Citation Nr: 20009682 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 17-50 693 DATE: February 6, 2020 REMANDED Entitlement to service connection for ataxia is remanded. Entitlement to special monthly compensation (SMC) based on aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1948 to June 1959. 1. Entitlement to service connection for ataxia is remanded. This issue was remanded by the Board most recently in June 2019 for further development. Specifically, the Board requested that an addendum opinion be obtained clarifying whether it is at least as likely as not that the Veteran has any balance, dizziness, or gait issues that are related in any way to his service-connected coronary artery disease, hypertension, ischemic cerebrovascular disease, or the medications used to treat these disabilities, such as Metoprolol Tartrate. The examiner was asked to discuss the evidence that is favorable to the claim, such as the May 2014, December 2014, and April 2015 medical records, which discuss his dizziness spells within treatment records for his ischemic cerebrovascular disease and coronary artery disease. The examiner was also asked to discuss the fact that the evidence shows that the Veteran has experienced dizziness associated with hypertension since an October 1985 VA examination, several years prior to being diagnosed with diabetes mellitus. In a July 2019 VA opinion, a VA examiner determined that it is less likely than not that the Veteran has any balance, dizziness, or gait issues that are related in any way to his service-connected coronary artery disease, hypertension, ischemic cerebrovascular disease, or the medications used to treat these disabilities, such as Metoprolol Tartrate. However, the examiner failed to discuss the evidence showing that the Veteran has experienced dizziness associated with hypertension since an October 1985 VA examination, several years prior to being diagnosed with diabetes mellitus. The examiner also did not discuss in any detail the evidence that is favorable to the claim, such as the May 2014, December 2014, and April 2015 medical records, which discuss his dizziness spells within treatment records for his ischemic cerebrovascular disease and coronary artery disease. As such, the Board finds that a remand is necessary for an adequate VA medical opinion. Further, the Board notes that the VA examiner indicated that the mechanism by which coronary artery disease, cerebrovascular disease, hypertension, and Metoprolol would produce the Veteran’s complaints of dizziness and poor balance would be one of inadequate cerebral perfusion in conditions such as orthostatic hypotension, which has been ruled out based on testing in the past. Subsequently, the Veteran submitted a statement in September 2019 noting that he had been diagnosed with orthostatic hypotension/venous insufficiency in a June 2019 VA treatment record. As such, this should be addressed in the new VA medical opinion as well. Additionally, upon remand, all outstanding VA treatment records should be associated with the claims file. 2. Entitlement to SMC based on aid and attendance is remanded. Because a decision on the issue of service connection for ataxia could significantly impact a decision on the issue of entitlement to aid and attendance, the issues are inextricably intertwined. A remand is therefore required. The matters are REMANDED for the following action: 1. Associate all outstanding treatment records from Central Texas Veterans Health Care System (and associated outpatient clinics) from July 15, 2019, to the present. 2. Forward the claims file to an appropriate VA examiner for an addendum medical opinion. After review of the claims file, the examiner should provide opinion as to whether it is at least as likely as not that the Veteran has any balance, dizziness, or gait issues that are related in any way to his service-connected coronary artery disease, hypertension, ischemic cerebrovascular disease, or the medications used to treat these disabilities, such as Metoprolol Tartrate. The examiner should specifically discuss the following: (a) Evidence that is favorable to the claim, such as the May 2014, December 2014, and April 2015 medical records, which discuss his dizziness spells within treatment records for his ischemic cerebrovascular disease and coronary artery disease; (b) Evidence showing that the Veteran has experienced dizziness associated with hypertension since an October 1985 VA examination, several years prior to being diagnosed with diabetes mellitus; and (c) Evidence showing that the Veteran has orthostatic hypertension, to include whether it is at least as likely as not that orthostatic hypertension would be related to any of the Veteran’s service-connected disabilities or medications he takes for his service-connected disabilities. A thorough rationale should be provided. If additional examination is needed in order to provide an adequate opinion, such should be scheduled. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Durham, 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.