Citation Nr: 20028817 Decision Date: 04/24/20 Archive Date: 04/24/20 DOCKET NO. 12-03 931 DATE: April 24, 2020 ORDER Entitlement to service connection for benign paroxysmal positional vertigo (BPPV), secondary to service-connected headaches on a causation basis, is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s service-connected headaches cause his BPPV. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for BPPV, secondary to headaches on a causation basis, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1944 to November 1944. The Board of Veterans’ Appeals (Board) notes that this matter has been remanded multiple times, to include remands dated November 2014, October 2017, and October 2019, with multiple medical opinions obtained on the question of whether the Veteran’s BPPV is caused by his service-connected headaches. Entitlement to service connection for BPPV In response to the October 2019 Board remand directive, a VA opinion was obtained in December 2019 to address whether the Veteran’s BPPV was caused or aggravated by his service-connected headaches. The VA physician found it was less likely than not that the Veteran’s BPPV was due to a specific condition, exposure, or underlying etiology, and the Veteran’s record was silent for any likely predisposing conditions. The VA physician additionally noted that, according to the medical literature, BPPV is well-established to occur idiopathically. However, a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate. Bailey v. O’Rourke, 30 Vet. App. 54, 60 (2018). Thus, as the December 2019 VA physician did not address whether the Veteran’s BPPV is caused or aggravated by the Veteran’s service-connected headaches, the opinion is inadequate. At this point, the Board could remand the case for yet another medical opinion. However, as contended by the Veteran’s representative in the April 2020 written brief presentation, a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) (“The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination”). A January 2018 VA opinion is ambiguous as to the etiology of the Veteran’s BPPV and the other medical opinions generally indicate a lack of nexus, but they have all been found inadequate. The Veteran’s representative cited medical literature indicating an association between headaches and vertigo and related disorders. Medical article and treatise evidence may suffice to establish nexus in instances where “standing alone, [it] discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion.” Sacks v. West, 11 Vet. App. 314, 317 (1998). Moreover, medical article and treatise evidence “can provide important support when combined with an opinion of a medical professional.” Id. Given the above facts and circumstances of this case, the evidence is at least evenly balanced as to whether the Veteran’s BPPV is caused by his service-connected headaches. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for BPPV, secondary to service-connected headaches on a causation basis, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Styer, 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.