Citation Nr: 1552260 Decision Date: 12/14/15 Archive Date: 12/23/15 DOCKET NO. 14-15 535 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUE Entitlement to service connection for memory loss due to Alzheimer's disease, to include as secondary to service-connected epilepsy (claimed as seizure disorder). REPRESENTATION Appellant represented by: James M. McElfresh, Agent WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD Mary E. Rude, Associate Counsel INTRODUCTION This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2015). 38 U.S.C.A. § 7107(a)(2) (West 2014). The Veteran served on active duty from March 1957 to December 1960 and from February 1961 to July 1987. This case comes before the Board of Veterans' Appeals (Board) from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. The Veteran testified before the undersigned at a May 2015 videoconference hearing. A transcript has been associated with the file. In July 2015, the Board found that new and material evidence had been received to reopen the claim of entitlement to service connection for memory loss due to Alzheimer's disease, and remanded the issue for further development. The case has now been returned to the Board. The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the appellant if further action is required. REMAND In July 2015, the Board remanded this issue in order to obtain an opinion from an appropriate specialist examiner on the etiology of the Veteran's Alzheimer's disease. The examiner was asked to address whether it was at least as likely as not that the Veteran's Alzheimer's disease was related to his in-service head injuries and whether it was at least as likely as not caused or aggravated by his service-connected epilepsy. The Veteran was afforded a VA examination in September 2015 with a neurologist examiner. The examiner discussed the Veteran's medical history, including his reports of head injuries in service. He reported that the Veteran had three seizures during his lifetime: in 1987, 2008, and 2015. After physical examination, the examiner found mild cognitive deficits, but the examination was otherwise unremarkable. He diagnosed the Veteran with Alzheimer's disease. The September 2015 examiner opined that the Veteran's Alzheimer's disease was less likely than not incurred in or caused by an in-service injury, event, or illness. While the examiner did note that the Veteran's seizures were not a plausible physiologic mechanism for the development or Alzheimer's disease and provided an opinion regarding aggravation by a service-connected disorder, unfortunately he did not provide the correct standard for evaluating claims for service connection caused by a service-connected disability. See 38 C.F.R. § 3.310 (2015). The examiner erroneously stated a second time that the claimed condition was incurred in or caused by an in-service injury, rather than providing a finding on whether Alzheimer's disease was caused by service-connected epilepsy. The Board also specifically requested that the examiner discuss the medical studies submitted by the Veteran regarding a relationship between traumatic brain injury and Alzheimer's disease. This was not addressed. The Board therefore requests that the examiner, or a similarly situated VA examiner, provide an addendum medical opinion prior to further adjudication of this issue. See Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, the case is REMANDED for the following actions: (This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). Expedited handling is requested.) 1. Obtain an addendum opinion from the examiner who performed the September 2015 examination for mental disorders. If the September 2015 examiner is no longer available, forward the request to an appropriate examiner to address the following questions: (a) Is it at least as likely as not that the Veteran's Alzheimer's disease is either (1) caused or (2) aggravated by his service-connected epilepsy? Please fully explain why or why not, including discussion of the likely etiology of the Veteran's epilepsy/seizures. (b) Address all medical studies cited by the Veteran's agent, to include those on the web site alz.org, those showing a relationship between traumatic brain injury and Alzheimer's, and any other relevant medical literature. If the examiner determines that additional studies or opinions are necessary, then appropriate action should be taken to accomplish the suggested development. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, that his reports must be taken into account in formulating the requested opinions, and that his account of in-service head injuries has been found by the Board to be credible. 2. After the above development has been completed, readjudicate the claim for entitlement to service connection for memory loss due to Alzheimer's disease, to include as secondary to service connected epilepsy. If the benefit sought on appeal remains denied, furnish the Veteran and his agent a supplemental statement of the case and return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West 2014). _________________________________________________ PAUL SORISIO Acting Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2014), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2015).