Citation Nr: 1323137 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 07-22 049 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for a neurological disorder, to include a traumatic seizure disorder and Bell's palsy. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD L. A. Rein, Counsel INTRODUCTION The Veteran served on active duty from July 1973 to October 1973. This matter before the Board of Veterans' Appeals (Board) arises from a January 2006 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that declined to reopen the Veteran's previously denied service connection claim. In February 2011, the Board reopened the Veteran's claim and remanded it for additional development. FINDINGS OF FACT 1. Any head disorder that pre-existed active service is not shown by clear and unmistakable to have been aggravated beyond the natural progression of the condition during active service. 2. The evidence fails to show that the Veteran has a current diagnosis of seizure disorder or Bell's palsy. No injury to the head is noted in service. CONCLUSION OF LAW The criteria for service connection for a neurological disorder, to include a traumatic seizure disorder and Bell's palsy, are not met. 38 U.S.C.A. §§ 1110, 1111, 1153, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.306 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any of element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S.Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the appellant is harmless because of the thorough and informative notices provided throughout the adjudication and because the appellant had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. The record does not show prejudice to the appellant, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was notified in an August 2005 letter. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful or prejudicial falls on party attacking agency determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board considers it significant that the subsequent statements made by the Veteran and his representative suggest actual knowledge of the elements necessary to substantiate the claim. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what is necessary to substantiate a claim). Thus, VA has satisfied its duty to notify the appellant and had satisfied that duty prior to the adjudication in the most recent March 2012 supplemental statement of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. The appellant has not referred to any additional, unobtained, relevant, available evidence. VA has obtained an examination with respect to the claim on appeal. Thus, the Board finds that VA has satisfied the duty to assist provisions of law. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d) (2012). The Veteran contends that he currently has seizures and related neurological problems that had their onset in service, when he reportedly fell and sustained a closed-head injury, which required inpatient treatment. In the alternative, he asserts that his current neurological problems are manifestations of a head disorder and syncopal episodes, which preexisted service and underwent a permanent worsening during his period of active duty. While the Veteran does not deny a pre-service history of headaches and syncopal episodes, he essentially contends that the symptoms permanently worsened in service to the point that he needed to be hospitalized. He further asserts that, since leaving service, he has experienced ongoing headaches, seizures, and related symptoms. Additionally, the Veteran now maintains that, during one of his in-service "passing-out spells," he fell and sustained a closed-head injury, which caused or permanently aggravated his current seizure-related symptoms. A Veteran is presumed in sound condition except for defects noted when examined and accepted for service. Noted denotes only conditions that are recorded in examination reports. The existence of conditions prior to service reported by the Veteran as medical history does not constitute a notation of the conditions, but will be considered together with all other material evidence in determining the question of when a disease or disability began. 38 C.F.R. § 3.304(b)(1) (2012). Clear and unmistakable evidence that the disability existed prior to service and was not aggravated by service will rebut the presumption of soundness. Once the presumption of soundness has attached, VA holds the burden of proving by clear and unmistakable evidence that both (1) the Veteran's disease or injury pre-existed service, and (2) that the disease or injury was not aggravated by service. 38 U.S.C.A. § 1111 (West 2002). Clear and unmistakable evidence is a more formidable evidentiary burden than the preponderance of the evidence standard. Vanerson v. West, 12 Vet. App. 254 (1999) (clear and convincing burden of proof, while a higher standard than a preponderance of the evidence, is a lower burden to satisfy than clear and unmistakable evidence). It is an onerous evidentiary standard, requiring that the no-aggravation result be undebatable. Cotant v. West, 17 Vet. App. 116 (2003). Concerning clear and unmistakable evidence that the disease or injury was not aggravated by service, the second step necessary to rebut the presumption of soundness, a lack of aggravation may be shown by establishing that there was no increase in disability during service or that any increase in disability was due to the natural progress of the pre-existing condition. Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 38 U.S.C.A. § 1153 (West 2002). The burden is on the government to rebut the presumption of soundness by clear and unmistakable evidence that a condition was both preexisting and not aggravated by service. The record shows that, on February 1973 pre-induction examination, the Veteran reported a history of headaches. Although contemporaneous clinical examination was negative for findings of neurological abnormalities, the service examiner assessed the Veteran with a pre-existing head disorder, based on his reported history. In September 1973, he was hospitalized after experiencing a series of four or five in-service syncopal episodes. At that time, the Veteran reported that he had first experienced such episodes as an adolescent. He added that, prior to entering service, he had undergone a private evaluation, which had been negative for any neurological abnormalities. Nevertheless, the Veteran maintained that, throughout his teens and early twenties, he had experienced recurrent syncopal episodes at frequencies ranging from four per year to one to two per month. He further indicated that, since his enlistment, the frequency of his syncopal attacks had increased. The Veteran described his current attacks as "passing out spells," which were preceded by feelings of dizziness and sleepiness and manifested by sudden loss of consciousness and falls to the ground. Additionally, eyewitnesses observed that the Veteran's in-service syncopal episodes were accompanied by stiffness and shakiness. Significantly, one of the Veteran's in-service treating providers opined that the episodes were characteristic of "seizure-like activity." However, a different in-service medical provider disagreed that the Veteran's symptoms met the diagnostic criteria for a seizure disorder. Neither in-service examiner offered an opinion as to the etiology of the Veteran's symptoms. Following his hospitalization, the Veteran suffered an additional in-service syncopal attack. He subsequently was referred to a Medical Examination Board (MEB), which determined that his syncopal episodes had no known etiology, but nonetheless had preexisted service and not been aggravated therein. The MEB further determined that those episodes rendered the Veteran unfit for retention in service. He was subsequently discharged after less than four months of active duty. Post-service medical records show that shortly after leaving service, in November 1973, the Veteran was treated at a VA medical facility for an apparent seizure. Those records show periodic treatment for a seizure disorder resulting from head trauma of unspecified etiology. A February 1974 VA hospital record shows that the Veteran complained of having had a seizure. The Veteran stated he had a history of seizures for eight to nine years, about two times a month. He has only taken medication for the past four to five months, and ran out. The Veteran stated that he was seizure free for 10 months prior to entrance in service, and that in service he began having spells and was discharged because of seizures. An electroencephalographic report shows that the Veteran had a normal EEG, awake and asleep. While approximately 20 percent of the "epileptic" population has normal EEGs, it was most unusual to see a normal EEG in a patient with true seizures with focal motor onset. He was diagnosed with anxiety reaction manifested by syncopal episodes. In July 1974, the Veteran was admitted to a VA hospital. He provided a history of epileptic attacks that began at 10 years of age, characterized by sleeplessness for two to three days prior to the attack and a bitter taste in the mouth one or two days prior to his attacks. The attacks seem to be "brought on by heat, stress, exertion, etc." Prior to the attacks, he had a funny and drowsy feeling. The Veteran stated that the latest attack happened earlier in the month where the Veteran had two epileptic seizures, one hour apart. The Veteran was brought to the hospital during the second attack and a tongue blade was in the mouth and the Veteran was motionless with his eyes rolled backward. The Veteran was evaluated on the medical service and later transferred to the psychiatry service as they felt that the seizures were not due to neurological brain disease, but rather were hysterical in nature. The Veteran related the onset of his seizures at age 10, six months after a blow to the head and an anterior temporal laceration after a "swing hit him in the head." He had attacks every two to three months since then. Various observers described his attacks as starting in the arms with tremors, and then later generalized convulsions with "eyes rolled back" and no incontinence, urinary or otherwise. He had been on Dilantin and Phenobarbital, but, approximately one month ago, ran out of medication. During the course of hospitalization, the Veteran was observed to have two so-called "seizures" which were not considered to be typical of either grand mal seizures or psychomotor seizures. Electroencephalograms were ordered and they were normal as was an EEG and brain scan. The Veteran was evaluated by psychological testing, which revealed that the seizures could well be hysterical. The discharge diagnoses included conversion, hysteria (Briquet's syndrome), and schizophrenia, schizo-affective type, acute (depressed). A June 1980 VA hospital record shows that the Veteran presented to the emergency room after having generalized seizures. He provided a history of a seizure disorder since age 12. The Veteran, by history, stated that he has taken Dilantin daily since age 12 and with the addition of Phenobarbital, which he has discontinued on his own for the last year and had intermittently taken his Dilantin over the last two to three month period. Despite non-compliance, he noticed only approximately one seizure per month. Discharge diagnosis was seizure disorder, probably idiopathic by history, exacerbation secondary to non-compliance. A July 1982 VA hospital summary shows that on the day prior to admission, the Veteran was at work at Mid-South Hospital when he felt hot and sweaty. Following that, he regained consciousness in the emergency room. Co-workers told him that he passed out. There was