Entitlement to an initial rating of 10 percent, but not higher, for orthostatic hypotension, is granted.

Citation Nr: A26069931 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 250908-583058 DATE: July 30, 2026 ORDER Entitlement to an initial rating of 10 percent, but not higher, for orthostatic hypotension, is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) from December 1, 2021, is granted. FINDINGS OF FACT 1. The Veteran's orthostatic hypotension was manifested by occasional dizziness. 2. From December 1, 2021, the Veteran's service-connected disabilities rendered him unable to obtain and/or maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating, but no higher, for orthostatic hypotension are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, DC 6204. 2. The criteria for entitlement to TDIU from December 1, 2021, have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1992 to August 1994. The rating decisions on appeal were issued in June 2025 and July 2025 and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the June 2025 and July 2025 agency of original jurisdiction (AOJ) decisions 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. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. If 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. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Orthostatic hypotension The Veteran generally contends he is entitled to a compensable rating for his service-connected orthostatic hypotension. See September 2025 Notice of Disagreement. The Veteran's orthostatic hypotension was initially rated under Diagnostic Code (DC) 7101 hypertensive vascular disease. However, the rating criteria under DC 7101 is based entirely on high blood pressure readings. The DC lists no other symptoms. Thus, rating the Veteran's disability involving low blood pressure using this criteria is not analogous. DC 6204 for peripheral vestibular disorder directly addresses the Veteran's reported symptom of dizziness and the functions effected by his dizziness. Under this DC, a 10 percent rating is warranted for occasional dizziness. Occasional is not defined in the rating criteria. The Merriam-Webster dictionary defines occasionally as "now and then." See Merriam-Webster website at https://www.merriam-webster.com/dictionary/occasionally last accessed July 27, 2026. A 30 percent rating is warranted for dizziness and occasional staggering. The Board also considered the criteria for vertigo, however, the Veteran provided a description of his dizziness to a VA clinician who noted the symptoms were better defined as lightheadedness rather that vertiginous. See May 2025 VA Treatment Record A January 28, 2025 emergency room assessment reports that the Veteran was brought to the emergency room complaining of nausea, dizziness, and chills. He had a colonoscopy earlier that day. The clinician noted that the Veteran's dizziness was better described as lightheadedness and not vertiginous. See May 2025 VA Treatment Record. A May 2025 VA examiner confirmed the Veteran's diagnosis of orthostatic hypotension. The Veteran reported that his symptoms included chronic, occasionally mild dizziness and lightheadedness when arising fast from a chair or walking fast. The Veteran stated that his dizziness had not caused him to become unconscious. The examiner opined that the Veteran's orthostatic hypotension would not affect his ability to function in an occupational environment as the symptoms were mild and occasional. The examiner also noted that the Veteran had declined medication for his orthostatic hypotension due to the mild nature of the symptoms. Based on the above, the Board finds the Veteran's orthostatic hypotension symptoms are more approximate to the 10 percent rating criteria for DC 6204. In the medical evidence of record the Veteran consistently described his dizziness as both mild and occasional. His appeal is granted. A higher rating of 30 percent is not warranted since at no time during the period of review did the Veteran report that he staggered due to his dizziness. TDIU The Veteran contends he is entitled to TDIU from December 1, 2021. See March 2026 Third Party Correspondence. At the time of the Veteran's claim, he had established service connection for somatic symptom disorder, bilateral patellofemoral pain syndrome, and rhinitis. See March 2020 Rating Decision - Code Sheet. In Ray v. Wilkie, the Court defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran's history, education, skill, and training, whether the veteran has the physical ability to perform the type of activities required by the occupation at issue, and whether the veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, 31 Vet. App. 58 (2019). Regarding the economic TDIU component, the Veteran has not been engaged in substantial and gainful employment since November 4, 2016, when he worked as a correctional officer earning $40,297 annually. See December 2019 Claim. The Veteran's wages were above poverty rate established by the United States Department of Commerce, Bureau of the Census, as the poverty threshold for one person. See Poverty Thresholds, U.S. Census Bureau, http://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html (last visited July 27, 2026). The Court defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). The Veteran's reported employment does not meet the criteria for a protected environment. He was paid a typical salary and was offered no special consideration due to his service-connected disabilities. Thus, the Veteran's last period of gainful employment ended November 4, 2016. The remaining inquiry is whether the Veteran was physically and mentally able to obtain and maintain gainful employment before August 10, 2022. The medical evidence of record shows the Veteran's service-connected disabilities limited his ability to work as a corrections officer or any other position. The Veteran stated that the pain in his legs, knees, and lower back held him back from doing his duty to the fullest. He reported that while he worked as a corrections officer he was limited in responding to emergency calls due to tripping and falling, and he felt that it had put his coworkers in danger. He reported that the pain in his legs burned with intense sharp pain and muscle cramps with swelling in his lower legs. See December 2019 Claim. In an October 2021 VA treatment record, the Veteran reported increased pain in his knee cap. Pain was described as sharp and intense, and the pain is rated as an 8 out of 10. In a November 2021 VA treatment record, the VA clinician documented the Veteran's report of right hand, neck, and bilateral knee pain score of 5. See December 2021 VA Treatment Record. A February 2022 VA treatment record documented that the Veteran was unable to taper to a lower dose of fentanyl. A March 2022 VA treatment record documents that the current pain generators were the Veteran's back, knees, thigh, and right hand. The Veteran was on a fentanyl patch to manage his pain. See October 2022 VA Treatment Record. A December 2022 VA examiner diagnosed the Veteran with bilateral knee instability, bilateral patellofemoral pain syndrome, and bilateral degenerative arthritis, other than post traumatic. The Veteran stated that his symptoms included continued sharp, bilateral knee pain, limited range of motion, and inability to bear weight. He reported that he could not run or walk long distances, he was unable to lift objects and was prevented from driving by having to frequently adjust positions due to discomfort. The Veteran also reported that flare- ups of the right knee occur multiple times a day and that the knee flare-ups are severe and last up to an hour and are precipitated by daily motions. The flare-ups are alleviated by time. Range of motion testing reflected that the Veteran's flexion of the left knee was limited to 30 degrees and of the right knee was limited to 45 degrees. The examiner estimated that during flare-ups the Veteran was unable to move his knees. The examiner noted no muscle atrophy or ankylosis. In a December 2022 VA examination, the Veteran was diagnosed with somatic symptom disorder and depressive disorder. The examiner reported that the Veteran's symptoms included depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss; flattened effect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; inability to establish and maintain effective relationships; impaired impulse control; and neglect of personal appearance and hygiene. The examiner noted that the Veteran is not physically able to talk because he had his tongue and jawbone removed and had to communicate with the examiner through a white board. The examiner noted that the Veteran walked using a walker. The record shows that the Veteran's mental health symptoms had an impact on his ability to work as early as December 2021. The December 2022 examiner noted that the Veteran was not working and reported that he was struggling with insomnia and depression. The Veteran's sleep disruptions and depression significantly impacted his ability to work. The Veteran's bilateral knee disabilities impacted his mobility and prevented him from working in positions that require walking or sitting from long periods of time. Based on the above, the Board finds that the medical evidence of record weighs in favor of the Veteran being unemployable due to his service-connected disabilities, including his mental health and bilateral knee disabilities since December 1, 2021. His limitations due to education and occupational history, coupled with his functional impairments significantly impacted the possibility of the Veteran being employable. Resolving all reasonable doubt in favor of the Veteran, the Board finds that from December 1, 2021, the Veteran's service-connected disabilities precluded him from obtaining and maintaining substantially gainful employment and his appeal is granted. The Board notes that it is a combination of the Veteran's service-connected disabilities that render him unemployable. Thus, entitlement to an earlier effective date for SMC pursuant to 38 U.S.C. § 1114(s) is not at issue. See 38 C.F.R. §§ 3.350; 4.16(a); Bradley v. Peake, 22 Vet. App. 280, 294 (2008); Buie v. Shinseki, 24 Vet. App. 242, 250 (2011). JIMMY L. BARDIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Danilowicz, B. 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.