HYPERTENSION

Summary

The veteran, who served from June 1965 to December 1968, appeals the denial of an increased rating for his service-connected hypertension. The veteran sought a higher rating, contending his systolic blood pressure readings were predominantly 160 or more. The Board reviewed evidence from October 2023 through April 2025, the period relevant to the claim. While the veteran's testimony regarding occasional high readings was found credible, the Board noted that most readings were within reasonable values, and systolic pressures predominantly measured 160 or more only sporadically, particularly after surgery in September 2024. The Board applied the definition of "predominant" as "most frequent or common" and found that the evidence did not consistently show systolic pressures at or above 160. Historical diastolic readings were also not predominantly over 100. The Board concluded that the evidence persuasively weighed against meeting the criteria for a 10 percent rating, and thus the benefit of the doubt doctrine did not apply. Consequently, the appeal for an increased rating for hypertension was denied.

Rationale

Systolic readings not predominantly 160 or more; Historical diastolic readings not predominantly over 100; Evidence persuasively weighs against meeting criteria

Full Decision Text

Citation Nr: A26040737
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250823-579059
DATE: April 30, 2026

ORDER

Entitlement to a compensable rating for hypertension is denied. 

FINDING OF FACT

During the appeal period, the Veteran's hypertension did not manifest with diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more.  Also, the Veteran does not have a history of diastolic pressure predominantly greater than 100 prior to using medication for control.

CONCLUSION OF LAW

The criteria for a compensable rating for service-connected hypertension have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.104, Diagnostic Code 7101.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1965 to December 1968. 

In April 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2025 decision. In July 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2025 decision.  Therefore, the Board may only consider the evidence of record at the time of the April 2025 decision and any evidence submitted during an applicable evidentiary window.

In the August 23, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 17, 2025.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Specifically, the Board has considered evidence received prior to the April 9, 2025, rating decision. Evidence submitted by the Veteran or his representative from December 17, 2025 (the date of the Veteran's hearing) to March 17, 2026, is also eligible for review.  Any evidence submitted from April 10, 2025, to December 16, 2025, is ineligible to be reviewed.  Likewise, any evidence submitted after March 17, 2026, is ineligible for review.  

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Increased Ratings

Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.  

In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition.  Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result
 nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.  

In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition.  Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made.  Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods.  

Entitlement to a rating of 10 percent for hypertension is granted. 

The Veteran is seeking a higher rating because he contends that his systolic pressure is predominantly 160 or more. 

Diagnostic Code (DC) 7101 provides a 10 percent disability evaluation when diastolic pressure is predominantly 100 or more, systolic pressure is predominantly 160 or more, or the individual has a history of diastolic pressure of 100 or more and requires continuous medication for control. A 20 percent disability evaluation is warranted when diastolic pressure is predominantly 110 or more or systolic pressure is 200 or more. A 40 percent evaluation is warranted where diastolic pressure is predominantly 120 or more, and a 60 percent evaluation is warranted where diastolic blood pressure is predominantly 130 or more. With regard to a 10 percent rating, "The plain text of DC 7101 directs VA to consider historical, rather than current, blood pressure readings and that the relevant 'historical blood pressure readings' are those taken before the veteran began medication." See Wilson v. McDonough, 35 Vet. App. 75, 76 (2021). Wilson held that Diagnostic Code 7101 "offers three distinct avenues for veterans to pursue" and that veterans can demonstrate "current blood pressure readings-either systolic pressures predominantly 160 or above or diastolic pressure of 100 or greater-or, if veterans use medication to control their hypertension, historical blood pressure readings predominantly greater than 100." Id. at 78. 

There are three notes to 38 C.F.R. § 4.104, DC 7101. Note (1) provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure (i.e., bottom number) is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure (i.e., top number) is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Note (2) requires the evaluation of hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3) states that hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease.

