## Facts

- Billy D. McCarroll, a U.S. Army veteran, was service-connected for hypertension.
- A private physician prescribed antihypertensive medication after he filed his VA claim.
- After medication began, VA examination readings showed diastolic pressure under 100.
- The VA assigned a noncompensable rating under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101 based on recorded blood-pressure readings.
- McCarroll argued that his rating should reflect what his blood pressure would be without medication and that medication’s effects should be disregarded.
- The Board denied a compensable rating, and McCarroll appealed to the Court, which heard the case en banc.

## Issues

1. Whether, under DC 7101, VA must evaluate hypertension by estimating blood-pressure levels without medication rather than using actual medicated readings.
2. Whether the rule limiting consideration of symptom relief by medication applies when the diagnostic code expressly references medication.
3. Whether the Board erred by not addressing referral for an extraschedular rating when that theory was not raised before the agency.

## Decision

- The Court affirmed the Board’s denial of a compensable rating for hypertension.
- Because DC 7101 expressly incorporates medication into the rating criteria, VA need not disregard medication’s effects or speculate about unmedicated blood pressure.
- The evidence did not show diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more with continuous medication for control.
- The Board did not err by not addressing extraschedular referral where the issue was not raised and was not otherwise reasonably raised.

## Legal Principles

- When a diagnostic code expressly references medication, adjudicators may consider the condition as controlled by medication and rely on actual recorded measurements.
- The limitation on denying higher ratings based on medication-relieved symptoms applies to diagnostic codes that are silent regarding medication, not to codes that explicitly address medication use.
- Under DC 7101, a single elevated diastolic reading over 100 does not establish a “history of diastolic pressure predominantly 100 or more.”
- The Board is not required to discuss extraschedular referral absent argument or record-based indicators that reasonably raise the issue.

## Conclusion

The Court held that DC 7101’s text permits reliance on medicated blood-pressure readings and does not require conjecture about unmedicated hypertension; because the veteran’s documented history did not meet any compensable threshold and extraschedular entitlement was not raised, the noncompensable rating was affirmed.


McCarroll v. McDonald, 28 Vet. App. 267 (Vet. App. 2016)