HYPERTENSION

M. M. CELLI · 2026 · Case ID: A26039711

DENIED

Summary

The veteran served from November 1996 to November 2000. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision concerning claims for hypertension (HTN) and heart palpitations. The veteran contended that his HTN began during service and continued thereafter, while also seeking an increased rating for his service-connected heart palpitations. Regarding HTN, the Board found that while the veteran's representative submitted medical records after the September 2024 Board hearing diagnosing HTN in May 2015, the evidence of record at the time of the appeal did not establish service connection. Specifically, service treatment records showed elevated blood pressure readings but did not meet the diagnostic criteria for hypertension, nor was there evidence of treatment or complaints within a year of separation. The Board also noted that the veteran's lay opinion on the etiology of HTN was not competent. Consequently, service connection for HTN was denied. For heart palpitations, service connection was previously granted at a non-compensable level. The veteran sought an increased rating. The Board reviewed VA examination findings from December 2020, which noted symptoms but no diagnosis of atrial fibrillation or supraventricular tachycardia, and no continuous medication use at that time. Although the veteran testified to being prescribed propranolol about a year prior to the September 2024 hearing, the earliest documentation of this prescription was November 16, 2023, after the relevant appeal period. However, applying the benefit of the doubt and considering the amended rating criteria for supraventricular tachycardia (DC 7010) effective November 14, 2021, the Board granted a 10 percent rating for heart palpitations based on the continuous use of medication for control, as documented from November 16, 2023. A higher rating was denied due to insufficient evidence of more frequent episodes or interventions.

Rationale

No diagnosis of hypertension during service; No evidence of treatment or complaints within one year of separation; Veteran's lay opinion on etiology not competent

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7101

Docket No.

210819-180995

Full Decision Text

Citation Nr: A26039711
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210819-180995
DATE: April 28, 2026

ORDER

Service connection for hypertension (HTN) is denied.

Entitlement to an initial compensable rating prior to November 16, 2023, for heart palpitations is denied.

Entitlement to a disability rating of 10 percent, but no higher, on and after November 16, 2023, for heart palpitations is granted, subject to the laws and regulations governing the payment of monetary benefits.

FINDINGS OF FACT

1. The Veteran's HTN is not shown to be causally or etiologically related to his military service and did not manifest to a compensable degree within one year of his separation from service.

2. Prior to November 16, 2023, the Veteran's heart palpitations were not manifested by permanent atrial fibrillation (lone atrial fibrillation), one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor, or continuous use of oral medication or use of vagal maneuvers.

3. As of November 16, 2023, the Veteran's heart palpitations required continuous use of oral medication.

CONCLUSIONS OF LAW

1. The criteria for service connection for HTN have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. Prior to November 16, 2023, the criteria for an initial compensable rating for heart palpitations have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, Diagnostic Code (DC) 7010.

3. As of November 16, 2023, the criteria for a 10 percent rating for heart palpitations have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, DC 7010.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1996 to November 2000. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).

The Veteran requested the Hearing docket at the Board, specifically requesting a video hearing before a Veterans Law Judge (VLJ) in his August 2021 VA Form 10182. The Veteran testified at a hearing before a VLJ in September 2024. A transcript of the hearing has been associated with the claims file. Under the rules of the AMA, the Board may only consider the evidence of record at the time of the May 2021 rating decision on appeal, as well as any evidence submitted by the Veteran and his representative at and within 90 days following the hearing. 38 C.F.R. § 20.302(a)(3).

1. Entitlement to service connection for HTN.

The Veteran contends he has HTN that began during and has continued since military service.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. Generally, service connection requires three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d. 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain diseases, such as HTN, are considered chronic diseases that will be presumed related to service if they were noted or diagnosed as chronic in service; or if they manifested to a compensable degree within one year after discharge from active duty; or if chronicity or continuity of the same symptomatology has existed since service; with no intervening cause. 38 U.S.C. §§ 1101, 1113, 1137; Walker v. Shinseki,
, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain diseases, such as HTN, are considered chronic diseases that will be presumed related to service if they were noted or diagnosed as chronic in service; or if they manifested to a compensable degree within one year after discharge from active duty; or if chronicity or continuity of the same symptomatology has existed since service; with no intervening cause. 38 U.S.C. §§ 1101, 1113, 1137; Walker v. Shinseki, 708 F.3d. 1331, 1338 (Fed. Cir. 2012); 38 C.F.R. §§ 3.303(b), 3.309(a)(3).

In deciding the Veteran's claim, the VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether the persuasive evidence is against the claim, in which case the claim is denied. 38 U.S.S. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

After the September 2024 Board hearing and within the appropriate evidentiary window, the Veteran's representative submitted additional medical treatment records documenting a May 11, 2015, impression of HTN. Consequently, the first element required for service connection has been met.

