Citation Nr: 21005034 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-29 545 DATE: January 28, 2021 REMANDED Entitlement to service connection for dizziness is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1992 through January 1994. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in April 2018 and again in July 2020 when it was remanded for additional development. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issues of dizziness and a gastrointestinal disorder and, therefore, remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for dizziness is remanded. As noted in the July 2020 Board remand, the Veteran was previously afforded a January 2020 VA examination, which included contradictory findings on the one hand finding no current evidence of “dizziness,” and, on the other hand, noting a “current” diagnosis of “vertigo” with a history of peripheral vestibular disorder since 1994. There was no explanation for the onset date listed as 1994, nor was there an explanation for the apparent ambiguity of whether the Veteran had a disability or not. Thus, the matter was remanded for an addendum opinion to clarify these contradictory findings. Regrettably, the resulting opinion, obtained in August 2020, does not adequately resolve the ambiguity. Rather than clarifying whether the Veteran has a current disability (such as peripheral vestibular disorder or vertigo) and, if so, the onset of the diagnosis and likely etiology, the examiner explained in general what happens to a person from jet fuel exposure. The opinion did not specifically consider the Veteran’s facts, evidence, or circumstances, did not address service connection in the Veteran’s case, did not address the “onset” date of 1994 assigned to the peripheral vestibular disorder, and did not address the apparent contradiction of stating on the one hand current diagnoses, but on the other hand, finding no current diagnoses. Once again, the opinions of record are insufficient to adequately adjudicate the claim on appeal and another remand is necessary to obtain an adequate VA medical opinion (and examination if deemed necessary). 2. Entitlement to service connection for a gastrointestinal disorder is remanded. Similarly, the Board previously remanded the Veteran’s gastrointestinal claim in July 2020 seeking clarification with regard to a similarly ambiguous January 2020 VA examination. In particular, the January 2020 VA examination, on the one hand, noted diagnoses of dyspepsia and irritable bowel syndrome with “onset” in 1994, but on the other hand found no gastrointestinal condition related to service. The examination appeared contradictory in terms of whether the Veteran has a current disability and, if so, when the condition started and whether the condition is related to service. Thus, the Board previously remanded to obtain a clarification opinion from the examiner. Unfortunately, the resulting August 2020 opinion was non-responsive to the Board’s opinion and, instead, merely explained in general terms what happens to a person from jet fuel exposure. The opinion was devoid of specific facts of the Veteran’s service or an articulated opinion of whether the Veteran has a current gastrointestinal condition and, if so, whether the condition was related to active duty, had its onset during service, or alternatively related to exposure to jet fuel. No such opinion was offered. Thus, and regrettably, another remand is necessary to once again obtain an addendum medical opinion. The matters are REMANDED for the following action: 1. Obtain any additional treatment records from the VA or private medical centers, to include records from July 2020 to the present. 2. After obtaining any outstanding records to the extent possible, ask a new VA examiner of appropriate expertise to provide an addendum opinion for clarification of whether the Veteran has any diagnosis associated with her symptoms of dizziness, such as peripheral vestibular disorder and/or vertigo as well as the likely nexus for any diagnosis found. The necessity of an in-person examination is left to the discretion of the examiner. The evidentiary record, including a copy of this remand, must be made available to and must be reviewed by the examiner. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. (a.) The examiner should confirm any and all diagnoses found associated with the Veteran’s claim of “dizziness,” to include peripheral vestibular disorder and/or vertigo, identify when any such diagnosis began (to the extent possible). The examiner should provide a detailed rationale for any “onset date” opinion provided. (b.) For each diagnosis found, the examiner should state whether it is at least as likely as not (50 percent or greater possibility) the disorder existed during, or within one year of leaving, active duty. The examiner should explicitly consider any and all lay statements provided by the Veteran about the state of her health during service. (c.) For each diagnosis found, the examiner should state whether it is at least as likely as not (50 percent or greater possibility) that this disorder was caused by any event of service, to include as a result of exposure to jet fuel during service. A complete rationale for all opinions is requested, to include a discussion of the facts and medical principles involved. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After obtaining any outstanding records to the extent possible, ask a new VA examiner of appropriate expertise to provide an addendum opinion for clarification of whether the Veteran has any diagnosis associated with her gastrointestinal symptoms, such as dyspepsia and/or irritable bowel syndrome as well as the likely nexus for any diagnosis found. The necessity of an in-person examination is left to the discretion of the examiner. The evidentiary record, including a copy of this remand, must be made available to and must be reviewed by the examiner. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. (a.) The examiner should confirm any and all diagnoses found associated with the Veteran’s gastrointestinal claim, to include dyspepsia and irritable bowel syndrome, identify when any found diagnosis began (to the extent possible). The examiner should provide a detailed rationale for any “onset date” opinion provided. (b.) The examiner should state whether it is at least as likely as not (50 percent or greater possibility) that this disorder existed during, or within one year of leaving, active duty. The examiner should explicitly consider any and all lay statements provided by the Veteran about the state of her health during service. (c.) For each diagnosis found, the examiner should state whether it is at least as likely as not (50 percent or greater possibility) that this disorder was caused by any event of service, to include as a result of exposure to jet fuel during service. A complete rationale for all opinions is requested, to include a discussion of the facts and medical principles involved. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Boivin, 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.