Citation Nr: 20004536 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 19-20 837 DATE: January 21, 2020 REMANDED Entitlement to service connection for facial nerve damage, to include as secondary to his service-connected dementia/brain disease due to closed head injury incurred in a motor vehicle accident, is remanded. Entitlement to service connection for bilateral tremors of the upper extremities, to include as secondary to his service-connected dementia/brain disease due to closed head injury incurred in a motor vehicle accident, is remanded. Entitlement to service connection for right hip condition, to include as secondary to his service-connected dementia/brain disease due to closed head injury incurred in a motor vehicle accident or the service-connected right lower extremity, causing gait problems, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1996 to November 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran’s appeal brief addresses the issue of entitlement to an increased rating for diplopia. Although the June 2019 Statement of the Case refers to the claim, a June 2017 rating decision denied entitlement to service connection for diplopia and no subsequent rating code sheets identify diplopia other than as a denied claim for service connection. At any rate, the Veteran did not perfect an appeal for this issue and the Board therefore does not have jurisdiction to review it. A remand is necessary to provide the Veteran with new VA examinations to determine the nature and etiology of facial nerve damage, bilateral tremors of the upper extremities, and/or a right hip condition that may be currently diagnosed on remand. Additionally, the Veteran should be afforded the opportunity to obtain a clarification to the July 2019 private medical opinion. In 2017 and 2018, VA examiners concluded that the Veteran does not have a current diagnosis of facial nerve damage, bilateral tremors of the upper extremities, or a right hip condition. However, in a March 2018 letter, private neurologist M.E., MD indicated the Veteran had tremors and a right hip injury related to a head injury from an April 1998 motor vehicle accident, and in a July 2019 letter, C.P., a physician’s assistant to M.E., opined that “it is within reasonable medical certainty” that the Veteran’s facial nerve damage, tremors, and right hip dysfunction are related to the 1998 head injury during service. See Letter from M.E., MD dated March 6, 2018; Letter from C.P., PA-C dated July 1, 2019. It is not clear from either letter whether facial nerve damage, bilateral tremors of the upper extremities, and/or right hip condition are currently diagnosed disorders, and no treatment records reflecting diagnoses of these disorders during the period on appeal have been associated with the claims file. Additional medical evidence is therefore needed to decide the claims. As the Veteran’s September 2013 claim suggests that his right hip condition may be caused by his service-connected right lower extremity gait dysfunction, this question must be addressed by a VA examiner on remand. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Contact the Veteran and invite him to submit any additional evidence from his neurologist that further explains whether (a) he is currently diagnosed (from the date of claim) with bilateral upper extremity tremors, facial nerve damage, and/or right hip condition or residuals thereof, and (b) whether it is at least as likely as not that the diagnosed disorders are secondary to his April 1998 in-service head injury in a motor vehicle accident. 3. Then, regardless of whether additional evidence is received, request addendum opinions from the VA examiners who provided the February 2017 medical opinion regarding facial nerves, and the June 2017 VA medical opinion regarding tremors to determine the nature and etiology of any currently diagnosed facial nerve damage and tremors of the upper extremities or residuals thereof. The claims file and a copy of this Remand will be made available to the examiners, who will acknowledge receipt and review of these materials. *The need for another examination(s) is left to the discretion of the medical professional offering the addendum opinion. Should an examination(s) be necessary, all indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a complete review of the claims file and examination of the Veteran, the examiner is asked to address the following: (a) Identify all facial nerve damage and tremors of the upper extremities, or residuals thereof, diagnosed since the commencement of the claim period on September 3, 2013. (b) Provide an opinion, with adequate rationale, as to whether any currently diagnosed facial nerve damage and/or tremors of the upper extremities or residuals thereof, are at least as likely as not (50 percent or higher degree of probability) CAUSED or AGGRAVATED by the service-connected dementia/brain disease due to closed head injury incurred in a motor vehicle accident. *Any increase/aggravation is sufficient, permanent aggravation is NOT required. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019) (permanent worsening is not a requirement for secondary service connection of a non-service-connected injury or disease). (c) If the answer to directive (b) above is in the negative, for each diagnosed facial nerve damage and/or tremors of the upper extremities or residuals thereof, provide an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that the disability had its onset during active service, to include injuries received in the motor vehicle accident during service in April 1998. 4. Regardless of whether additional evidence is received, request an addendum opinion from the VA examiner who provided the March 2018 VA medical opinion regarding right hip conditions to determine the nature and etiology of any currently diagnosed right hip injury(s) or residuals thereof. The claims file and a copy of this Remand will be made available to the examiners, who will acknowledge receipt and review of these materials. *The need for another examination(s) is left to the discretion of the medical professional offering the addendum opinion. Should an examination(s) be necessary, all indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a complete review of the claims file and examination of the Veteran, the examiner is asked to address the following: (a) Identify all right hip injuries or residuals thereof, diagnosed since the commencement of the claim period on September 3, 2013. (b) Provide an opinion, with adequate rationale, as to whether any currently diagnosed right hip injury or residuals thereof are at least as likely as not (50 percent or higher degree of probability) CAUSED or AGGRAVATED by, the service-connected right lower extremity disability causing gait problems or the service-connected right lower extremity, casing gait problems. *Any increase/aggravation is sufficient, permanent aggravation is NOT required. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019) (permanent worsening is not a requirement for secondary service connection of a non-service-connected injury or disease). (c) If the answer to directive (b) above is in the negative, for each diagnosed right hip injury or residuals thereof, provide an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that the disability had its onset during active service, to include injuries received in the motor vehicle accident during service in April 1998. 5. Thereafter, readjudicate the remanded claims. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brad Farrell, Associate Attorney 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.