[00:00:00] Speaker 03:
The first appeal we'll hear argument on is docket number 23-2201, Pelt v. Collins.

[00:00:09] Speaker 03:
Mr. Niles?

[00:00:10] Speaker 04:
Thank you, Your Honor, and may it please the Court.

[00:00:14] Speaker 04:
To assign the correct disability rating for hypertension, VA must address the veteran's historical pre-medication blood pressure readings.

[00:00:25] Speaker 04:
Here, the Board of Veterans' Appeals did not do this.

[00:00:27] Speaker 04:
It was the Veterans Court that addressed that in the first instance, despite this Court's repeated admonishments against the Veterans Court, finding facts in the first instance.

[00:00:40] Speaker 04:
Mr. Pelt respectfully requests that this Court vacate the Veterans Court's decision in a remand because, pursuant to this Court's precedence in Tadlock and Slaughter and Stinson and Deloach, such first-instance fact-finding

[00:00:55] Speaker 04:
is to be made by the board.

[00:00:57] Speaker 03:
Go ahead.

[00:00:59] Speaker 00:
But didn't the Veterans Court consider the evidence that was on the record in making its decision?

[00:01:06] Speaker 00:
And maybe they alluded to other evidence.

[00:01:11] Speaker 00:
But wasn't that simply sort of a confirmatory observation?

[00:01:17] Speaker 04:
Yes, but, Your Honor.

[00:01:19] Speaker 04:
Yes, the Veterans Court addressed at appendix page four the 10 pre-medication blood pressure readings that Mr. Pelt had and addressed it then at the initial brief before the Veterans Court page two.

[00:01:32] Speaker 04:
And they're in this appendix at page 27, 30, 33, 36, 39, 44, 48, and 50 across the seven visits, again, for medical care, before the medication for the hypertension, with only three of those visits having two or more readings at once, as the Diagnostic Code 7101 first note alludes to.

[00:01:55] Speaker 04:
And yes, the Veterans Court made a finding

[00:01:59] Speaker 04:
that there is no reasonable possibility under one possible definition of the word predominantly, as it is used in VA's regulation for rating hybrid.

[00:02:08] Speaker 03:
And if we were to conclude that is the only reasonable interpretation, then do you lose your case?

[00:02:17] Speaker 04:
Yes, Your Honor.

[00:02:17] Speaker 03:
OK.

[00:02:19] Speaker 03:
So I also want to make sure I understand your understanding of

[00:02:24] Speaker 03:
your allegation that the Veterans Court engaged in impermissible fact-finding.

[00:02:30] Speaker 03:
My understanding is that there's no dispute over the identification of what blood pressure readings should be considered.

[00:02:41] Speaker 03:
Is that right?

[00:02:44] Speaker 03:
My understanding is your side presented to the Veterans Court 10 specific readings for the Veterans Court to consider.

[00:02:51] Speaker 04:
Again, yes, but, Your Honor.

[00:02:53] Speaker 04:
Yes, Mr. Pelt presented the ten readings, but segmented them into the seven different visits, three of which had the two or more readings at the same time.

[00:03:03] Speaker 03:
You're making a visits-based argument now about how to understand the diagnostic code.

[00:03:09] Speaker 03:
Did you make that argument below in front of the Veterans Court?

[00:03:12] Speaker 04:
When Mr. Pelt moved for reconsideration before the Veterans Court, arguing the Veterans Court misunderstood or overlooked a point-of-factor law, yes, at appendix pages 104 to 105.

[00:03:22] Speaker 03:
But I thought the nature of the appeal was really more about this mode-based analysis, the mathematical mode, which of all the different readings

[00:03:32] Speaker 03:
of different values of the readings is the most common value.

[00:03:39] Speaker 04:
That is the possible interpretation of predominantly that the Veterans Court latched onto and rejected.

[00:03:46] Speaker 04:
Right.

