Citation Nr: 21005247 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 15-02 840 DATE: January 29, 2021 REMANDED Entitlement to service connection for a seizure disorder is remanded. Entitlement to service connection for coronary artery disease is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1984 to November 1987. The Veteran testified before a Veterans Law Judge in June 2018. She was notified in November 2020 that the VLJ is no longer with the Board and was offered the opportunity to request another hearing before the Board. The Veteran did not respond to the letter within 30 days from the date of the letter, thus the Board assumes the Veteran does not want another hearing and is proceeding with adjudication. An August 2018 decision Board decision denied entitlement to service connection for an acquired psychiatric disorder, a seizure disorder, and CAD. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (CAVC). In August 2019 the CAVC granted a joint motion for remand (JMR) to vacate and remand the August 2018 decision. While the case was pending at CAVC an April 2019 rating decision granted service connection for an acquired psychiatric disability, as well as bulimia as secondary to the service-connected post-traumatic stress disorder with bipolar II. The issue of entitlement to service connection for a seizure disorder and CAD was remanded by the Board in February 2020 for a VA examination and to obtain Social Security Administration records. 1. Entitlement to service connection for a seizure disorder is remanded. 2. Entitlement to service connection for coronary artery disease is remanded. The Veteran contends that her seizure disorder and heart condition is related to an in-service military sexual trauma and issues which followed including, PTSD and bulimia. The Veteran testified after the incident she developed an eating disorder which led to potassium imbalances, fainting spells, and blackouts. The Veteran believes her eating disorder has damaged her body, causing and contributing to a cascade of disabilities, including her seizure disorder and CAD. The February 2020 Board remand requested a VA examiner opinion as to whether the Veteran’s service-connected bulimia contributed to the development of CAD. The May 2020 VA examiner opined that the Veteran’s CAD was less likely than not related to her military service as there is no evidence of CAD in-service and PTSD does not cause cardiac issues. The examiner did not provide an opinion as to whether the Veteran’s eating disorder could have contributed to the development of or aggravated her CAD. Moreover, the examiner’s rationale for direct service connection is inadequate as it does not appear to consider the Veteran’s lay evidence that she believes she had CAD in service. Accordingly, remand for a new opinion is warranted. A June 2012 VA examination addressed the etiology of the Veteran’s seizure disorder. At the time of this opinion the Veteran was not service connected for PTSD or bulimia. Another opinion is necessary to address whether the Veteran’s bulimia could have caused or contributed to the Veteran’s seizure disorder. A remand is necessary to determine the nature and etiology the of the Veteran’s seizure disorder and CAD and whether these disabilities were caused by the Veteran’s bulimia and whether the Veteran’s bulimia contributed to her seizure disorder or CAD. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any chronic heart disability. An in-person or telehealth examination is only required if deemed necessary by the examiner. After reviewing the claims file and examining the Veteran, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran’s chronic heart condition, to include CAD: (a.) had its onset in service or is otherwise etiologically related to active service. In providing the requested opinion, consider the Veteran’s description of her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran’s reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? (b.) was proximately due to the Veteran’s service-connected bulimia. (c.) was aggravated beyond its natural progression by the service-connected bulimia. The term “aggravation” includes any incremental increase in disability, regardless of its permanence. In other words, the disability DID NOT have to permanently worsen, due to the service-connected bulimia. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any chronic seizure disability. An in-person or telehealth examination is only required if deemed necessary by the examiner. After reviewing the claims file and examining the Veteran, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran’s seizure disability: (a.) had its onset in service or is otherwise etiologically related to active service. In providing the requested opinion, consider the Veteran’s description of her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran’s reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? i. Consider the June 2012 VA medical opinion which stated that there were in service symptoms of light headedness, dizziness, falls and excessive breathing diagnosed as vasovagal syncope and hypokalemia secondary to bulimia. (b.) was proximately due to the Veteran’s service-connected PTSD or bulimia. (c.) was aggravated beyond its natural progression by the service-connected PTSD or bulimia. The term “aggravation” includes any incremental increase in disability, regardless of its permanence. In other words, the disability DID NOT have to permanently worsen, due to the service-connected PTSD or bulimia. Both the PTSD and bulimia must be addressed as potential causes or aggravating factors of any heart disability. (Continued on the next page)   The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. If upon completion of the above action any benefit sought on appeal remains denied, the case should be returned to the Board after compliance with appellate procedure. A. Rocktashel Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Rekowski 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.