HYPERTENSION

Summary

The veteran, who served from August 1967 to April 1969, appeals the denial of increased disability ratings for hypertension (HTN) and residuals of prostate cancer. The Board reviewed the evidence of record as of the October 2025 rating decision, as the veteran elected Direct Review and waived consideration of later-submitted evidence. For HTN, the Board considered the veteran's history of diastolic pressure predominantly 100 or more, noting that blood pressure readings taken prior to medication use and during the October 2025 VA examination were predominantly 100 or more, or in the high 90s. Applying the benefit of the doubt, the Board granted a 10 percent rating for HTN, finding the criteria for higher ratings were not met due to insufficient readings. For prostate cancer residuals, the veteran sought a higher rating for voiding dysfunction, specifically urinary frequency. The Board considered the veteran's October 2025 VA examination, which noted no voiding dysfunction but did mention benign prostatic hyperplasia and lower urinary tract symptoms. The veteran's January 2026 affidavit, which the Board considered despite being submitted after the rating decision, reported frequent urination, waking 3-4 times nightly and 7-8 times daily. The Board found this credible and consistent with the criteria for a 20 percent rating, granting that rating for voiding dysfunction due to prostate cancer treatment. The veteran is already in receipt of Special Monthly Compensation (SMC) for erectile dysfunction related to prostate cancer.

Rationale

History of diastolic pressure predominantly 100 or more; Requires continuous medication for control; Benefit of the doubt applied

Full Decision Text

Citation Nr: A26039733
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260114-612546
DATE: April 28, 2026

ORDER

A 10 percent rating for hypertension (HTN) is granted. 

A 20 percent rating for residuals of prostate cancer is granted. 

FINDINGS OF FACT

1. The Veteran has a history of diastolic pressure predominantly 100 or more that requires continuous medication for control.

2. The Veteran's prostate cancer residuals include a daytime voiding interval between 1 and 2 hours or awakening to void 3 to 4 times per night. 

CONCLUSIONS OF LAW

1. The criteria for a 10 percent rating for service-connected HTN have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.104, Diagnostic Code (DC) 7101.

2. The criteria for a 20 percent rating for residuals of prostate cancer have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.115a, 4.115b, DC 7528.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1967 to April 1969.

This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2025 rating decision issued by a Regional Office (RO). 

In a January 2026 Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran selected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the 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. 

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. He waived his right to change his Board review docket selection and requested review of his appeal as soon as possible by correspondence dated February 2026. See Williams v. McDonough, 37 Vet. App. 305 (2024).

Increased Disability Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall 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. In considering the severity of a disability, it is essential to trace the veteran's medical history. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

HTN

The Veteran contends that he is entitled to a compensable rating for HTN. 

Hypertensive vascular disease (hypertension and isolated systolic hypertension) is rated pursuant to DC 7101. 38?C.F.R. §?4.104. Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; the minimum evaluation for an individual with a history of diast
 that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

HTN

The Veteran contends that he is entitled to a compensable rating for HTN. 

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

A 40 percent rating is warranted for diastolic pressure predominantly 120 or more. 

A 60 percent rating is warranted for diastolic pressure predominantly 130 or more.  38?C.F.R. §?4.104, DC 7101.

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.

Blood pressure readings taken before a Veteran began medication to control hypertension must be considered to determine if the Veteran has a history of diastolic pressure predominantly 100 or more, regardless as to whether such readings were taken during the period on appeal. Wilson v. McDonough, 35 Vet. App. 75 (2021). 

As DC 7101 explicitly contemplates the effects of medications, the ameliorative effects of blood pressure medication need not be discounted, and blood pressure readings taken while a Veteran is using medication may be considered. McCarroll v. McDonald, 28 Vet. App. 267, 273 (2016).

The Veteran's representative argues that a 10 percent rating is warranted for diastolic pressure predominantly 100 or more. In support of his argument, he provided a number of the Veteran's blood pressure readings from a September 2025 automated review summary document. 

The Veteran was afforded an October 2025 VA examination, in which the onset of his HTN was noted to be in 2009. The Board notes that September 2009 blood pressure readings are, affording the Veteran the benefit of the doubt, predominantly 100 or more, and notes that most of the values under 100 are in the high 90's. Furthermore, the Veteran's October 2025 VA examination reported that the Veteran takes continuous medication for control. 

