Citation Nr: 21061390 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 15-14 116 DATE: October 1, 2021 REMANDED Entitlement to service connection for vertigo is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1983 to June 1986. This matter came before the Board of Veterans' Appeals (Board) on appeal from an August 2014 decision by the Department of Veterans Affairs (VA). The Veteran's claim for service connection for vertigo was previously remanded by the Board in July 2020 and March 2021 after a determination that the pervious VA examinations of record were inadequate. The Veteran underwent another VA examination in June 2021. However, that VA opinion is also inadequate and another remand is necessary. A June 2021 rating decision granted the Veteran's claims for service connection for a left knee disability degenerative arthritis, a right knee disability degenerative arthritis, and GERD and assigned an initial rating for each disability. As this decision represents a full grant of the benefits sought with respect to these claims for service connection, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). The June 2021 VA examiner opined that the Veteran's service treatment records are silent for episodes of vertigo, that there was a vertigo on a prior examination in 2019 but did have a negative Dix-Hallpike test at that time. The examiner further found that the Veteran did not have true vertigo as claimed, that it is indirectly caused by the service claimed disorder and that he has symptoms related to medication he is taking for his service connected anxiety disorder with panic attacks. The examiner found there was no evidence of vertigo on exam. However, the Board notes that the July 2020 VA examination shows a diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) diagnosed in November 2014. Hence, the June 201 opinion appears to be based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 460, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). Therefore, a diagnosis of vertigo is conceded during the Veteran's appellate period. The Board finds that this examiner failed to provide an etiology opinion for the Veteran's diagnosed vertigo. As such, the Board must find that such opinion to be inadequate and the claim must be remanded for further development. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, submit the file to a VA examiner who has not previously examined the Veteran or provided an opinion regarding his claimed vertigo. The claims file must thoroughly be reviewed by the examiner. If the examiner determines another VA examination is necessary, one should be provided. The examiner must respond to the following questions: (A) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed vertigo began in service or is otherwise related to service? (B) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed vertigo is caused or aggravated beyond its natural progression by his service-connected disabilities, to include tinnitus and his acquired psychiatric conditions, and to include as due to medications take for such? The opinion must address causation and aggravation, which are two separate inquiries. The examiner is directed to discuss correspondence submitted by the Veteran in September 2014, "PTSD and Physical Health" in the opinion. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.