The term "predominant" is not defined in the rating criteria. Predominantly means "being most frequent or common." See Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/predominant. In the context of DC 7101, this means "above a certain level more often than it was below it." See Thompkins v. McDonald, No. 15-4128, 2016 U.S. App. Vet. Claims LEXIS 2013 (Dec. 29, 2016) (Greenberg, J.) (accepting this definition of predominant in the Board's decision and affirming based on the Board's application of the definition to the facts of that case); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

The Board notes that, because DC 7101 lists "continuous medication for control" as a criterion in the 10 percent rating, the DC, when read as a whole, contemplates the effects of medication in assigning a disability evaluation. See McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016).

The Veteran's increased rating claim was received
 this definition of predominant in the Board's decision and affirming based on the Board's application of the definition to the facts of that case); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

The Board notes that, because DC 7101 lists "continuous medication for control" as a criterion in the 10 percent rating, the DC, when read as a whole, contemplates the effects of medication in assigning a disability evaluation. See McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016).

The Veteran's increased rating claim was received on October 29, 2024. Therefore, the appeal period begins on October 29, 2024, with a one-year "look back" to October 29, 2023. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

For the reasons that follow, the Veteran's hypertension has not more nearly approximated the criteria corresponding to a 10 percent rating. 

The Veteran testified that his diastolic pressure has not been measured above 100. The Board has reviewed the claims file, and consistent with the Veteran's hearing testimony, his historical diastolic blood pressure readings and his current readings (i.e., during the appeal period under review) have not been predominantly greater than 100. The Board has noted a blood pressure of 198/102 in December 2002; however, he was on blood pressure medication at that time. Prior to this, the service treatment records do not show a history of diastolic blood pressure predominantly greater than 100. Thus, the remainder of the focus will be on the Veteran's systolic blood pressure readings (which the Veteran contends are predominantly 160 or more) and whether there is sufficient evidence to warrant a 10 percent rating or higher.

The Board observes an October 30, 2023 treatment report which indicates that the Veteran brought in his personal blood pressure readings from over the last few weeks. The dates of these readings were listed as '10/10, 10/13, 10/16, 10/25, 10/27, 10/29, and 10/30.'  The report shows reflects systolic pressures measuring 159, 157, 117, 126, 160, 133, 134, 161, 159. Beginning on October 29, 2023 (the first day of the "look back" period) systolic readings were 140, 160, and 129. On the day of the office visit, the systolic reading was recorded by the clinical as 154/76 (systolic pressure measured 160 or more on 1 of 4 readings). In short, systolic pressure measured 160 or more for only one of the readings during the appeal period under review.

A June 2024 treatment report reflects that the Veteran sought treatment because he was not feeling well (fatigue and dizziness). His blood pressure was 80/40. After resting and drinking fluids, it rose to 110/50. 

A July 2024 treatment report includes blood pressure readings taken in the second week of July. They measured 109, 132, 137, 110, and 118. Another July 2024 treatment report reflects a systolic reading of 124. His systolic readings never measured 160 or greater. 

The Veteran submitted a September 2024 correspondence in which he stated that on September 29, 2024, he underwent vascular surgery, and a stent was installed. He stated that his blood pressure medication was adjusted (which he stated is an "ongoing thing"). He stated that he went to St. James Emergency Room twice to lower his blood pressure, where systolic readings measured anywhere from 180 to 215. 

A September 2024 treatment report reflects that the Veteran stated he thought medications would bring his blood pressure down; but they are still elevated. He stated that that systolic pressures are "usually in the 130s to 150s" and now he is "running today around 180-200."  He also stated that his blood pressure has been about 180 (multiple readings) after his initial rating was 200. He stated that he was given one tablet of clonidine and that his blood pressure was in the 160's now.  Two of the September 2024 treatment reports reflect systolic measured at 170 and 169. Additional treatment reports dated September 2024 reflect systolic readings of 148 and 172. Finally, yet another September 2024 treatment report reflects systolic readings of 182, 184, and 
 are still elevated. He stated that that systolic pressures are "usually in the 130s to 150s" and now he is "running today around 180-200."  He also stated that his blood pressure has been about 180 (multiple readings) after his initial rating was 200. He stated that he was given one tablet of clonidine and that his blood pressure was in the 160's now.  Two of the September 2024 treatment reports reflect systolic measured at 170 and 169. Additional treatment reports dated September 2024 reflect systolic readings of 148 and 172. Finally, yet another September 2024 treatment report reflects systolic readings of 182, 184, and 175. An October 2024 treatment report reflects a systolic reading of 149.

