Citation Nr: 21061519 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 19-04 623 DATE: October 4, 2021 ORDER Service connection for seizures, to include as secondary to service-connected right/left internal carotid artery blockage due to herbicide exposure, is granted FINDING OF FACT The competent and probative evidence is at least in equipoise that the Veteran's current seizures is proximately due to the Veteran's service-connected right/left internal carotid artery blockage. CONCLUSION OF LAW The criteria for secondary service connection for seizures are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1964 to July 1967, to include service in Vietnam. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified, sitting in San Antonio, Texas, before the undersigned via a videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed. This case was most recently before the Board in June 2021, at which time the Board remanded the matter for further development, to include updated records and medical opinions. As the requested development has been substantially completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Regulations provide that service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disorder may be service connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439, 449 (1995); 38 C.F.R. § 3.310(b). In order to establish entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). In relevant part, 38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). Service connection for seizures. The Veteran contends that his seizures condition is due to service. Alternatively, the Veteran contends that his seizures condition is proximately due to or aggravated by his service-connected Parkinson's disease as a result of exposure to herbicide agents. During an August 2019 Board hearing, the Veteran testified that he had been prescribed medication for his seizures and tremors. The Veteran further indicated that his symptoms had progressively worsened. 08/27/2019, Hearing Transcript. A February 2021 VA examination noted a diagnosis of tonic-chronic seizures or grand mal (generalized convulsive seizures). The examiner opined that the Veteran's seizures condition is less likely than not related to his service-connected Parkinson's disease. 03/01/2021, C&P Exam; 03/01/2021, C&P Exam (medical opinion). A June 2021 Board decision found the February 2021 VA examiner's opinion to have little probative value as the opinion is entirely conclusory without any accompanying support or rationale. Specifically, the examiner did not provide an opinion as to whether the Veteran's seizures were aggravated by a service-connected disability, to include Parkinson's disease. The examiner did not provide an opinion as to whether the Veteran's seizures were at least as likely as not related to his period of active service, to include his presumed herbicide exposure. Additionally, the examiner did not provide any opinion as to etiology of the Veteran's seizures. The Board remanded the claim and directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding VA treatment records and also obtain an addendum opinion to determine the nature and etiology of his seizures. The clinician was directed to provide an opinion whether any current seizure diagnosis, to include as noted on the February 2021 seizure disorder disability benefits questionnaire, is at least as likely as not related to an in-service injury, event, or disease, to include due to presumed herbicide agent exposure. The clinician was further directed to provide an opinion as to whether any current diagnosis related to seizures is at least as likely as not proximately due to or aggravated beyond its natural progression by a service-connected disability, to include Parkinson's disease. 06/03/2021, BVA Decision. In August 2021 VA medical opinions, the clinician opined that the Veteran's seizures are less likely than not related to his period of active service, to include exposure to herbicide agents. The clinician further opined that the Veteran's seizure condition is less likely than not proximately due to or aggravated by the Veteran's Parkinson's disease. Specifically, the clinician noted that the Veteran's seizures arose as a result of an endarterectomy in 2012. The Veteran started having seizures after the surgery in August 2012, with the last seizure noted in February 2013. The clinician indicated that the seizures are not related to herbicide agent exposure, as herbicide agents do not cause seizures that are caused by surgery or residual of surgery. The clinician also noted that the Veteran's current seizure condition and his Parkinson's disease are separate conditions anatomically and pathophysiologically. The clinician further found no evidence of aggravation beyond the natural course, as the Veteran's last seizure was in 2013, and the fact of the Veteran having been seizure-free for eight years is favorable for no further recurrences. The clinician also remarked that seizures may return or require a higher dose of medication to control, but this does not constitute an aggravation as this is common in seizure disorders. However, the clinician provided an opinion as to the etiology of the Veteran's seizures, indicating that the seizures likely occurred as a result of restricted blood flue to the small focus of the brain, impacted by the Veteran's carotid vessel disease and endarterectomy. 08/17/2021, C&P Exam; 08/17/2021, C&P Exam. Notably, a February 2021 VA examination regarding the Veteran's service-connected right/left internal carotid artery blockage noted that the Veteran was diagnosed with the aforementioned condition in 2012 and the Veteran suffered seizures after surgery. 03/01/2021, C&P Exam. The Board finds that the evidence is at least in equipoise regarding whether the current seizure condition is proximately related to his service-connected right/left internal carotid artery blockage. 38 C.F.R. § 3.310(a). Although the August 2021 VA examiner opined that the Veteran's seizures are not related to service or his service-connected Parkinson's disease, the examiner's opinion regarding the etiology of the seizure condition supports a finding that the Veteran's service-connected internal carotid artery blockage and associated surgical treatment via endarterectomy is the likely cause of the Veteran's seizures. The August 2021 VA examiner's rationale is further supported by the February 2021 VA examination, which noted that the Veteran suffered seizures following surgical treatment of his internal carotid artery blockage in 2012. Additionally, there is no competent evidence against the theory of secondary service connection with regard to the Veteran's service-connected right/left internal carotid artery blockage. (Continued on the next page) As such, the Board finds that the Veteran's current seizure condition is proximately due to his service-connected right/left internal carotid artery blockage. 38 C.F.R. § 3.102, 3.310(a). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Han 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.