Citation Nr: 21021367 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 19-29 139A DATE: April 12, 2021 ORDER Entitlement to service connection for hypertension is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The Veteran had hypertension, which was found by probative medical evidence to be caused by his service-connected traumatic brain injury (TBI). 2. From August 11, 2014, to February 16, 2021, the Veteran’s service-connected disabilities prevented him from obtaining and retaining substantially gainful employment consistent with his educational background and work experience. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension have been met.  38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 2. The criteria for the award of a TDIU have been met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1983 to July 1986. The Veteran died in February 2021. The Veteran’s surviving spouse has been substituted as the appellant. This case comes to the Board of Veterans’ Appeals (Board) from May 2016 and March 2018 rating decisions. In June 2020, the issue of entitlement to a TDIU was remanded so that a Statement of the Case could be issued, pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). A Statement of the Case was issued in August 2020, and the Veteran perfected an appeal of this issue in September 2020. Hypertension The Veteran had applied for service connection for hypertension, and the Board affords the Veteran the benefit of the doubt and finds that there is adequate probative medical evidence establishing that his hypertension was caused by his service-connected TBI. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service.  38 U.S.C. § 1131; 38 C.F.R. § 3.303(a).  Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a). The Veteran has a current diagnosis of hypertension, which was diagnosed by the February 2018 and December 2019 VA examiners. There is also probative medical evidence which relates his hypertension to his service-connected TBI. The Veteran submitted a private evaluation from a neurologist in September 2018. The examiner wrote that there was evidence that TBI can lead to the development of hypertension, with or without a family history of hypertension. He explained that the condition was likely intertwined with the Veteran’s chronic headaches. He further explained that the conditions were caused by dysautonomia or autonomic dysfunction, and provided citations explaining how this dysfunction of the autonomic nervous system following a TBI can lead to increased sympathetic activity and immune system depression. He cited further research studies indicating that hypertension could follow traumatic brain injury, and concluded that hypertension following injury was at least as likely as not a consequence of the TBI. While the December 2019 VA examiner came to a different conclusion regarding the etiology of the Veteran’s hypertension, that examiner did not address the medical literature referenced by the September 2018 private examiner or the impact of a TBI on the nervous system. The Board therefore finds that while the December 2019 medical opinion has some probative value, it does not outweigh the findings of the September 2018 private opinion. The Board therefore finds that there is competent and probative medical evidence indicating that the Veteran had hypertension that was caused by his service-connected TBI. The claim is granted. TDIU After reviewing all of the evidence of record, the Board finds that entitlement to a TDIU is also warranted. VA may grant a TDIU when the evidence shows that a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities.  38 C.F.R. §§ 3.340, 3.341, 4.16. While the Veteran submitted a VA Form 21-8940 Application for Increased Compensation Based on Unemployability in March 2016, he indicated that he could not work due to TBI, migraines, and PTSD, and these issues were already in appeal status following the submission of an August 2015 Notice of Disagreement. The Veteran’s initial claim for these issues was submitted on August 11, 2014, and because the claim for a TDIU stems from these claims, the current period on appeal is August 11, 2014, until the Veteran’s death on February 16, 2021. For the entire period on appeal, the Veteran was assigned a total disability rating of 90 percent, including a 70 percent rating for TBI, later recharacterized as TBI with PTSD. He therefore did meet the criteria to be eligible for a schedular TDIU under 38 C.F.R. § 4.16(a). There is also adequate medical evidence which establishes that the Veteran’s psychiatric and neurological symptoms significantly impaired his occupational functioning such that he was as likely as not unable to obtain or maintain employment. The Veteran submitted a July 2018 private evaluation from a psychologist who found that the Veteran had very severe limitations of social and occupational functioning that rendered him unable to perform even occupations which required non-exertional activities, due to problems with communicating, remembering instructions, using judgment, adapting to change, dealing with supervisors, coworkers, and the public. The Veteran also submitted an August 2018 evaluation by a private neurologist. He discussed the Veteran’s medical history and symptoms at length. He found that the Veteran’s headache symptoms would have rendered him unable to secure long-term employment due to pain interfering with work performance and causing excessive absences, and that the changes in his behavior and problems with impulse control would cause interference with even activities of daily living. These findings are consistent with the VA psychiatric examinations, which did find that the Veteran had severe impairment in occupational functioning, and the January 2019 VA examination for TBI also found that the Veteran had memory impairment, inappropriate social interaction, mildly impaired spatial orientation, headaches, irritability, fatigue, and anger issues, and these symptoms would cause at least moderate impairment in any employment. The findings are also supported by statements submitted by the Veteran and his family members about how significant and disruptive his symptoms could be. In July 2018, the Veteran submitted a statement describing the problems he had from his PTSD and TBI, including violent outbursts, nightmares, panic attacks, and suicide attempts. He wrote that he had a tough time with jobs because of these problems and was fired from a job when he hit a coworker who had startled him. The Board assigns great probative value to the private evaluations submitted by the Veteran, as they are consistent with the symptoms demonstrated in the Veteran’s VA treatment records and reported by the Veteran and his family members. These examiners discussed the nature of the Veteran’s psychiatric and neurological symptoms, and why they were of a type that would significantly impact his ability to function appropriately in a job. The Board therefore finds that the preponderance of the evidence demonstrates that the Veteran’s service-connected disabilities, including residuals of TBI and PTSD, prevented him from being able to maintain any gainful employment for the entire period on appeal, August 11, 2014, to February 16, 2021. Entitlement to a TDIU is granted. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, 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.