Citation Nr: 18159983 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 15-26 559 DATE: December 20, 2018 REMANDED Service connection for dizziness is remanded. Service connection for fainting is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1994 to June 2008. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In December 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. Service connection for dizziness and fainting are remanded. The Board finds that additional development is necessary prior to adjudicating the Veteran’s claim. The Veteran specifically alleged service connection for fainting and dizziness. The Veteran stated that these conditions began in service, and additionally alleged that they could be secondary to his service-connected left ventricular hypertrophy, hypertension, and/or depressive disorder. The Veteran was afforded a VA examination in May 2015, in which no diagnosis or etiology was stated. The Veteran was afforded another VA examination in June 2015, in which the examiner opined that the Veteran’s syncope and dizziness are less likely than not proximately due to or the result of the Veteran’s left ventricular hypertrophy. The examiner additionally found that there is no significant cardiac diagnosis to explain the Veteran’s chronic symptoms of dizziness, chest pain, and syncope. The VA examiners did not adequately address the etiology of the Veteran’s fainting and dizziness. The June examiner opined that the Veteran’s syncope and dizziness are less likely than not proximately due to or the result of the Veteran’s left ventricular hypertrophy, but did not address whether the Veteran’s service-connected hypertension and/or depressive disorder may have caused or aggravated the Veteran’s fainting and dizziness. In addition, the examiners did not address whether the Veteran’s fainting and dizziness are symptoms of his service-connected left ventricular hypertrophy, hypertension, and/or depressive disorder, or whether they are separate and distinct disabilities. As these two VA opinions are inadequate, the Board finds that new examinations by and opinions by a neurological specialist are needed to address the issues of service connection for fainting and dizziness. Finally, the Board notes that the 2015 VA examination was conducted by a specialist, a neurologist, the new examination should also be conducted by a specialist as the record already shows that an examination by a specialist is needed. The matters are REMANDED for the following action: 1. Obtain and associate with the claim file all outstanding VA and private treatment records since the most recent records associated in the file since 2015. The Veteran should be requested to provide releases of information forms as needed to help in obtaining any relevant treatment records. 2. The AOJ should arrange for a neurological VA examination by a neurologist of the Veteran to determine the nature and likely cause of the Veteran’s dizziness and fainting. The claim file (including this remand) should be made available to and reviewed by the examiner and the examination report should state a review of the file was completed. All necessary tests should be performed and all findings should be reported in detail. After a review of the file and examination of the Veteran, the examiner should provide an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent) that the Veteran’s fainting and dizziness are separate and distinct disabilities caused by or related to his military service, rather than symptoms of his service-connected left ventricular hypertrophy, hypertension, and/or depressive disorder. The examiner should consider the Veteran’s statements that he was treated for fainting and dizziness during active duty. The examiner should provide an additional opinion as to whether it is more likely than not (i.e., probability greater than 50 percent) that the Veteran’s fainting and/or dizziness is caused by or aggravated (permanently worsened) beyond normal progression by the Veteran’s service-connected left ventricular hypertrophy, hypertension, and/or depressive disorder. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. A complete rationale for all opinions expressed should be provided in the examination reports. 2. If upon completion of the above action the claim remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Kerner, Associate Counsel