Citation Nr: 19192829 Decision Date: 12/10/19 Archive Date: 12/10/19 DOCKET NO. 14-99 792A DATE: December 10, 2019 REMANDED Entitlement to service connection for traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from December 1967 to December 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2014 rating decision by the Department of Veterans Affairs (VA) Regional Offices (RO) in Los Angeles, California. This matter was previously before the Board in June 2018, when it was remanded for a new VA examination given that the Veteran failed to attend his previously scheduled VA examination and the Board was unable to confirm whether the Veteran was scheduled for and provided notice of that VA examination. The record further reflects that the Veteran had previously cancelled a scheduled September 2013 examination for a Compensation and Pension (C & P) examination through a VA contractor at the Lancaster, CA, VA facility. The Veteran asserted that he could not get to the appointment on time due to lack of adequate transportation and requested that any subsequent appointments be scheduled at a closer location. Pursuant to the Board's June 2018 remand, the RO scheduled a VA examination (at a closer location) to determine the nature and etiology of the Veteran's claimed TBI. However, this examination was cancelled because the RO was unable to contact the Veteran and notices to him at his last address of record were returned. Subsequently, an April 2019 correspondence with a representative at the Veteran’s dialysis unit indicates that the Veteran had been hospitalized for pneumonia and had also been at a rehabilitation center. In July 2019, the Veteran contacted the RO, submitting a letter in which he explained that he has had some challenges due to complications from his ongoing ill health, and that at some point he had been homeless. Rather than adjudicating this claim based on the current evidence of record, given these facts, the Board finds that another opportunity should be afforded the Veteran to appear for the requested VA examination. Accordingly, this matter is REMANDED for the following action: 1. Contact the Veteran and ask him to verify his current mailing address to send all future correspondences. The correct address should be noted in the claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current nature and etiology of any residuals of TBI. Ask the Veteran to identify the closest facility accessible to where he currently resides. The examination must be scheduled at an agreed upon facility accessible to the Veteran, if available. 3. The claims file must be made available to the examiner for review in conjunction with clinical examination of the Veteran. The examiner is requested to opine whether TBI, if diagnosed, is at least as likely as not (50 percent probability or higher) related to an in-service injury, event, or disease, including the documented September 1968 motorcycle accident. The examiner is advised that 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 conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. A clear and complete rationale must be provided for all findings and conclusions reached. If the examiner determines that an opinion cannot be provided without resort to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted regarding the etiology of any diagnosed disorder or whether additional testing or information could be obtained that would lead to a conclusive opinion. The examiner should consider all evidence of record, including lay statements and medical treatment records, particularly VA treatment records indicating positive medical history for a mild TBI/concussion resulting from the September 1968 motorcycle accident, and a December 2009 outpatient treatment record which reflects an inconclusive diagnosis of TBI. 4. The Veteran is reminded that he must cooperate fully cooperate to facilitate and attend his subsequently scheduled examination for his TBI claim. When a claimant fails to report, without good cause, for a VA examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 U.S.C. § 501 (2012); 38 C.F.R. § 3.655. After the above development has been completed, the Agency of Jurisdiction (AOJ) should readjudicate the issue on appeal. If the benefit sought is not granted, the AOJ should send the Veteran and his representative a Supplemental Statement of the Case, provide an opportunity to respond, and then, if necessary, return the case to the Board for further appellate review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.