on July 1, 1992; 136/90, 140/90, and 151/75 on July 2, 1992. Various medical appointments were noted with the following blood pressure readings: 195/95 on September 1, 2015; 146/80 on April 5, 2018; 148/78 and 150/92 on April 23, 2019; 148/78 on August 27, 2019; 152/93 on September 23, 2019; 134/76 on October 25, 2019, with a note that the Veteran had a low salt diet and was on Lisinopril. See Correspondence received October 2, 2020.

VA treatment records noted the following blood pressure readings and dates: 160/80 and 154/79 on December 23, 2020; 133/88, 150/93, 153/92, 132/82, 133/77, 154/88, 168/91, 148/90, and 143/81 on December 1, 2020; 126/75 on November 19, 2020; 144/88, 147/81, 146/86 on November 13, 2020; 157/91 on November 6, 2020; 154/76 and 151/83 on October 19, 2020; 134/77 on September 11, 2020; 134/76 on October 3, 2019; 150/90, 155/87, and 152/83 on September 23, 2019, with a note he has not taken medication yet that day; 125/77 and 134/79 on September 18, 2019; 117/69 on September 17, 2019; 129/78 and 148/78 on August 27, 2019; 132/77 and 148/75 on May 2, 2019; 150/92 on April 23, 2019; 143/78 and 148/78 on February 25, 2019; 129/74 and 145/91 on December 10, 2018; 151/73 and 151/79 on December 5, 2018; 124/78 on November 1, 2018, with a note that the Veteran's systolic blood pressure reads in the 140s at times with his home checks; 138/85 on July 6, 2018; 137/80 on April 16, 2018; 146/80 on April 5, 2018; 125/67 on September 12, 2005; 126/68
2019; 143/78 and 148/78 on February 25, 2019; 129/74 and 145/91 on December 10, 2018; 151/73 and 151/79 on December 5, 2018; 124/78 on November 1, 2018, with a note that the Veteran's systolic blood pressure reads in the 140s at times with his home checks; 138/85 on July 6, 2018; 137/80 on April 16, 2018; 146/80 on April 5, 2018; 125/67 on September 12, 2005; 126/68, 130/86, 111/64, 154/85, 154/94, 154/97, and 157/93 on September 3, 2005; 124/66 on May 16, 2005; 129/88 on May 11, 2005. 

An April 5, 2018, VA treatment record indicated that the Veteran was taking Lisinopril at 10 mg in the past but was not at the time of the appointment. The provider noted that he would restart Lisinopril at 10 mg daily. A July 6, 2018, VA treatment record noted that his Lisinopril would be increased to 20 mg daily.

The Veteran was provided with a VA examination in July 2020. The examiner noted a diagnosis of hypertension with taking continuous medication of Lisinopril. The examination noted current blood pressure readings of 148/84, 153/84, and 149/86. 

The Veteran was provided with a VA examination on December 17, 2020. The examiner noted a 1998 diagnosis of hypertension. The examiner noted that the Veteran began medication in 2017 at a 5 mg dose and that he is now using a 40 mg dose of Lisinopril. During the examination, the Veteran's blood pressure readings were 160/100, 160/90, and 160/100.

The evidence of record indicates that the highest the Veteran's blood pressure has reached is 160/100, which was recorded twice during a December 2020 VA examination. 

A higher 20 percent rating under DC 7101 is not warranted unless diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more. Here, the evidence of record does not indicate diastolic pressures measuring 110 or more, even for brief periods, nor does it indicate systolic pressure measuring 200 or more, even for brief periods. Thus, during the appeal period, the Veteran's hypertension did not manifest in diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.  

Accordingly, entitlement to a rating in excess of 10 percent for hypertension must be denied. 

2. Entitlement to a rating in excess of 10 percent for TN.

Service connection for TN was awarded in a January 2021 rating decision with a 10 percent rating effective February 16, 2018. 

The Veteran's TN is rated under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8205. Under DC 8205, moderate, incomplete paralysis of the trigeminal cranial nerve warrants a 10 percent rating; severe, incomplete paralysis of the trigeminal cranial nerve warrants a 30 percent rating; and complete paralysis of the trigeminal cranial nerve warrants a 50 percent rating. A note states, "Dependent upon relative degree of sensory manifestation or motor loss." 

