Citation Nr: 21063916 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-16 932A DATE: October 18, 2021 REMANDED Entitlement to an initial compensable disability rating for traumatic brain injury (TBI), prior to July 10, 2020, and in excess of 70 percent thereafter is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1997 to March 1999, October 2001 to August 2002, September 2004 to January 2005, June 2006 to August 2006, and from July 2008 to February 2009 with periods of Active Duty for Training (ADUTRA). This matter comes before the Board of Veteran's Appeals (Board) from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) dated March and May 2014. A hearing was held before the undersigned Veterans Law Judge (VLJ) in February 2020, a transcript of which has been associated with the record. The matter was previously remanded by the Board in April 2020 and 2021 for additional development, and has now returned for further appellate review. 1. Entitlement to an initial compensable disability rating for traumatic brain injury (TBI), prior to July 10, 2020, and in excess of 70 percent thereafter is remanded. Pursuant to the April 2021 Board remand, an addendum medical opinion by a psychiatric examiner was obtained to determine the severity of the Veteran's service-connected TBI in June 2021. The examiner reviewed the Veteran's file and noted that a previous July 2020 psychiatric examination report did not document any cognitive screening measure, however the examiner went on to state that subjective memory and concentration problems are not supported by objective screening measures. As it is unclear what type of screening measures were utilized to determine the severity of the Veteran's TBI, the Board finds that remand is once again necessary to obtain a VA examination regarding the severity of the Veteran's TBI throughout the period on appeal. Accordingly, the matter is remanded. 2. Entitlement to service connection for hypertension is remanded. The Veteran is seeking service connection for hypertension, which he contends is etiologically related to active duty service. In a March 2014 VA examination, the examiner stated that the Veteran's hypertension clearly and unmistakably existed prior to service and that the condition was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. By way of rationale, the examiner stated that the Veteran's 1991 Army Reserve enlistment examination showed that the Veteran was "in good health except for high blood pressure." However, a review of the Veteran's 1991 enlistment examination does not show any indication of high blood pressure. Accordingly, the Board finds the March 2014 examination to be inadequate for determining entitlement to service connection as it is based on inaccurate factual premises. Thus, remand is necessary to obtain a new VA examination. The matters are REMANDED for the following action: 1. Afford the Veteran an examination with a psychiatric examiner of appropriate expertise to provide a medical opinion regarding the severity of the Veteran's service-connected TBI throughout the period on appeal. Specifically, the examiner is asked to comment on each and every positively affected facet, as well as those noted in in the Veteran's prior TBI examination reports, to specifically include: a) headaches: _____________; b) memory impairments: _____________; c) concentration impairments: _____________; d) impaired judgment: _____________; e) inappropriate social interaction: _____________; f) disorientation: _____________; g) visual spatial impairment: _____________; h) tinnitus: _____________; i) insomnia: _____________; j) task learning impairments: _____________. The examiner must state whether the Veteran's manifestations are attributable to his psychiatric disorder, TBI, or whether attribution to one or the other is impossible. The examiner must also provide a complete rationale for each attribution made. If the examiner is unable to provide any required opinion, he should explain why. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 2. Afford the Veteran an examination with an examiner of appropriate expertise to determine the nature and etiology of the Veteran's claimed hypertension. The examiner should state an opinion with respect to the following questions: (a) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that any currently diagnosed hypertension preexisted the Veteran's active service, to include ADUTRA. (b) If so, state whether there is clear and unmistakable evidence that the preexisting hypertension was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (c) If hypertension is NOT found to clearly and unmistakably exist prior to the Veteran's service, the examiner should opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed hypertension is related to the Veteran's service. (Continued on next page) If the examiner is unable to provide any required opinion, he should explain why. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Gorum, 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.