A November 2024 treatment report reflects that the Veteran called to update on his blood pressure over the past few weeks. He stated that systolic pressure is usually around 118, and that he has been feeling well. He was instructed to continue with the current medication regimen. A February 2025 report shows a systolic reading of 120. 

The Veteran underwent a VA examination in November 2024. The examiner noted that the Veteran's treatment plan includes taking continuous medication for hypertension or isolated systolic hypertension. He was taking 12.5 mg. of carvedilol twice per day, 20 mg. of benazepril twice per day, and 5mg./10mg. of amlodipine/benazepril twice per day. His systolic readings at the examination were 114, 118, and 114. The examiner found that there were no other pertinent physical findings, complications, conditions, signs or symptoms related to hypertension. He opined that the hypertension does not impact his ability to work. 

At his Board hearing, the Veteran testified that he takes his blood pressure twice per day, and that he checks it all the time. He was encouraged to submit additional blood pressure readings to help substantiate his claim. In February 2026, he submitted a three page Statement in Support of the Claim (VA Form 21-4138).

On the first page, one of the blood pressure readings was taken in May 2022; three were taken in 2023 (on October 25th, 27th and 29th); and three were taken in 2024 (on September 14, 17, and 24th). The Board observes that three of these readings were already noted and accounted for in this decision.

On the third page, the Veteran listed several blood pressure readings (14 in total) but did not include the specific year they were recorded. Five of the fourteen readings showed a systolic pressure at 160 or higher. On this same page, the Veteran also listed six additional blood pressure readings taking in October 2024 and November 2024. Only one of these showed a blood pressure with a systolic reading at 160 or higher.

Based on review of the evidence, the Board cannot find that the Veteran's blood pressure systolic readings, during the course of this appeal, have been "predominantly" over 160. The Board acknowledges that during September 2024, and following his vascular surgery, the Veteran's systolic blood pressure measured over 160 on several occasions. However, the majority of the recorded systolic blood pressure readings from October 2023 to September 2024, and after September 2024 to April 2025 (the date of the rating decision on appeal), are not shown to have been predominantly 160 or more. Moreover, the Veteran's own Board hearing testimony regarding blood pressure readings was that "most of the time it's in reasonable values. But there are times, as we are saying, the other day it was 178 over like 90."  The Board finds the Veteran's testimony to be credible. However, he acknowledged at his hearings that "most of the time" his systolic readings are reasonable, and that "there are times" when it is over 160. In a September 2024 treatment report, he stated that systolic pressures are "usually in the 130s to 150s." The Board recognizes that in September 2024, he went to St. James Hospital and that systolic readings were 160 or more on several occasions. However, the record fails to reflect that 160 or more was "predominant," "most frequent," or "common." 

Additionally, the Veteran's historical diastolic blood pressure readings, and his current readings recorded during the appeal period under review, have not been predominantly greater than 100. 

Therefore, the competent and probative evidence persuasively weighs against finding that the criteria for a 10 percent rating for the service-connected hypertension are met.  As the evidence persuasively
 he stated that systolic pressures are "usually in the 130s to 150s." The Board recognizes that in September 2024, he went to St. James Hospital and that systolic readings were 160 or more on several occasions. However, the record fails to reflect that 160 or more was "predominant," "most frequent," or "common." 

Additionally, the Veteran's historical diastolic blood pressure readings, and his current readings recorded during the appeal period under review, have not been predominantly greater than 100. 

Therefore, the competent and probative evidence persuasively weighs against finding that the criteria for a 10 percent rating for the service-connected hypertension are met.  As the evidence persuasively weighs against the claim; the benefit of the doubt doctrine does not apply.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).  Consequently, entitlement to an increased rating for hypertension is denied.

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Prem, 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.