The words "moderate" and "severe" as used in the various Diagnostic Code are not defined in the Rating Schedule. Merriam-Webster Dictionary defines "moderate" as not severe or intense, or limited in scope or effect. https://www.merriam-webster.com/dictionary/moderate (last visited April 14, 2026). The term "severe" is defined as very painful or harmful, or of a great degree. https://www.merriam-webster.com/dictionary/severe (last visited April 14, 2026).

The Veteran reported severe pain in his jaw and facial tingling and numbness. See Correspondence received March 26, 2018.

The Veteran was provided with a VA examination in July 2020. The examiner noted a diagnosis of trigeminal neuralgia. The examiner noted moderate numbness of the lower face and side of the mouth and throat. No difficulty chewing, swallowing, or speaking were noted nor was any change in salivation or gastrointestinal symptoms noted. Muscle strength testing was normal as wall upper face, forehead, and
 "severe" is defined as very painful or harmful, or of a great degree. https://www.merriam-webster.com/dictionary/severe (last visited April 14, 2026).

The Veteran reported severe pain in his jaw and facial tingling and numbness. See Correspondence received March 26, 2018.

The Veteran was provided with a VA examination in July 2020. The examiner noted a diagnosis of trigeminal neuralgia. The examiner noted moderate numbness of the lower face and side of the mouth and throat. No difficulty chewing, swallowing, or speaking were noted nor was any change in salivation or gastrointestinal symptoms noted. Muscle strength testing was normal as wall upper face, forehead, and midface sensation testing. Lower face sensation testing indicated decreased sensation for both the right and left sides. Moderate, incomplete paralysis of the trigeminal nerve was noted.

The Veteran was provided with a second VA examination in December 2020. The examiner noted a diagnosis of trigeminal neuropathy. Mild intermittent pain and mild paresthesias and/or dysesthesias were noted on the left side of the upper face, mid face, lower face, and side of the mouth and throat. Moderate numbness was noted on the left side of the upper face, mid face, lower face, and side of mouth and throat. Moderate difficulty chewing and mild difficulty speaking were noted. Mild strength loss was noted on the left side. Decreased sensation was noted on the left side of the upper face and forehead, mid face, and lower face. Moderate, incomplete paralysis of the trigeminal nerve was noted. 

The Board finds that the evidence of record does not indicate severe, incomplete paralysis of the trigeminal nerve.

The Board notes mild pain and paresthesias and/or dysesthesias and moderate numbness found during the December 2020 VA examination. Moderate difficulty chewing and mild difficulty speaking were also noted along with decreased sensation and mild strength loss on the left side of the Veteran's face.

The note in DC 8205 states that the rating is dependent upon the relative degree of sensory manifestation or motor loss.

The July 2020 VA examination found moderate numbness and decreased sensation. The December 2020 VA examination found more severe symptoms than the July 2020 VA examination. However, the degree of sensory manifestation or motor loss was described as mild or moderate at its worst during either VA examination.

Thus, the evidence of record does not indicate TN symptoms that rise to the level of severe, incomplete paralysis. Accordingly, entitlement to a rating in excess of 10 percent for trigeminal neuropathy must be denied.

3. Entitlement to a rating in excess of 20 percent for TMD.

The Veteran was awarded service connection for TMD in a January 2021 rating decision at a 20 percent rating effective February 16, 2018.

The Veteran's TMD is rated under 38 C.F.R. § 4.150, DC 9905. Under DC 9905, a 10 percent rating is warranted for a range of lateral excursion of 0 to 4 mm, or inter-incisal range of 30 to 34 mm of maximum unassisted vertical opening without dietary restrictions to mechanically altered foods. A 20 percent rating is warranted for inter-incisal range of 30 to 34 mm of maximum unassisted vertical opening with dietary restrictions to soft and semi-solid foods, or inter-incisal range of 21 to 29 mm of maximum unassisted vertical without dietary restrictions to mechanically altered foods.

A 30 percent rating is warranted for inter-incisal range of 30 to 34 mm of maximum unassisted vertical opening with dietary restrictions to full liquid and pureed foods, inter-incisal range of 21 to 29 mm of maximum unassisted vertical opening with dietary restrictions to soft and semi-solid foods, or 11 to 20 mm of maximum unassisted vertical opening without dietary restrictions to mechanically altered foods.