no tonic-clonic movement, no tongue biting, and no incontinence. The Veteran reported that he had spells like that intermittently since age 14. He stated that the spells were usually precipitated by stressful situations and a nervous feeling, sometimes associated with nausea, then he became unconscious, occasionally falling, but had never injured himself or bitten his tongue. No incontinence, tonic-clonic movements, or post-ictal confusion had ever been witnessed or reported to him. The Veteran stated that he came to feeling weak and nervous, often with a bilateral frontal headache. Pertinent laboratory findings included Dilantin level which was negative and Phenobarbital level of 3.5. The Veteran was admitted to neurology services and on the third day, he experienced an apparent episode of syncope and was found face down on the floor. The Veteran described the episode like the episode one day prior to admission and his previous "seizures" in the past. As the Veteran had a history of noncompliance with his medicines, Dilantin was stopped and his Phenobarbital was tapered. The syncope which was felt to be vasodepressor was addressed with a psychiatry consult. A July 1982 VA hospital psychiatry consultation report shows that the Veteran provided a history of seizures. Documented syncopal episodes were probably vasovagal or hyperventilatory. The Veteran described himself as nervous, with frequent nausea and vomiting. He presented with headaches and normal EEG tracings, leading medical service to question the seizure diagnosis. The diagnosis was primary depressive illness, unipolar, rule out reactive depression. The hospital discharge diagnoses include syncopal episodes, probable etiology vasodepressor; probable unipolar depression; and possible history of seizures. Subsequent VA and private medical records show ongoing treatment for headaches, seizures, and related neurological symptoms, and diagnoses of seizure disorder and Bell's palsy. A December 2005 private medical record notes a seizure disorder and that Dilantin levels were subtherapeutic. An October 2006 MRI of the brain was normal. A May 2011 VA neurological examination report shows that the examiner conducted a thorough examination of the claims file and physical examination. The Veteran dated the onset of "seizure" to 1964. The Veteran stated he was "shaking all over" when he was 12. He did not remember having a high fever or having an accident hitting his head. He remembered being put on Phenobarbital and Dilantin, missing school, being kept overnight in the hospital a few times, and that the seizures stopped when he was about 15 or 16, so he quit taking the medicine, about 1968. With regard to Bell's palsy, the Veteran stated that his mouth was twisted and he was talking funny. He was hospitalized with the VA. His headaches had their onset in late 2010. The Veteran stated that in service in August 1973, he was in formation and it was hot and he fell backwards, hitting his head. He could not remember what was done for him, but he was pretty sure he was in the hospital for about a week and had a bandage on his head. A thorough examination was undertaken including an MRI of the brain with minimal non-specific findings and extensive laboratory testing. The VA examiner noted that the Veteran had been treated at the VA since 1988. He has received Dilantin and Phenobarbital off and on since 1994. His Dilantin and Phenobarbital levels were checked 31 times from 1994 to 2004 and he did not have a therapeutic level of either drug 30 times. He had a therapeutic level of Phenobarbital once, in August 1999. His levels were usually below detectable limits. The VA examiner noted that every time a "seizure medication" was prescribed, it was because the Veteran gave a history of seizures. When pressed, he related that he has had it since childhood. Any provider would then be required to prescribe the medication that he had "been on for years." The examiner noted that the Veteran had frequently related that "I passed out," then continued that he has had "seizure disorder" since childhood. However, syncopal episodes are not seizures and could be caused by many things, including cardiac arrhythmias, metabolic disorders, and other causes. In review of the Veteran's service records, the examiner noted that when the Veteran was hospitalized for epididymitis, a urologist witnessed an "episode" and got a medicine consultation to advise him as to whether or not that was really a seizure. The examiner stated that if the urologist had been sure that it was a seizure, he would not have asked for an internal medicine physician. The internal medical physician observed what the Veteran has always called seizures and was not convinced that the Veteran was having a seizure. The urologist discharged the Veteran and there was no further work-up for the "episodes." The urologist put him on seizure medication, just in case. Initially, the VA examiner opined that it was less likely than not that the Veteran had a true seizure disorder. The examiner noted that there were a few sporadic mentions of headache, but nothing consistent. The radiologic studies were normal and the blood work did not show anything out of the ordinary. There was one mention of the Veteran seeing double. The examiner could find numerous VA medical records, back to 1988, where the Veteran related a history of a seizure disorder. The chief complaint the Veteran related is that he was extremely hot and "passed out." He said that he was on seizure medicine. However, when the doctors run Phenobarbital or Dilantin levels, they were always low to undetectable and the physician prescribed seizure medication as a precaution. In post-service records, the Veteran was always prescribed seizure medication based on his given history of seizures. The VA examiner also opined that there was no clear and unmistakable