[00:03:46] Speaker 03:
When you say they latched onto it, it was because that was what Mr. Pelt argued to the Veterans Court, right?

[00:03:53] Speaker 04:
Mr. Pelt certainly highlighted that in his brief, but is of the position and consistently of the position, Your Honor, that ultimately this went to

[00:04:02] Speaker 04:
prejudice.

[00:04:03] Speaker 04:
And as again, Mr. Pelt included in the motion for reconsideration, the Veterans Court had overlooked or misunderstood that there was more at play here than just 10 visits mathematical mode.

[00:04:15] Speaker 04:
Instead, what happened here was the board entirely failed to address these pre-medication readings.

[00:04:23] Speaker 04:
And when the board left that blank space.

[00:04:26] Speaker 03:
The board noted that the examiner looked at those readings and concluded that there wasn't a predominant number of those readings that showed 100 or more diastolic pressure, right?

[00:04:40] Speaker 04:
Yes, Your Honor.

[00:04:41] Speaker 04:
And for that examination to be adequate for adjudicative purposes, it had to comport with accepted medical practices and the facts of record.

[00:04:53] Speaker 04:
Part of the premise it has to adhere to then is, what is the definition of predominantly?

[00:05:00] Speaker 04:
When VA asks the examiner, is there a history here predominantly of diastolic readings, 100 or more, if the examiner is answering that person with the wrong legal definition, that's a bad exam.

[00:05:13] Speaker 04:
That then is a material issue for the board to address.

[00:05:16] Speaker 03:
But you don't dispute that of the 10 readings, 10 separate readings of diastolic pressure, only four of them had a reading of 100 or more.

[00:05:28] Speaker 03:
Is that right?

[00:05:29] Speaker 03:
That's correct, Your Honor.

[00:05:30] Speaker 03:
So a minority of the readings has 100 or more.

[00:05:35] Speaker 04:
If the definition of predominantly requires looking reading by reading, as opposed to across the visits of at least one,

[00:05:44] Speaker 04:
reading of 100 or more, or as Diagnostic Code 7101's first note focuses in on, just those visits with two or more readings, or as VA's own internal policy manual considers the issue for requiring that the readings be for diagnostic evaluation purposes.

[00:06:07] Speaker 00:
On what basis should the readings be considered on a per-visit basis?

[00:06:19] Speaker 04:
Diagnostic Code 7101's first note requires that the readings come from two or more readings, at least three days.

[00:06:28] Speaker 04:
And so consistent with that text, then, it would be a reasonable interpretation that it goes visit, where you're looking for visits with two or more.

[00:06:38] Speaker 04:
And here you have seven visits, four of which have a reading of 100 or greater, and then four of seven, as opposed to four of 10.

[00:06:47] Speaker 04:
The Veterans Court did not

[00:06:49] Speaker 04:
affirmatively interpret the term predominantly in this case, but instead rejected a possible interpretation of it.

[00:06:59] Speaker 04:
And the distinction matters because what was left then were issues that remained debatable.

[00:07:05] Speaker 04:
And so when the Veterans Court affirmed, even when those issues remained debatable, it overstepped Tadlock and Stinson 38 USC, Section 7261C, which those cases interpret.

[00:07:16] Speaker 04:
and was acting beyond the scope of its statutory authority.

[00:07:29] Speaker 04:
And so with the board having left these issues unaddressed, the definition of predominantly, and the actual pre-medication readings, and the Veterans Court not having found against a reasonable possibility of success through each of them,

[00:07:46] Speaker 04:
What we're left with is, again, the Veterans Court overstepping in affirming the Board error in not addressing those issues, filling that gap when those issues were not undebatable.

[00:07:59] Speaker 04:
And so again, Mr. Pell respectfully requests that this Court vacate the Veterans Court's decision and remand, preferably with instructions for the Veterans Court to remand for the Board to resolve these fact-based issues in the first instance.

