Citation Nr: 20052909 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 19-12 100 DATE: August 10, 2020 REMANDED Entitlement to service connection for Meniere's disease, to include as secondary to tinnitus is remanded. REASONS FOR REMAND The Veteran was a Member of the National Guard from October 1982 to October 1988, to include a period of active duty for training (ACDUTRA) from June 1983 to September 1983. Entitlement to service connection for Meniere's disease, to include as secondary to tinnitus is remanded. The Veteran is seeking entitlement to service connection for vertigo, which was subsequently diagnosed as Meniere’s disease, to include as secondary to tinnitus. The Veteran contended that he has experienced vertigo since service. As an alternative, the Veteran contends that his Meniere’s disease/vertigo is secondarily related to his service-connected tinnitus. The Veteran was diagnosed with Meniere’s disease at the September 2018 VA examination. Thus, there is evidence of a current disability. Service connection has been established for tinnitus. A 10 percent disability rating was assigned for tinnitus, effective April 24, 2018. Thus, there is evidence of a service-connected disability. The Veteran is also service connected for bilateral hearing loss. The remaining question is whether there is a medical nexus or relationship between the Veteran’s vertigo and/or currently diagnosed Meniere’s disease and his service-connected tinnitus disability or his time in service. The Board of Veterans’ Appeals (Board) notes that many of the Veteran’s service treatment records (STRs) cannot be located, and so evidence of any asserted in-service treatment is not associated with the claims file. All efforts to obtain the records were exhausted. In that regard, the claims file contains documentation of efforts the Agency of Original Jurisdiction (AOJ) made to attempt to obtain these records. The Veteran was afforded a VA examination in September 2018. The Board finds this examination to be inadequate for the purposes of determining service connection. See generally Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The September 2018 examiner opined that the Veteran’s Meniere’s disease is less likely than not proximately due to or the result of the Veteran’s service-connected tinnitus. The examiner provided the rationale that vertigo and tinnitus are two typical symptoms of Meniere’s disease which may not be secondary to noise exposure, but its presence may make affected patients who are exposed to high noise levels more susceptible to inner ear damage. The examiner further provided that since vertigo and tinnitus are two typical symptoms of Meniere’s disease, vertigo is not caused by tinnitus. The Board finds the September 2018 opinion to be inadequate for rating purposes because the examiner failed to address the aggravation prong of secondary service connection. Additionally, the examiner did not address direct service connection, despite the Veteran’s contentions that he has had vertigo symptoms since his military service. Thus, a VA medical examination/addendum opinion is necessary to make a determination on the Veteran’s claim. Additionally, the Veteran has indicated that he was seen at the Mayo clinic for vertigo and submitted medical treatment records from a February 2019 vestibular and balance evaluation. The private records indicate that the Veteran was also seen in 2015. While the file contains more recent records from the Mayo clinic, records more proximate to service may be probative as to the instant issues. Remand is also necessary to attempt to obtain these medical records. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of all records from the VA Medical Center and its associated clinics where the Veteran receives treatment. If any pertinent private treatment has been rendered, specifically to include those generated from the Mayo clinic in 2015, the Veteran’s assistance in obtaining these records should be requested as needed. All attempts to obtain records should be documented in the claims file. 2. Obtain an addendum opinion from a VA examiner of appropriate expertise to ascertain the current nature and etiology of the Veteran’s complaints of vertigo and his diagnosed Meniere’s disease. (If it is determined that additional examination is needed, it should be scheduled in accordance with applicable procedures.) The claims file should be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should address the following: (a.) Offer an opinion as to whether it is at least as likely as not (probability of at least 50 percent) that the Veteran’s vertigo and/or Meniere’s disease had its onset or is otherwise etiologically related to the Veteran’s period of active service, excessive noise exposure, a period of ACDUTRA, or a service-connected disability, to include tinnitus and bilateral hearing loss. This should include a discussion of whether the Veteran’s vertigo or Meniere’s disease is proximately due to, the result of, or aggravated by the service-connected bilateral hearing loss or tinnitus; Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. (b.) The examiner should provide a detailed rationale for all opinions offered, including a discussion of the evidence of record and medical principles which led to the conclusions reached. If an opinion cannot be provided without resort to speculation, the examiner should explain why it is not possible to provide an opinion. (c.) It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. 3. After the development requested has been completed, the RO should review the expanded record to ensure   complete compliance with the directives of this REMAND. If any report is deficient in any manner, implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Frazier, 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.