Citation Nr: 19126278 Decision Date: 04/05/19 Archive Date: 04/05/19 DOCKET NO. 16-45 932 DATE: April 5, 2019 REMANDED Entitlement to service connection for vertigo, also claimed as Meniere’s syndrome and a peripheral vestibular disorder is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from July 1979 to August 1999. This case comes to the Board of Veterans’ Appeals (Board) on appeal from September 2013 and July 2014 rating decisions of a Department of Veterans Affair (VA) Regional Office (RO). In March 2019, a Travel Board hearing was held before the undersigned. Entitlement to service connection for vertigo, also claimed as Meniere’s syndrome and a peripheral vestibular disorder Based on testimony from the Travel Board hearing in March 2019, as well as the two medical opinions of record, it is the judgment of the Board that a medical opinion is needed to reconcile the conflicting conclusions reached by the examining physician (an otolaryngologist-ENT) in the December 2012 VA examination report and by Dr. Bash, (a neuro-radiologist) in the June 2018 private opinion report. Also, any updated evaluation and treatment records for the claimed disability should be obtained. The matter is REMANDED for the following action: 1. Secure for the record updated (to the present) all outstanding VA medical records pertaining to evaluations and treatment the Veteran has received for vertigo, Meniere’s disease, and peripheral vestibular disorder. Also, ask him to submit any private medical records pertaining to his evaluations and treatment for the claimed disability (or submit authorization for VA to obtain them on his behalf). If he submits an authorization, obtain the private records. 2. Then, obtain a medical advisory opinion by a neurologist or ENT addressing the nature and etiology of the Veteran’s claimed vertigo, Meniere’s disease, and peripheral vestibular disorder. If an examination of the Veteran is deemed necessary, it should be arranged. The Veteran’s claims file must be reviewed by the consulting provider. The consulting provider should: (a). Identify (by diagnosis) each ear or peripheral vestibular disability found/shown by the record. The examiner is asked to comment on the varying clinical findings of record, to include the finding of no diagnosis by the ENT on the December 2012 VA examination report and the finding of Meniere’s disease by Dr. Bash in his June 2018 report. (b). Identify the likely etiology for any manifested by vertigo, Meniere’s disease, or peripheral vestibular disability diagnosed at any time during the relevant period (from May 2012). Specifically, is it at least as likely as not (i.e., a 50 percent or greater probability) that any such disability began in (or is otherwise related to) the Veteran’s military service? The examiner is asked to comment on the conclusions by the ENT on December 2012 VA examination (that there were no objective findings for inner ear damage based on the examination and that the claimed vertigo was not caused by or a result of his [service-connected] right ear tinnitus) and by Dr. Bash (that the Veteran has had dizziness since service consistent with Meniere’s disease which was likely caused by acoustic trauma in service) on his June 2018 report. All opinions must include complete rationale, which should include explanation of what is needed to establish a diagnosis of Meniere’s (and/or disabilities manifested by vertigo or a peripheral vestibular disorder). The examiner should review the Veteran’s lay statements (see, for example, his November 2012 statement) to the effect that he has had episodes of dizziness since service, that such episodes began in February 1982 with a mortar round explosion and were followed by vomiting which medics attributed to dehydration, and that such episodes were “periodic and somewhat infrequent” until a “notable event” required him to seek emergency room treatment in February 2006 after which his dizziness events significantly increased. The examiner should opine how the Veteran’s statements comport with generally accepted medical norms. The examiner is advised that the absence of documentation during or after service cannot be the sole basis for rejecting a possible nexus to service, but providing an [alternate] likely etiology, beyond any assertion that there was no documentation of the claimed disability during service and for years after service, may overcome this. Th rationale should, to the extent possible, include citation to supporting factual data and pertinent medical literature. George R. Senyk Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Debbie Breitbeil, Counsel