[00:08:15] Speaker 03:
Has Mr. Pelt been getting any other subsequent blood pressure readings?

[00:08:21] Speaker 04:
He has, Your Honor, but Mr. Pelt is on continuous blood pressure medication.

[00:08:26] Speaker 04:
And the test under diagnostic code 7101 of the pertinent diagnostic criteria on here is it warrants a 10% rating so long as the veteran is on continuous blood pressure medication and before that, before the medication began, had a history of diastolic pressure of 100 or more.

[00:08:46] Speaker 04:
I'd be happy to address any additional questions the panel has at this time.

[00:08:53] Speaker 03:
Let's hear from the government, and we'll save your extra time for rebuttal.

[00:09:14] Speaker 01:
Good morning, Your Honors, and may it please the Court

[00:09:17] Speaker 01:
In this case, both the VA examiner and the board looked at the objective medical evidence to conclude that Mr. Pelt's history of diastolic blood pressure was not predominantly 100 millimeters of mercury or more.

[00:09:30] Speaker 01:
The Veterans Court did not err in affirming that decision.

[00:09:34] Speaker 01:
Before the Veterans Court, Mr. Pelt directed this court's attention to 10 premedicated blood pressure readings.

[00:09:42] Speaker 01:
Now, the board and the VA examiner did not

[00:09:45] Speaker 01:
explicitly list out those 10 blood pressure readings.

[00:09:49] Speaker 01:
But these blood pressure readings, undisputably, were before the VA examiner, they were before the board, and the VA examiner specifically stated that he was evaluating the entire medical record.

[00:10:03] Speaker 01:
Even if the VA examiner and the board erred by not listing these 10 blood pressure readings, the VA, the Veterans Court properly determined that this error was harmless.

[00:10:16] Speaker 01:
These readings undoubtedly show that Mr. Pelt's premedicated diastolic blood pressure is not 100 or more.

[00:10:25] Speaker 01:
Indeed, six out of 10 of these readings are below 100.

[00:10:28] Speaker 01:
And this is precisely the type of clear-cut issue that the doctrine of harmless error was intended to address.

[00:10:37] Speaker 00:
Mr. Niles argues that the blood pressure readings should be considered on a per-visit basis.

[00:10:44] Speaker 00:
What's your reaction to that?

[00:10:47] Speaker 01:
We would respectfully disagree with that interpretation.

[00:10:50] Speaker 01:
Diagnostic code 7101 speaks in terms of blood pressure.

[00:10:55] Speaker 01:
It speaks in terms of blood pressure.

[00:10:58] Speaker 01:
And blood pressure is measured by readings, not by visits.

[00:11:02] Speaker 00:
What is the implication of the statement in the rule that the readings must be taken at least three different visits?

[00:11:12] Speaker 00:
The visits are implicated somehow.

[00:11:15] Speaker 01:
Sure.

[00:11:16] Speaker 01:
And that the purpose of that note is to reinforce the importance of getting a longitudinal analysis of the veterans alleged hypertension, not just a snapshot at one visit.

[00:11:28] Speaker 01:
But even more, this interpretation of visits

[00:11:31] Speaker 01:
cuts against common sense.

[00:11:33] Speaker 01:
Everybody knows if you're struggling or potentially struggling with hypertension, a medical provider will never just do one reading and call it a day.

[00:11:41] Speaker 01:
There's a well-documented phenomena of the white coat syndrome.

[00:11:46] Speaker 01:
And so they will always do multiple readings.

[00:11:48] Speaker 01:
Well, they should typically do multiple readings in a single visit to check against the risk of white coat syndrome.

[00:11:54] Speaker 01:
But regardless, the clear text of 7.101 speaks in terms of blood pressure.

[00:12:00] Speaker 01:
and not visits.

[00:12:02] Speaker 01:
You measure blood pressure with blood pressure readings.