evidence that the Veteran's syncopal episodes pre-existed service. The VA examiner stated that there was no way to discern whether the Veteran was truthful on his preinduction or he was truthful later in the Army hospital relating his medical history without resorting to mere speculation. The VA examiner provided that the only evidence in the claims file that the Veteran's syncopal episodes pre-existed service was from the history provided by the Veteran. The examiner noted the findings in service hospital records, noting that he could find no documentation of a "previous evaluation by a clinic in Memphis" that did not reveal an etiology for the Veteran's attacks. In addition, there was no documentation of the "four to five attacks." That the Veteran experienced since he had been on Active duty. The examiner noted that someone would have noticed the Veteran passing out and he would have been taken for medical attention. Also that was the opposite of what the Veteran reported in his induction report of medical history in which he wrote "I am in good health." In the same form, the Veteran responded "yes" to frequent or severe headache, recent gain or loss of weight, and stutter or stammer habitually. He denied dizziness or fainting spells, and epilepsy or fits and periods of unconsciousness. Under physician's summary, it was written "occ headache" and "gain 3 lbs." When asked whether it was at least as likely as not that any preexisting neurological disorder, to include any head disorder or syncopal episodes, was aggravated or permanently worsened by a head injury incurred in service, the VA examiner opined that there was not enough evidence to conclude that the Veteran had a head injury serious enough to aggravate or permanently worsen any pre-existing neurological disorder, to include any head disorder or syncopal episodes, without resorting to mere speculation. The examiner explained that the only evidence was from the Veteran's own history in September 1973 that he had "spells" since the age of 12 including "a sudden loss of consciousness and a fall to the ground." The Veteran further added that "he has occasionally injured himself in the fall." The examiner further noted that while the Veteran reported four to five attacks since entering active duty, that would have been almost one per week and nowhere in the Veteran's service treatment records was there documentation of him seeking medical attention for those "four to five attacks" and surely if he had visible injury to his head, he would have sought medical attention or another soldier would have brought him in for medical attention. The VA examiner referenced a service treatment record relating the Veteran's own history that he had been "found in the shower Sunday night, cut head, clonic-tonic movements described by friend - taken to ER and begun on anticonvulsant (records not available to me) EEG-normal." The VA examiner noted that there was no mention of the Veteran having any significant contusions, swelling, or lacerations still present. If the "cut" or injury had been serious, surely there should have still been evidence of that injury or the sutures, but none were noted. A senior physician reviewed and wrote that the Veteran did not have a seizure and discontinued the seizure medication. The VA examiner also opined that it was less likely than not that any pre-existing neurological disorder, to include any head disorder or syncopal episodes, was aggravated or permanently worsened by any other aspect of military service. In the "six weeks" that the Veteran was on active duty, there was no documentation, nor did the Veteran ever mention having any systemic or CNS infection. There was no documentation of, nor did the Veteran mention having a dangerously high fever. There was no documentation, nor did the Veteran mention having any symptoms of heat exhaustion or heat stroke. There was no documentation that the Veteran had any adverse reaction to any other aspect of military service. The VA examiner also opined that there was no clear and convincing evidence that the Veteran had a pre-existing neurologic disorder to aggravate, permanent worsen, or naturally progress. The examiner explained that the Veteran had only had a therapeutic medication level of his seizure medication, only once in the last 17 years. Such a non-complaint patient would have likely have had a number of seizures and ER visits for the same. But there had been no seizure activity witnessed and documented by a health care professional who stated unequivocally that the Veteran exhibited seizure activity. When asked whether it was at least as likely as not that any current neurologic disorder, to include a seizure disorder or Bell's Palsy, was caused or aggravated by an in-service head injury or in-service syncopal episodes, or any other aspect of military service, the VA examiner opined that was a moot point as there is no clear and convincing evidence that there was a current neurologic disorder, including a seizure disorder. The Veteran had Bell's palsy which was successfully treated by antivirals, and there was no clear and convincing evidence that there was a significant in-service head injury or that the Veteran had in-service syncopal episodes. With regard to Bell's palsy, which there was documentation that the Veteran had, it had never been shown to be caused by head trauma. It had a clear etiology (viral) and was treated as such (with antiviral medication), as shown in the Veteran's medical records. The VA examiner also stated that in the first five of the Veteran's six weeks on active duty, there was no documentation of, nor did the Veteran mention having, any neurologic disorder, seizure, or syncopal episodes. Only when he was hospitalized for an unrelated problem did he tell the doctor that he had four to five syncopal episodes since he had been on active