At the September 2024 Board hearing, the Veteran testified to being monitored for HTN while in service. Upon review of the Veteran's service treatment records (STRs), there are two notations of high blood pressure. There is a November 10, 1998, blood pressure reading of 140/92, which was assessed as "high BP- 5 day BP and follow up in 1 month". There is also an October 19, 1999, dental patient medical history showing the Veteran was monitored for one month for high blood pressure. The Board notes the dental notation does not provide a blood pressure reading and also does not show the Veteran was prescribed medication for HTN. This corroborates the Veteran's testimony that he did not take medication for elevated blood pressure readings during military service. A September 22, 2000, report of medical assessment conducted 2 months prior to the Veteran's separation from active duty does not reflect a notation of hypertension or medication therefor.

Note (1) under Diagnostic Code 7101, which addresses hypertension, directs that hypertension must be confirmed by readings taken two or more times on at least three different days. The term hypertension means that the diastolic blood pressure is predominantly 90 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. Here, the evidence of record does not reflect readings that meet the criteria for a diagnosis of hypertension during service. Moreover, the record shows the Veteran's blood pressure was normal at separation from service, indicating any high blood pressure had normalized.

The Veteran has not been afforded a VA medical examination to ascertain the nature and etiology of his HTN per McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Under McLendon, VA is obligated to provide an examination only when the record contains (1) competent evidence of a current disability (or persistent or recurrent symptoms of a disability), (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file to decide the claim. 38 U.S.C. § 5103A(d). At the time of the Veteran's claim, his medical treatment records did not contain a diagnosis of HTN. The Veteran's representative confirmed this during the September 2024 Board hearing. As previously explained, this medical evidence was submitted after the May 2021 rating decision on appeal. Additionally, as discussed above, the evidence did not reflect a diagnosis of hypertension during military service, and the record does not reflect complaints of or treatment for hypertension within the year following his separation from service. Consequently, there was no duty to afford the Veteran a VA medical examination at the time of the rating decision on appeal.

In addition, the Board has considered
claim. 38 U.S.C. § 5103A(d). At the time of the Veteran's claim, his medical treatment records did not contain a diagnosis of HTN. The Veteran's representative confirmed this during the September 2024 Board hearing. As previously explained, this medical evidence was submitted after the May 2021 rating decision on appeal. Additionally, as discussed above, the evidence did not reflect a diagnosis of hypertension during military service, and the record does not reflect complaints of or treatment for hypertension within the year following his separation from service. Consequently, there was no duty to afford the Veteran a VA medical examination at the time of the rating decision on appeal.

In addition, the Board has considered the Veteran's statements that his hypertension had its onset during or is otherwise related to his military service; however, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In this regard, the etiology of hypertension is a matter not capable of lay observation. Rather, such requires medical expertise to determine. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his hypertension is not competent evidence and, consequently, is afforded little probative value.

As a final matter, concerning presumptive service connection for chronic disabilities, the record does not demonstrate a diagnosis of HTN within one year of separation, nor does it establish a continuity of symptomatology from service to the present. As previously explained, the private medical treatment records submitted after the September 2024 Board hearing show a diagnosis of HTN in May 2015. There is no medical evidence of an earlier documentation. At the September 2024 Board hearing, the Veteran testified that he started taking medication for HTN after he left service. Thus, while Board interprets the Veteran's cumulative testimony that he has had HTN since military service, his post-military medical records do not corroborate his testimony. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a service connection claim.

In summary, the Board finds the evidence does not show that the Veteran's current hypertension is causally or etiologically related to his military service or that such manifested to a compensable degree within one year of separation from service. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the probative, competent evidence persuasively weighs against the claim, the doctrine is not applicable, and the claim must be denied. 38 C.F.R. § 3.102.

2. Entitlement to an initial compensable rating for heart palpitations.

The Veteran contends his service-connected heart palpitations are more severe and warrant a higher disability rating. Service connection was granted for heart palpitations in the May 2021 rating decision on appeal. A noncompensable rating was established, effective July 21, 2020. The Veteran appealed the rating, and as such, the claim stems from the date of service connection.

Disability evaluations 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 C.F.R. § 1155; 38 C.F.R. § 3.321, 4.1. Disabilities are organized by diagnostic codes (DCs) in the Rating Schedule, which list out the criteria on which they are rated.

VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2.

Any reasonable doubt regarding the degree of disability shall be resolved in favor of the claimant. 38 C.F.R. § 4.3.

Where there is a question as to which of two evaluations to apply, the higher of the two should be assigned where the disability picture more nearly approximates the criteria for the next higher rating. 38
Disabilities are organized by diagnostic codes (DCs) in the Rating Schedule, which list out the criteria on which they are rated.

Any reasonable doubt regarding the degree of disability shall be resolved in favor of the claimant. 38 C.F.R. § 4.3.

The Veteran's service-connected heart palpitations are currently rated under 38 C.F.R. § 4.104, DC 7099-7010. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. The first four numbers reflect the diagnosed disability. The second four numbers after the hyphen identifies the criteria used to evaluate that disability. Regulations provide that when a disability not specifically provided for in the rating schedule is encountered, it will be rated under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20.

DC 7099 is used to identify unlisted cardiovascular disorders, such as the Veteran's heart palpitations. According to 38 C.F.R. § 4.104, for DCs 7009, 7010, 7011, and 7015, a single evaluation will be assigned under the DC that reflects the predominant disability picture.