[00:12:04] Speaker 01:
But even so, even if this court... Rather, this court doesn't have an occasion to consider the interpretation of 71-01, or the meaning of predominant, even though the government's position is the only reasonable interpretation of that word, because the Veterans Court simply did not err when it looked at the blood pressure readings that Mr. Pelt himself

[00:12:27] Speaker 01:
put before the Veterans Court.

[00:12:29] Speaker 01:
It's important to remember the context of the Veterans Court decision.

[00:12:33] Speaker 01:
Mr. Pelt brought principally a reasons and basis challenge to the Board's decision.

[00:12:38] Speaker 01:
Now, the Veterans Court could have simply looked at Appendix page 99, which is the Board's decision, and say,

[00:12:45] Speaker 01:
Mr. Pelt, the board considered the medical records and considered the factual findings, considered the examination results, and considered the VA examiner's evaluation of the medical records.

[00:12:58] Speaker 01:
That's sufficient and we dismiss your appeal.

[00:13:01] Speaker 01:
Instead, what the Veterans Court did is entertain this predominance argument, spelled it out perhaps to the benefit of the veteran to fully educate the issues and describe why they disagree with him.

[00:13:13] Speaker 01:
And now before this court, Mr. Pelt is challenging the Veterans Court's decision to fully explain their analysis to the veteran.

[00:13:22] Speaker 01:
And so we would suggest that Tadlock should not be read in a way that discourages the Veterans Court

[00:13:30] Speaker 01:
to look at the record and give these fulsome explanations when doing so is warranted.

[00:13:37] Speaker 01:
Nor should padlock be read in a way that encourages the Veterans Court to remand cases when there's no reason to remand.

[00:13:45] Speaker 01:
And in this case, there simply is no reason to remand this back to the board, because as the Veterans Court decided or clarified,

[00:13:53] Speaker 01:
There is, quote, no reasonable possibility that analysis of these 10 blood pressure readings would alter the outcome.

[00:14:01] Speaker 01:
And that's the paradigm case of harmless error.

[00:14:05] Speaker 01:
There's simply no world in which spelling out and listing these 10 blood pressure readings would alter the outcome of this case.

[00:14:14] Speaker 03:
What if the facts were a little different?

[00:14:15] Speaker 03:
What if Mr. Pelt had appealed to the veterans court and said,

[00:14:23] Speaker 03:
The board was wrong in saying I don't have a predominant number of blood pressure readings at 100 or more.

[00:14:33] Speaker 03:
They didn't really review my records properly.

[00:14:39] Speaker 03:
If you, the Veterans Court, look at my records, you'll see it.

[00:14:43] Speaker 03:
And then the Veterans Court

[00:14:45] Speaker 03:
starts looking through all of his medical history files and then plucks out these 10 readings and says, OK, I'm going to now do the analysis of these 10 readings I found in your records.

[00:14:57] Speaker 03:
Would that be going too far?

[00:14:58] Speaker 03:
Because now that would be engaging in some kind of fact finding.

[00:15:03] Speaker 01:
And so just so I'm clear, Your Honor, does that imply that there's more than 10 readings and they selectively chose these 10?

[00:15:09] Speaker 03:
We don't know.

[00:15:10] Speaker 01:
So in that case, Your Honor, that may be the context that Tadlock discussed, where this is an issue open to debate.

[00:15:19] Speaker 01:
And because it's open to debate as to whether or not the readings are predominantly 100 or more, in that case, the Veterans Court should be very wary of making findings a fact in the first instance.

[00:15:30] Speaker 01:
Two points on that.

[00:15:31] Speaker 01:
First, there is no finding of fact in the first instance here because the VA examiner clearly said as a factual matter that the pre-medication blood pressure readings are not 100 or more.

[00:15:41] Speaker 01:
That's at page 24 of the appendix.

[00:15:45] Speaker 01:
So there's already that factual finding.

[00:15:47] Speaker 03:
Here's another question.

[00:15:48] Speaker 03:
What if, say, Mr. Pelt is a 70-year-old man and is the VA going to look at blood pressure readings

[00:15:57] Speaker 03:
going back 50 years to when he was 20 years old?

[00:16:01] Speaker 03:
In his medical files, there's 50 different blood pressure readings over 50 years.

[00:16:08] Speaker 03:
Are they going to look at all 50 of those and say, well, we need to find 26 readings that are at 100 or more in order to classify this person as someone with hypertension?

[00:16:21] Speaker 01:
Well, under the Newhouse case, 947 F3 1302, there is a presumption that the finders of fact, in this case the VA examiners, do evaluate all the medical evidence before them.

[00:16:37] Speaker 01:
But this case is even a step beyond that, because all the parties agree.

[00:16:41] Speaker 03:
But I think the concern I have is what is the VA's understanding of this predominantly hundred or more

[00:16:51] Speaker 03:
rule in the diagnostic code.

[00:16:55] Speaker 03:
Does it have to be 50 years of readings?

[00:17:00] Speaker 03:
Maybe when Mr. Pelt was in this hypothetical in his 20s and 30s, all of those readings are just irrelevant to the question.

[00:17:09] Speaker 03:
And so it's unfairly charging him with healthy readings back when he was a healthy young man in evaluating whether he has hypertension now.

[00:17:21] Speaker 01:
Understood, Your Honor.

[00:17:22] Speaker 01:
And again, I think that would raise the scenario in Tadlock where this becomes open to debate.

[00:17:29] Speaker 01:
And so I think in that context, Your Honor, again, I'm... This is not a fact-finding question.

[00:17:35] Speaker 03:
This is an understanding of how do you interpret the code.

[00:17:40] Speaker 03:
The history of diastolic pressure, predominantly 100 or more.

[00:17:46] Speaker 03:
It's a technical matter.

[00:17:48] Speaker 03:
the patient that I'm talking about or the veteran that I'm talking about has 50 years worth of blood pressure readings.

[00:17:53] Speaker 03:
Are you really going to look at all of 50 years of those?

[00:17:58] Speaker 01:
Well, when the VA examiner makes a determination on the disability benefits questionnaire that that veteran with 50 years of medical history with blood pressure readings does not present with blood pressure of 100 or more predominantly, that is a finding of facts that I think there's the presumption that that finding of fact does take into account all of the time.

[00:18:24] Speaker 02:
period to look at in applying this regulation for this code?

[00:18:28] Speaker 01:
Well, there is retrospectively once the medication is taken.

[00:18:32] Speaker 01:
But in terms of pre-medication, I don't believe there is a time component to this regulation.

[00:18:38] Speaker 02:
But there must be some kind of general standard that the VA has to rely on relevant factual evidence.

[00:18:45] Speaker 01:
There very well may be.

[00:18:46] Speaker 01:
I'm not familiar standing up here today as to what that might be.

[00:18:51] Speaker 02:
Because it's essentially evidence of what his condition is at the relevant time period, right?

[00:19:01] Speaker 02:
Right.

[00:19:01] Speaker 02:
Whether some kid who entered the Army at 20 had good blood pressure for 30 years is not medically relevant, is it?

[00:19:12] Speaker 02:
much later.

[00:19:14] Speaker 02:
And when you're determining, without a time period in the regulation, I assume that the RO and the board and the Veterans Court are going to require that it have a sound medical analysis and theory.

[00:19:27] Speaker 02:
And that may be only relevant in the last five years, in the last two years.

[00:19:32] Speaker 02:
I mean, obviously, everybody knows that some people develop blood pressure problems later in life.

[00:19:40] Speaker 02:
And so you certainly wouldn't.

[00:19:42] Speaker 02:
discount those higher readings if just because somebody had blood pressure appropriate for their age in their 20s and 30s, would you?

[00:19:54] Speaker 01:
No, Your Honor, and these would be the sorts of... Let me give you a really stark hypothetical.

