Citation Nr: 18153549
Decision Date: 11/28/18	Archive Date: 11/27/18

DOCKET NO. 16-39 562
DATE:	November 28, 2018
REMANDED
Entitlement to service connection for vasovagal syncope is remanded.
REASONS FOR REMAND
Introduction
The Veteran served on active duty in the United States Army from November 1986 to March 1987, and from May 1993 to May 2014.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi.
Entitlement to service connection for vasovagal syncope
The Veteran has experienced two episodes of feeling lightheaded and fainting while in service.  He reports that these episodes have continued to the present day.
The Veteran’s service treatment records include an incident in September 2006 and in December 2010 where he went to the hospital because of fainting and hitting his head.  In December 2010, the Veteran was diagnosed with vasovagal syncope.  The Veteran was afforded a VA medical examination in April 2015 at which the examiner failed to indicate whether the Veteran currently has vasovagal syncope and failed to offer an opinion as to the etiology of his vasovagal syncope. 
The Boards finds that the evidence currently of record provides an inadequate basis to determine whether the Veteran currently has vasovagal syncope and the etiology of his vasovagal syncope.  Therefore, a new medical examination is necessary.
The matter is REMANDED for the following action:
1.  Schedule the Veteran for a VA examination to determine the nature and etiology of any current disability manifested by lightheadedness and dizziness, to include vasovagal syncope.  The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay statements. 
The Veteran is competent to attest to factual matters of which he has first-hand knowledge.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. 
Based on the review of the claims file, and examination of the Veteran, the examiner should identify any current disability manifested by lightheadedness and dizziness, to include vasovagal syncope, present during the appeal period.  (Please specify the diagnosis (or diagnoses)). 
The examiner should then render an opinion for each diagnosis, consistent with sound medical principles, that answers the following question: 
Is it at least as likely as not (50 percent probability or greater) that the Veteran’s disability manifested by lightheadedness and dizziness, to include vasovagal syncope, is causally or etiologically related to the Veteran’s military service.
 (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.)
A clear rationale for all opinions should be expressed, and a discussion of the facts and medical principles involved should be noted.
2.  After completing the above development, and after conducting any additional development deemed necessary, the RO should readjudicate the claim.  If it remains denied, the Veteran and his representative should be provided with a supplemental statement of the case and an opportunity to respond before the case is returned to the Board.
 
T. REYNOLDS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Dion Roberts, Law Clerk