Effective November 14, 2021, VA amended the rating criteria for heart disease under 38 C.F.R. § 4.104. See 86 Fed. Reg. 54089 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the RO on or after November 14, 2021, as is the case here.

Under the amended rating criteria, DC 7010 addresses supraventricular tachycardia and provides that a 10 percent rating is warranted where supraventricular tachycardia is confirmed by echocardiogram (ECG) and one to four treatment interventions are necessary per year or continuous use of oral medications or use of vagal maneuvers is necessary for control. A 30 percent rating is warranted where supraventricular tachycardia is confirmed by ECG and five or more treatment interventions per year are required. Note (2) defines a treatment intervention as whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.

As DC 7010 specifically contemplates medication use, the Board need not discount its effects.

Prior to November 14, 2021, DC 7010 provided a 30 percent rating for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor. A 10 percent rating is warranted for permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor.

In December 2020, the Veteran was afforded a VA medical examination to ascertain the nature and etiology of his heart palpitations. The examiner noted the Veteran's symptoms of heat, anxiety, a "flipping" sensation in his chest, tightness, dizziness, and fatigue. The examiner noted the Veteran was not under any current treatment, nor was there continuous medication prescribed. The Veteran had cardiac arrhythmia and intermittent palpitations. The examiner found the Veteran did not have atrial fibrillation, atrial flutter, supraventricular tachycardia, or atrioventricular block. The examiner noted the Veteran's last ECG was October 27, 2020, which showed normal wall motion, abnormal wall thickness, and mild left ventricular hypertrophy. The conclusion from the October 2020 ECG was normal RV sizes/systolic function; mild LVE 6,1 CM with normal LVEF 57 percent; mild concentric LVH with normal diastolic function; mild pulmonary HTN RVSP 34 MMHG; and no val
. The Veteran had cardiac arrhythmia and intermittent palpitations. The examiner found the Veteran did not have atrial fibrillation, atrial flutter, supraventricular tachycardia, or atrioventricular block. The examiner noted the Veteran's last ECG was October 27, 2020, which showed normal wall motion, abnormal wall thickness, and mild left ventricular hypertrophy. The conclusion from the October 2020 ECG was normal RV sizes/systolic function; mild LVE 6,1 CM with normal LVEF 57 percent; mild concentric LVH with normal diastolic function; mild pulmonary HTN RVSP 34 MMHG; and no valvular abnormality.

At the September 2024 Board hearing, the Veteran testified to being prescribed propranolol for his HTN and heart palpitations approximately one year prior. In this regard, the Mayo Clinic describes propranolol as a beta-blocker, which works by affecting the response to nerve impulses in certain parts of the body, like the heart. The description includes that propranolol can be used to treat HTN and irregular heartbeats.

The Veteran's treatment records in his claims file prior to the May 2021 rating decision on appeal do not mention a prescription of propranolol. As previously explained, the Veteran's attorney submitted additional medical records after the September 2024 Board hearing and within the appropriate evidentiary window. The earliest notation of propranolol is November 16, 2023, from a discharge summary, which documents the prescription is for anxiety and was initiated while the Veteran was in the VA program.

Treatment records dated in December 2020, March 2021, and September 2021 reflect a normal heart rate, regular rhythm, and no murmur. There is additional documentation on August 22, 2023, of a normal ECG. Consequently, prior to November 16, 2023, the Board finds that the evidence does not show that an increased initial disability rating is warranted for heart palpitations. Specifically, the Veteran's heart palpitations were not manifested by permanent atrial fibrillation (lone atrial fibrillation), one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor, or continuous use of oral medication or use of vagal maneuvers. Therefore, a higher rating is not warranted under either the previous or current rating criteria prior to November 16, 2023.

However, given the aforementioned description from the Mayo Clinic and affording the Veteran the benefit of the doubt, the Board finds the Veteran's prescription for propranolol may serve him the dual purpose of helping him control his HTN and his heart palpitations. As such, the record shows the Veteran has taken continuous medication since November 16, 2023, for his heart palpitations to warrant a 10 percent rating, but no higher, under the current rating criteria.

However, because the Veteran's symptoms are not documented as four or more times per year by ECG, entitlement to the next higher rating of 30 percent is not warranted under the previous rating criteria. Likewise, as the Veteran does not require five or more treatment interventions per year, entitlement to a higher rating under the amended DC 7010 is also not warranted.

In reaching its conclusions in the instant case, the Board acknowledges the Veteran's belief that his heart palpitations are more severe than as reflected by the currently assigned disability rating. 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. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (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 persuasive.

Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine, which has resulted in the partial award of an increased
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 persuasive.

In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine, which has resulted in the partial award of an increased rating for the Veteran's heart palpitations as of November 16, 2023. However, insofar as the Board has denied a higher rating for the disability on appeal, the evidence is not in approximate balance and weighs against such aspects of the Veteran's claim. Thus, the benefit of the doubt doctrine is not applicable in such regard, and his increased rating claim must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Smith, 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.

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