Citation Nr: 18143676 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 12-20 461 DATE: October 19, 2018 REMANDED Service connection for Meniere’s disease, claimed with vertigo and inner ear injury is remanded. Service connection for back disability is remanded. Service connection for bilateral hearing loss is remanded. Service connection for tinnitus is remanded. Service connection for an acquired psychiatric disability, to include depressive disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to February 1969. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in January 2017. A transcript of the hearing is associated with the claims file. The Board adjudicated this appeal in an April 2017 decision. In that decision, the Board reopened the claims of service connection for hearing loss and a back disability and denied the underlying service connection claims as well as the Veteran’s claims for service connection for tinnitus. Meniere’s disease, and depressive disorder. The Veteran appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court). In March 2018 the Court granted a joint motion for partial remand (JMR) of the Veteran and the Secretary of Veterans Affairs (the Parties), vacated the service connection denials in the April 2017 Board decision, and remanded these issues to the Board for action consistent with the terms of the JMR. The JMR did not disturb the favorable portion of the decision, which reopened the Veteran’s claims of service connection for hearing loss and back disability. 1. Service connection for Meniere’s disease, claimed with vertigo and inner ear injury is remanded. At the January 2017 hearing, the Veteran indicated that there may be outstanding and relevant Civil Air Patrol and Army records, to include examinations in 1966 and 1967 respectively. A remand is required to allow VA to request these records. Additionally, the Board cannot make a fully-informed decision on the issue of Meniere’s disease because the record does not contain adequate evidence to establish whether for the Veteran’s in-service dizziness, fainting, and other symptoms were evidence of Meniere’s disease in service. The Veteran asserts that he was misdiagnosed with hypoglycemia during service when those symptoms were actually Meniere’s disease. In a September 2009 letter, Dr. J.V. stated that the “hypoglycemia” in service was likely a misdiagnosis of inner ear trouble. Given the stated diagnosis of hypoglycemia, the examiner must discuss the results of and significance of any in-service glucose testing or glucose testing from the year after his February 1969 discharge. If true, then the question becomes whether this condition clearly and unmistakably (undebatable) preexisted the Veteran’s service and was not aggravated by his active duty service. The Veteran also asserts that these symptoms were incorrectly identified as existing prior to service. In a September 2009 record, by audiologist P.N. stated that severe vertigo, hearing loss, and binaural tinnitus were initiated in military service. His service treatment records show symptoms of dizziness beginning within eight days of his entrance into service five weeks after his entrance into service he fainted. Throughout his in-service treatment for these conditions, he is noted to have reported a two-year history of similar symptoms, including two fainting episodes as a civilian. The examiner is asked to consider this and all the evidence in determining whether clearly and unmistakably preexisted the Veteran’s service and was not aggravated beyond its natural progression by his active duty service. Otherwise, the examiner must opined whether the Veteran’s Meniere’s disease was at least as likely as not related to an in-service injury, event, or disease, including in-service dizziness, fainting, and other symptoms or his November 1968 upper respiratory infection. 2. Service connection for back disability is remanded. 3. Service connection for bilateral hearing loss is remanded. 4. Service connection for tinnitus is remanded. 5. Service connection for an acquired psychiatric disability, to include depressive disorder is remanded. Finally, because a decision on the remanded issue of service connection for Meniere’s disease could significantly impact a decision on the issues of service connection for back disability, bilateral hearing loss, tinnitus, and an acquired psychiatric disability, the issues are inextricably intertwined. A remand of the claims for back disability, bilateral hearing loss, tinnitus, and an acquired psychiatric disability is required. The matters are REMANDED for the following action: 1. Obtain the Veteran’s federal records from the Civil Air Patrol and the Army, to include a Civil Air Patrol physical examination in 1966 and an Army examination in 1967. Document all requests for information as well as all responses in the claims file. 2. Ensure that the Veteran is scheduled for an examination by an appropriate clinician to determine the nature and etiology of Meniere’s disease. The examiner must address the following: (a.) What is the correct diagnosis for the Veteran’s in-service dizziness, fainting, extreme fatigability, syncope, feelings of extreme weakness, aural fullness, numbness in fingers and toes, mental confusion, nervousness, anxiety, and uneasiness? In providing this diagnosis, the examiner must discuss the results of and significance of any in-service glucose testing or glucose testing from the year after his February 1969 discharge. i. Did this condition clearly and unmistakably (undebatable) preexist the Veteran’s service? ii. If so, was clearly and unmistakably not chronically worsened by service? The Board has deliberately phrased this question in the negative as that is the legal determination that the Board must make. The examiner is asked to provide an opinion as to whether, if the diagnosed condition for the Veteran’s in-service symptoms preexisted his entrance into service, then can it be said that the condition was not chronically worsened by his service, a statement that there was no indication of worsening will not suffice, rather the examiner is asked to opine as to whether it can be said, with a high degree of confidence, that it did not chronically worsen during service, and if so, why? (b.) Is the Veteran’s current Meniere’s disease etiologically related to his in-service symptoms, including dizziness and fainting or his November 1968 upper respiratory condition? (c.) Additionally, the examiner must address the September 1, 2009, statement by Dr. J.V. and the September 23, 2009, statement by audiologist P.N. (Continued on the next page)   3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of back disability, bilateral hearing loss, tinnitus, and an acquired psychiatric disability. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Houbeck, Counsel