Citation Nr: 23016167 Decision Date: 03/16/23 Archive Date: 03/16/23 DOCKET NO. 18-49 991A DATE: March 16, 2023 REMANDED Entitlement to service connection for hypertension (HTN) is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to a total disability rating based on individual unemployability due to service connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 2008 to November 2009. The Veteran appeals the denial of service connection for hypertension and GERD. The Veteran argues that that his disabilities are related to his service and/or his service connected anxiety disorder. In relation to these clams, the Veteran was afforded a VA examination in May 2021. The VA examiner opined that the Veteran's hypertension and GERD conditions were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner further found that the hiatal hernia and hypertension were not likely directly related to service or caused by or aggravated by the Veteran's anxiety disorder. In so finding, the examiner reasoned, in part, that there was no documentation of hypertension until 2013 which was four years after active duty service, and that it was more likely a result of lifestyle. The examiner further commented that the exact causes of high blood pressure are not known, but several things may play a role including stress. With regard to GERD, the examiner reasoned in part, that there was no evidence of complaint or treatment of GERD until November 2012 which is three years after active duty service. The examiner noted that the condition was likely related to lifestyle habits such as smoking and drinking, weight gain, and lack of exercise. Here, the examiner listed stress as a possible factor for the Veteran's higher blood pressure but the examiner did not address whether such had a relation to the Veteran's anxiety disorder. Furthermore, the Board notes that the Veteran has submitted medical articles which discuss a possible connection between hypertension and anxiety, and GERD and mental disorders. The record, however, is unclear as to whether the examiner considered the medical literature submitted by the Veteran in relation to these claims. For the reasons stated, the Board finds that an addendum opinion on these matters is warranted. Lastly, the issue of TDIU is inextricably intertwined with the Veteran's appeal of service connection for hypertension and GERD because a positive resolution of the claims may affect the outcome of the claim for TDIU. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, the issue of TDIU will also be remanded. On remand, ongoing VA and private treatment records should also be obtained. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA and private treatment records. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his hypertension. The electronic claims file must be made available to and be reviewed by the examiner. After review of the record, the examiner should: (a) opine whether it is an approximately equal or greater probability that the Veteran's hypertension had its onset in service or is causally related to service; (b) whether it is an approximately equal or greater probability that the Veteran's hypertension was caused by, is due to, or is the result of the service-connected anxiety disorder; (c) whether it is an approximately equal or greater probability that the Veteran's hypertension has been aggravated, i.e., a medically discernible increase in disability, even if temporary, by the service-connected anxiety disorder. In so doing, the examiner must also specifically address: (1) whether stress plays a factor in causing this Veteran's high blood pressure and if so whether it is due to his anxiety disorder, and (2) the medical articles submitted in November 2018 which discuss a possible connection between hypertension and anxiety. A complete rationale for any opinion should be provided. The examiner must not rely solely on the absence of a diagnosis or symptom in service as the basis for a negative opinion. The mere passage of time without treatment is not a sufficient basis for finding that no relationship between a current disability and service exists. Any opinion should be reconciled with the service medical and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. If the lay evidence is rejected, an explanation must be provided. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of his GERD. The electronic claims file must be made available to and be reviewed by the examiner. After review of the record, the examiner should: (a) opine whether it is an approximately equal or greater probability that the Veteran's GERD had its onset in service or is causally related to service; (b) whether it is an approximately equal or greater probability that the Veteran's GERD was caused by, is due to, or is the result of the service-connected anxiety disorder; (c) whether it is an approximately equal or greater probability that the Veteran's GERD has been aggravated, i.e., a medically discernible increase in disability, even if temporary, by the service-connected anxiety disorder. In so doing, the examiner must consider the medical articles submitted in November 2018 which discuss a possible connection between GERD and mental disorders. A complete rationale for any opinion should be provided. The examiner must not rely solely on the absence of a diagnosis or symptom in service as the basis for a negative opinion. The mere passage of time without treatment is not a sufficient basis for finding that no relationship between a current disability and service exists. Any opinion should be reconciled with the service medical and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. If the lay evidence is rejected, an explanation must be provided. 2. Upon completion of the above requested development and any additional development deemed appropriate, the AOJ must readjudicate the issues to include the intertwined issue of entitlement to TDIU. If any benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case and allow an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S. Willie 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.