A 40 percent rating is warranted for an interincisal range of 21 to 29 mm with dietary restrictions to full liquid and pureed foods, and for an interincisal range of 11 to 20 mm with dietary restrictions to all mechanically altered foods, as well as for an interincisal range of zero to 10 mm without dietary restrictions to mechanically altered foods. A 50 percent rating is warranted for an interincisal range of zero to 10 mm with dietary restrictions to all mechanically altered foods.

Note 1 states "Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion. Note 2 states: "For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. Note 3 states: "For VA compensation purposes
 full liquid and pureed foods, and for an interincisal range of 11 to 20 mm with dietary restrictions to all mechanically altered foods, as well as for an interincisal range of zero to 10 mm without dietary restrictions to mechanically altered foods. A 50 percent rating is warranted for an interincisal range of zero to 10 mm with dietary restrictions to all mechanically altered foods.

Note 1 states "Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion. Note 2 states: "For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. Note 3 states: "For VA compensation purposes, mechanically altered foods are defined as altered by blending, chopping, grinding or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician."

The Veteran reported severe pain in his jaw and facial tingling and numbness. See Correspondence received March 26, 2018.

VA treatment records noted cracking bilateral TMJ with opening and closing of the Veteran's jaw. See September 23, 2019, VA treatment record. A later record noted jaw pain rated as a 5. See October 25, 2019, VA treatment record. 

The Veteran was provided with a VA examination in November 2020. The examiner diagnosed the Veteran with TMD. The Veteran reported jaw pain, clicking of his TMJs, difficulty chewing and generalized malocclusion problems. Upon examination, right TMJ crepitus and left TMJ severe click and pain with range of motion were noted. Pain with palpation of masseter muscles on both sides and the temporalis tendon on both sides was noted. The Veteran reported flare-ups about once a week, lasting for six to seven hours and numbness of the left side of his lips. 

The Veteran was provided with a VA examination in December 2020. The examiner noted a 1979 diagnosis of TMD. The Veteran reported pain when opening his mouth, difficulty chewing and talking, and malocclusion issues. His TMJs pop when he opens his mouth and noted intermittent headaches, stiffness of TMJs, and numbness and tingling on the left side of his face. The Veteran reported flare-ups when he opens his mouth and that he limits chewing and talking. Initial inter-incisal distance measured greater than 34 mm with lateral excursion greater than 4 mm. Pain was noted on mouth opening, lateral excursion, and with chewing. Localized tenderness or pain on palpation was noted along with crepitus or clicking of both TMJs. Right TMJ was noted as mild and left TMJ was noted as severe. Repetitive use testing did not result in additional loss of range of motion (ROM). The Veteran was not examined immediately after repeated use over time, but pain was noted to limit functional ability. The Veteran was not examined during a flare-up, but pain, fatigue, and weakness were estimated to cause 0-4 mm of lateral excursion and an inter-incisal distance of 21-29 mm. No dietary restrictions were noted despite the report of difficulty chewing. 

The Board finds that a rating in excess of 20 percent for TMD is not warranted.

As noted above, the Veteran's initial interincisal range measured greater than 34 mm with lateral excursion greater than 4 mm. However, flare-up estimates noted lateral excursion from 0 to 4 mm and 21-29 mm of maximum unassisted vertical opening. This measurement, combined with the note of no dietary restrictions to mechanically altered foods, indicates that a 20 percent rating under DC 9905 is warranted. 

The Board notes the Veteran's reports of pain, stiffness, and numbness and tingling and has considered these symptoms. The numbness and tingling are addressed above in the separate TN rating above. The evidence of record does not indicate that a physician has recorded or verified a texture-modified diet for the Veteran, nor has the Veteran reported a self-prescribed soft or liquid diet despite some pain while chewing. 

Without any further loss of interincisal range or dietary restrictions to soft and semi-solid or full liquid and pureed foods, a rating in excess of 20 percent is available.

Accordingly, entitlement to a rating in excess of 20 percent for TMD must be denied. 

 

 

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Saul, P.

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
 a physician has recorded or verified a texture-modified diet for the Veteran, nor has the Veteran reported a self-prescribed soft or liquid diet despite some pain while chewing. 

Without any further loss of interincisal range or dietary restrictions to soft and semi-solid or full liquid and pureed foods, a rating in excess of 20 percent is available.

Accordingly, entitlement to a rating in excess of 20 percent for TMD must be denied. 

 

 

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Saul, P.

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.