[00:19:58] Speaker 02:
Sure.

[00:19:59] Speaker 02:
You have a veteran who's age 50.

[00:20:02] Speaker 02:
48 to 50 every single reading had and let's just assume there's like 20 of them is over 100 sure But before that from age 45 to 20 all of his readings were normal and there were times You don't look at that whole time period and say well, it's predominantly under a hundred So no you look at the most recent relative ones and say he has a pattern of over a hundred

[00:20:29] Speaker 02:
Right.

[00:20:30] Speaker 02:
But that's a factual finding that the RO and ultimately the boards are going to make, and it has to be supported by.

[00:20:37] Speaker 01:
Right, and I believe that would be evaluated under the clear error standard review by the Veterans Court, whether that medical finding is supported by the evidence and whether or not they... I mean in that hypothetical where every single reading for the last two years was over a hundred, the ones before that were under a hundred, they found it wasn't predominantly over a hundred, that would probably be clear error.

[00:21:03] Speaker 01:
Well, I'm hesitant to comment.

[00:21:05] Speaker 02:
I know the movement never wants to continue.

[00:21:07] Speaker 01:
This is a hypothetical.

[00:21:08] Speaker 01:
Sure.

[00:21:08] Speaker 02:
We're not going to hold you against it.

[00:21:09] Speaker 01:
Understood, Your Honor.

[00:21:10] Speaker 01:
My impressions with that would be certainly problematic.

[00:21:12] Speaker 01:
And that certainly wouldn't do the purpose of the VA, which is to provide benefits to those.

[00:21:16] Speaker 01:
Right.

[00:21:16] Speaker 02:
Because the whole point is to try to determine if this person actually has high blood pressure.

[00:21:21] Speaker 02:
And they do.

[00:21:22] Speaker 00:
At that time.

[00:21:23] Speaker 00:
That's right, Your Honor.

[00:21:24] Speaker 00:
Is there anything in the rule that would prevent the VA from looking back

[00:21:32] Speaker 00:
Any time a veteran comes in and claims high blood pressure, hypertension, the veteran could come in and say, here are my blood pressure readings for the past two months.

[00:21:41] Speaker 00:
And all of them are over 100.

[00:21:45] Speaker 00:
And what would prevent the VA from, in every case, defeating that claim by just saying, well, we're going to go back.

[00:21:52] Speaker 00:
And when you were in this service 25 years ago, you were fine.

[00:21:56] Speaker 00:
So you're not predominantly

[00:22:00] Speaker 00:
I pretend.

[00:22:04] Speaker 01:
Perhaps what would prevent them from doing that?

[00:22:07] Speaker 00:
There has to be some temporal boundary here.

[00:22:10] Speaker 00:
But my question is, and this goes back to what Judge Shen raised in the first place, is there something in the rule that imposes some temporal bounds on this?

[00:22:23] Speaker 01:
So the short answer is I'm not sure if the rule has that temporal limitation.

[00:22:29] Speaker 03:
The rule doesn't.

[00:22:30] Speaker 03:
But the question is maybe the VA manual does.

[00:22:33] Speaker 01:
And again, the same answer.

[00:22:35] Speaker 01:
I'm not sure what the VA manual would speak to that or not.

[00:22:38] Speaker 01:
Perhaps what would check against that is the fact that these are all reviewed.

[00:22:42] Speaker 01:
And appellate review would find that to be clear error.

[00:22:45] Speaker 01:
I mean, cherry picking is a very clear-cut example of clear error.

[00:22:50] Speaker 01:
But I think, and I think your honors know where I would go next, which is in this case, we're looking between 2010 and 2014.

[00:22:59] Speaker 01:
So we're not like back loading readings from 50 years ago in order to support this predominance.

[00:23:05] Speaker 01:
We're using this four slice period of time.

[00:23:09] Speaker 03:
And just one last thing.

[00:23:11] Speaker 03:
These readings for history of diastolic pressure

[00:23:16] Speaker 03:
Those need to be readings without when the person's not taking any medication, right?

[00:23:23] Speaker 01:
Yes, Your Honor.

[00:23:24] Speaker 01:
Okay.

[00:23:25] Speaker 01:
And that's why the window of time we're looking at is 2010 to 2014 because in April 2014 he began taking the medication.

[00:23:34] Speaker 01:
Okay.

[00:23:34] Speaker 01:
And if there are no further questions, Your Honor, we ask that you affirm the decision of the Veterans Court.

[00:23:40] Speaker 03:
Okay, thank you.

[00:23:41] Speaker 01:
Thank you.

[00:23:44] Speaker 03:
Mr. Niles, do you have some time?

[00:23:55] Speaker 04:
Thank you, Your Honors.

[00:23:57] Speaker 04:
As Your Honor's colloquy with my friend show, there is reasonable doubt here in terms of how to, first of all, interpret the regulatory term predominantly, which has legal significance, and then ties to this court's rulings in Tadlock, and Stinson, and Slaughter, and Deloach.

[00:24:19] Speaker 04:
Tadlock is a case that has roots into the Chenary Doctrine, where

[00:24:24] Speaker 04:
The agency's decision has to come up with the agency's rationale.

[00:24:29] Speaker 04:
And that is, by and large, what is before the court reviewing the agency, the agency decision based on the agency's rationale.

[00:24:36] Speaker 04:
And here, when there is a blank space instead of rationale in terms of what does predominantly mean, and then in consideration of that in the 10 pre-medication readings across seven visits, only three of which happened with two or more readings on the same date,

[00:24:54] Speaker 04:
Was that April 2021 examiner's opinion against a compensative?

[00:24:58] Speaker 04:
And it's an opinion, not a finding of fact, by the way.

[00:25:00] Speaker 04:
An examiner does not find facts.

[00:25:01] Speaker 04:
An examiner fills the role of a medical expert whose opinion has to comport with accurate factual and legal premise to hold any sway.

[00:25:14] Speaker 04:
Is that consistent, then, with the definition of predominantly?

[00:25:18] Speaker 04:
Your honors were asking, my friend, about how far back, if this were in a hypothetical

[00:25:24] Speaker 04:
50 years of readings.

[00:25:26] Speaker 04:
The VA's internal policy manual is called the M21-1, and it does contain a provision that addresses when considering history of diastolic pressure.

[00:25:35] Speaker 04:
And the VA's internal policy manual says that VA should only consider blood pressure readings obtained when the veteran was undergoing a diagnostic evaluation for hypertension.

[00:25:44] Speaker 04:
And so here, again, you have these 10 readings from seven visits.

[00:25:48] Speaker 04:
You have April 29, 2010, with two readings of that day, one of which has diastolic

[00:25:54] Speaker 04:
of 100, that's appendix page 27.

[00:25:56] Speaker 04:
You have April 26, 2011, with diastolic reading of 100 from a single reading that day.

[00:26:03] Speaker 04:
And then book ending, three other below 100, is in February and April 2014.

[00:26:08] Speaker 04:
Two different visits, each with two different readings, with diastolic pressure of at least 100 taken during those visits.

[00:26:18] Speaker 04:
And so then that book ending here, I would submit, further shows the reasonable possibility that on remand, when the board is filling this gap in the first instance, Mr. Pelt has at least a reasonable possibility of a better disposition than the denial that the board issued without addressing those pre-medication readings.

[00:26:39] Speaker 04:
Your Honors, once again, Mr. Pelt would respectfully request that this Court vacate the Veterans Court's decision and remand.

[00:26:47] Speaker 03:
Okay.

[00:26:48] Speaker 03:
Thank you, Mr. Niles.

[00:26:49] Speaker 03:
The case is submitted.