Affording the Veteran the benefit of the doubt, his diastolic blood pressure was predominantly over 100 when considering blood pressure readings taken prior to controlling his HTN with continuous medication. Accordingly, a 10 percent rating for HTN is granted. In denying a higher rating, the Board notes that there are not a significant number of blood pressure readings in the evidence of record to support finding that diastolic pressure was predominantly 110 or more, or systolic pressure was predominantly 200 or more at any time. 

Prostate Cancer

The Veteran contends that he is entitled to a higher rating of 20 percent for prostate cancer, specifically for voiding dysfunction. 

Pursuant to DC 7528, following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination the rating will be reevaluated. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant. 

Voiding dysfunction is rated under the three subcategories of urine leakage, urinary frequency, or obstructed voiding.  38 C.F.R. § 4.115a.  Of note, these provisions are expressed using the disjunctive, indicating that a veteran is to be rated under only one of the three categories of urine leakage, urinary frequency, or obstructed voiding. Here, the Veteran has alleged urinary frequency. 

Regarding urinary frequency, a 10 percent rating is warranted for voiding interval between 2 and 3 hours, or; awakening to void 2 times per night. A 20 percent rating is warranted for daytime voiding interval between 1 and 2 hours, or; awakening to void 3 to 4 times per night. A 40 percent rating is
 urinary frequency, or obstructed voiding.  38 C.F.R. § 4.115a.  Of note, these provisions are expressed using the disjunctive, indicating that a veteran is to be rated under only one of the three categories of urine leakage, urinary frequency, or obstructed voiding. Here, the Veteran has alleged urinary frequency. 

Regarding urinary frequency, a 10 percent rating is warranted for voiding interval between 2 and 3 hours, or; awakening to void 2 times per night. A 20 percent rating is warranted for daytime voiding interval between 1 and 2 hours, or; awakening to void 3 to 4 times per night. A 40 percent rating is warranted for daytime voiding interval less than 1 hour, or; awakening to void 5 or more times per night.  

As noted above, evidence submitted to the Board following the rating decision on appeal generally cannot be considered. The Board specifically notes that the Veteran submitted a January 2026 affidavit following the rating decision on appeal. To the extent that the Veteran's affidavit is evidence rather than argument, the Board waives the claims processing rule to allow for consideration and further notes that the Veteran waived consideration of any new evidence or argument by the AOJ in January 2026 correspondence. See Bolds v. McDonough, 37 Vet. App. 359 (2024) (holding the claims processing rules pertaining to evidentiary windows can be explicitly or implicitly waived by parties). 

Initially, the Board notes that the Veteran is in receipt of special monthly compensation (SMC) for erectile dysfunction (ED) due to his prostate cancer. DC 7522 specifically provides that erectile dysfunction warrants a maximum schedular rating of zero percent, with or without penile deformity.  38 C.F.R. § 4.115b, DC 7522. The Board notes that a footnote to DC 7522 indicates that the disability is to be reviewed for entitlement to special monthly compensation (SMC) based on loss of use of a creative organ under 38 C.F.R. § 3.350(a). In this case, the Veteran is already in receipt of SMC for loss of use of a creative organ. As such, that matter is not at issue.

Turning to the evidence of record, the Veteran was afforded an October 2025 VA examination, in which the examiner noted that the Veteran's prostate cancer had an onset in approximately 2015, with treatment beginning about 3 years prior to the examination and consisting of radiation, which resulted in remission. The Veteran's only noted current symptom was ED. The Veteran was taking continuous medication, with no renal or voiding dysfunction. 

September 2024 and September 2025 VA treatment records note that the Veteran had benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS); however, he reported that he was satisfied with his voiding symptoms on Alfuzosin. 

In his affidavit, the Veteran reported that he had a frequent need to urinate, to include waking in the middle of the night 3 to 4 times to use the restroom and 7 to 8 times during the day. 

It is the role of the Board as finder of fact to evaluate the credibility of the evidence and to determine the weight that is to be assigned to it. The Veteran is competent to report that he awakened 3 to 4 times per night to use the restroom and 7 to 8 times during the day. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board notes that this frequency is consistent with the criteria for a 20 percent rating. 

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?

Therefore, affording the Veteran the benefit of the doubt, he has urinary frequency due to his prostate cancer treatment, and a 20 percent rating is warranted.  

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Resor, 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.