Citation Nr: 20007165 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 17-28 133 DATE: January 28, 2020 REMANDED Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had periods of active service from July 1998 to November 1998, from February 2005 to May 2005, and from February 2007 to August 2008. This included service in Iraq. 1. Entitlement to service connection for hypertension is remanded. The Veteran contends that his hypertension disorder is related to his exposure to environmental hazards while deployed on active duty service in Iraq. May 1998 STRS reveal a normal blood pressure reading of 124/76. March 2002 treatment records reveal a normal blood pressure reading of 129/84. March 2004 treatment records reveal a blood pressure reading of 119/83 May 2008 STRs reveal that the Veteran’s blood pressure was noted as normal with 124/83. Cholesterol was noted as elevated with hyperlipemia noted. Lifestyle changes such as exercise and smoking cessation were recommended. Dental records show some systolic readings around 140 prior to dental treatment in service. October 2008 STRs indicate that the Veteran reported shortness of breath. In a May 2010 VA hypertension examination, the examiner noted blood pressure reading at 142/92, 142/92, and 142/90. The examiner diagnosed the Veteran as negative for hypertension but did note a history of elevated blood pressure. In a May 2010 addendum opinion, the examiner noted that the Veteran’s symptoms were consistent with hypertensive heart disease with an EF of 55 percent with METS at 8-10 percent. July 2012 to January 2014 VA outpatient treatment records indicate hypertension as an active problem. In a November 2017 VA hypertension disability benefits questionnaire, the examiner noted a diagnosis of hypertension from May 2010. The Veteran’s blood pressure was noted at 146/71, 148/78, and 122/85. The examiner noted lightheadedness, dizziness, headaches, and slow focusing when blood pressure is high. The examiner also noted that the Veteran did not meet the VA criteria of the of two blood pressure on the same day for three different days. However; she noted that going through the claims file there is sufficient evidence of elevated blood pressure and continued treatment for hypertension over the years to diagnose hypertension on the day of the examination. In a March 2018 VA private treatment examination, the examiner noted that the Veteran’s service-connected PTSD caused the onset of his hypertension. The examiner explained that the brain-stem is an extension of the brain base and contains areas that control cardiac function. Therefore, it influences the blood pressure and cardiovascular function. The examiner opined that it is absolutely more likely than not that an increased blood pressure and a diagnosis of hypertension is due to the Veteran’s service-connected PTSD. In an October 2019 hearing before the undersigned, the Veteran testified that he did not think his hypertension was secondary to his PTSD. His contention is that his hypertension is related to his exposure to environmental hazards while deployed in Iraq. The Veteran reported experiencing symptoms of dizziness and energy loss while deployed in Iraq. During the hearing, the Veteran also reported that he was diagnosed with elevated blood pressure in-service and treated for hypertension. He reported that upon return from Iraq he was sent to Fort Hood for treatment of high blood pressure and was given medication at that point. These records do not appear to be a part of the record. Moreover, a new VA examination and opinion addressing the Veteran’s hypertension or any diagnosed heart disorder as it relates to his tour of duty in Iraq is also necessary to further investigate the Veteran’s claim. The matter is REMANDED for the following action: 1. As necessary, ask the Veteran to identify, and provide appropriate releases for, any care providers who may possess new or additional evidence pertinent to the issue on appeal. This should include a release of information for obtaining any private treatment records for hypertension the Veteran reported at his October 2019 hearing. If he provides the necessary release(s), assist him in obtaining the records identified. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. Also make a specific request to Fort Hood for any records they may have for this Veteran. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and is representative should be notified. All attempts to obtain records should be documented in the claims file. 2. Arrange for a VA examination to be conducted. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner must provide a full description of all symptoms and manifestations associated with the Veteran’s hypertension disorder. The examiner’s opinions should address whether the Veteran’s hypertension is related to his tour of duty in Iraq and provide an answer to the following: After reviewing the claims file and examining the Veteran, is it as likely as not (50 percent or greater probability) that any identifiable hypertension disorder is related to the Veteran’s time in-service? The examiner should discuss the Veteran’s period of active service in Iraq and whether his reported exposure to environmental hazardous caused the onset of his hypertension or any other heart disorder. The examiner should also discuss the March 2018 private examiners opinion and rational noting opining that the onset of the Veteran’s hypertension is related to his service-connected PTSD. If any identifiable evidence of a hypertension disorder is not found to be related to the Veteran’s service in Iraq, this should be set out in detail with the factors considered in making that determination. Also please determine whether the hypertension is caused by or made worse by any of the Veteran’s service connected disabilities, including the orthopedic disorders he has service connected. Please provide a complete rationale for all opinions entered. If the examiner cannot provide any of the requested opinions, they must affirm that all procurable and assembled data was fully considered, and a detailed rationale must be provided for why an opinion cannot be rendered. 3. The AOJ must ensure that the examiner’s report complies with this remand and answers the questions presented in the request. The AOJ must also ensure that the examiner documents consideration of the electronic claims file, including any records contained in Virtual VA and VBMS. If the report is insufficient, the AOJ should take corrective action. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Elliot Harris, Associate 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.