duty. The VA examiner stated that it would be highly unlikely that none of the episodes were witnessed or reported. There is no documentation of, nor did the Veteran mention having any adverse reaction to any other aspect of military service. Further, the VA examiner found that the Veteran's assertions regarding continuity of neurological symptomatology since Active Duty were moot as there had never been a witnessed, documented neurologic event in the Veteran. Even though the Veteran consistently had only a negligible amount of seizure medication in his blood. In this case, although the Veteran's clinical entrance examination was negative for any findings of neurological abnormalities, the in-service examiner assessed the Veteran with a preexisting head disorder, based on his reported history. The Board recognizes that the Veteran's preexisting head disorder was not considered disabling and he was found to be fit for basic training and active service. Nevertheless, in light of the abnormalities noted upon entry, the Board finds that the presumption of soundness is rebutted and the Board must consider whether the Veteran's preexisting head disorder was aggravated in service. 38 U.S.C.A. § 1111 (West 2002); 38 C.F.R. § 3.304(b) (2012). The May 2011 VA examiner opined that there was not enough evidence to conclude that the Veteran had a head injury serious enough to aggravate or permanently worsen any pre-existing neurological disorder, to include any head disorder or syncopal episodes, without resorting to mere speculation. That examiner also opined that it was less likely than not that any pre-existing neurological disorder, to include any head disorder or syncopal episodes, was aggravated or permanently worsened by any other aspect of military service. The VA examiner provided a thorough discussion of the rationale for all the opinions expressed, as provided in detail above. The Board finds that the evidence does not credibly show any increase in severity of any preexisting neurological disability during service. The Board may only rely on such opinion if it is supported by an explanation of the basis for such an opinion or if the basis is otherwise apparent in the Board's review of the evidence. Jones v. Shinseki, 23 Vet. App. 382 (2010). In this case, the Board finds that opinion is supported by a rationale that was apparently provided after the VA physician considered all procurable and assembled data and has provided clear and legitimate explanations for the part of the opinion in which he could not resort to speculation. Significantly, neither the Veteran nor his representative has presented or identified any contrary medical opinion that supports the claim for service connection. The Board also notes that VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In the alternative, if the Board were to accept the May 2011 VA examiner's opinion that there is no clear and unmistakable evidence that a seizure or other neurological disorder pre-existed service, and thus conclude that the Veteran was presumed sound at service entry regarding neurological disorders, to include a traumatic seizure disorder and Bell's Palsy, the outcome would be the same. The Board would still find that the preponderance of the evidence would be against the claim for service connection. Although the Veteran was diagnosed with and treated for Bell's palsy after service, the May 2011 VA examiner opined that condition was properly treated and resolved. Furthermore, the May 2011 VA examiner opined there was no evidence that the Veteran had a current neurologic disorder, including a seizure disorder. The Board finds that opinion highly persuasive as the examiner conducted a thorough analysis of all previous medical evidence to make that finding. Furthermore, the Veteran has not presented, identified, or alluded to the existence of medical evidence that he has a current neurological disorder, to include seizure disorder or Bell's palsy, and a relationship, if any, to service. Thus, notwithstanding the Veteran's contentions that he injured his head in service and that he has a neurological disorder related to service, without competent evidence of a diagnosed or identifiable condition, service connection cannot be granted. Congress has specifically limited entitlement to service connection for disease or injury incurred or aggravated in service to cases where such incidents have resulted in disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002). Where, as here, competent evidence does not establish the disability for which service connection is sought, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The only other evidence of record supporting the Veteran's claim is his own lay statements. The Board notes that the Veteran's lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. §§ 3.303(a), 3.159(a) (2012); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, a determination of whether a pre-existing neurological disorder was aggravated in service beyond its normal progression and whether any diagnosed neurological disorder, to include a traumatic seizure disorder and Bells Palsy, is related to service, requires specialized training for a determination as to diagnosis and causation, and is therefore not susceptible of lay opinions on etiology. Consequently, his statements do not constitute competent medical evidence in support of his claim. Under these circumstances, the Board finds that the claim for service connection for a neurological disorder, to include a traumatic seizure disorder and Bell's Palsy, must be denied. In reaching this conclusion, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for a neurological disorder, to include a traumatic seizure disorder and Bells Palsy, is denied. ____________________________________________ Harvey P. Roberts Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs