Citation Nr: 18146109 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-25 886 DATE: October 30, 2018 REMANDED Entitlement to service connection for hypertensive heart disease is remanded. Entitlement to service connection for residuals of stroke, to include as secondary to hypertensive heart disease is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty military service from December 1985 to February 1993. Entitlement to service connection for hypertensive heart disease Entitlement to service connection for residuals of stroke, to include as secondary to hypertensive heart disease Entitlement to TDIU The Veteran seeks service connection for hypertension as a result of his military service, as well as residuals of a stroke which has been attributed to his hypertension, and TDIU as a result of the stroke. The Veteran’s service treatment records show some blood pressure readings which were elevated and an incident of salmonella food poisoning which caused him to be hospitalized for several days. The Veteran has asserted that his food poisoning either caused or aggravated his blood pressure issues. He noted that he has experienced recurrent severe headaches and nosebleeds since his time in service and believes that these are related to his high blood pressure. He stated that during his time in service when his blood pressure was taken, the providers would take several readings and record only the lowest reading. The service treatment records show that he was counseled about hypertension in service. He has also noted that the symptoms he experienced at the time of his food poisoning in service were similar to those experienced at the time of his stroke. The Veteran was provided a VA examination and opinion in September 2012, which found that his hypertension was not the result of his military service but was likely due to a strong family history of hypertension. However, this opinion did not discuss his food poisoning in service, his history of headaches, or the question of aggravation. As such, it is inadequate. A Disability Benefits Questionnaire was completed by the Veteran’s primary care provider in April 2015 which listed the date of onset of hypertension as 1987, during the Veteran’s military service. However, this was not accompanied by a clear opinion and rationale for assigning this onset date. Thus, it is also inadequate. A new VA examination and opinion are necessary on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his hypertension and any residuals. The examiner must offer an opinion as to whether it is at least as likely as not (probability 50 percent or greater) related to the Veteran’s hospitalization for salmonella food poisoning, high blood pressure readings in service, headaches in service and since service, and/or nose bleeds in service and since service. The examiner should specifically address the significance, if any, of the Veteran’s elevated blood pressure readings in service and of the fact that he was counseled about hypertension in service. The examiner should offer an opinion as to whether these elevated blood pressure readings in service represented the onset of hypertension. In the event that the examiner believes that the Veteran’s hypertension did not have its onset in service and is more likely to be attributable to his family medical history, the examiner should offer an opinion as to whether it is at least as likely as not (probability 50 percent or greater) that any of the events in service, to include headaches, nosebleeds, or salmonella food poisoning aggravated (worsened beyond the expected course of the condition) his high blood pressure. The examiner should also address the Veteran’s assertions that his symptoms at the time of his salmonella food poisoning were the same as those experienced at the time of his stroke, and the significance, if any, of these symptoms. (Continued on the next page)   The examiner should offer an explanation or rationale for all opinions offered. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cheryl E. Handy, Counsel