Citation Nr: 21064890
Decision Date: 10/21/21	Archive Date: 10/21/21

DOCKET NO. 14-35 880
DATE: October 21, 2021

REMANDED

Entitlement to service connection for a seizure and/or headache disorder secondary to an in-service head injury is remanded.

REASONS FOR REMAND

The Veteran served on active duty from August 1967 to August 1969.  The Veteran was awarded with a Bronze Star Medal and Combat Infantryman's Badge.

The Board of Veterans' Appeals (Board) most recently remanded the issue above in August 2020 to the VA Agency of Original Jurisdiction (AOJ).  The case has since been returned to the Board for appellate review.

In September 2020, the Veteran appointed Disabled American Veterans (as reflected in a Department of Veterans Affairs (VA) Form 21-22a, Appointment of Veterans Service Organization as Claimant's Representative). The Board of Veterans' Appeals (Board) has recognized the change in representation.

Entitlement to service connection for a seizure and/or headache disorder secondary to an in-service head injury is remanded 

Unfortunately, a remand is required again in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure the Veteran is given every possible consideration.

The Board finds that the July 2021 VA medical opinion is inadequate as the examiner did not opine whether the Veteran's arteriovenous malformation was a congenital or developmental defect or disease, whether there was a superimposed injury or disease in active duty that resulted in additional disability, whether there was clear and unmistakable evidence that it did preexist the Veteran's active service, or whether it was aggravated by active service.  The August 2020 Board remand requested these opinions; however, the VA examiner did not provide the specific responses.  Therefore, an additional medical opinion should be obtained.

The matters are REMANDED for the following action:

1. Obtain a VA supplemental medical opinion by an appropriate examiner to provide the following opinions:

(a.) Whether the Veteran's arteriovenous malformation is a congenital or developmental defect or disease. Note: a disease generally refers to a condition that is considered capable of improving or deteriorating while a defect is generally not considered capable of improving or deteriorating. VAOPGCPREC 82-90 (1990).

(b.) If arteriovenous malformation is a congenital or developmental defect, explain whether it is at least as likely as not (a probability of 50 percent or greater) that there was a superimposed injury or disease in active duty that resulted in additional disability.

(c.) If arteriovenous malformation is a congenital disease and there is not clear and unmistakable evidence that it did pre-exist the Veteran's active service, is it at least as likely as not (a probability of 50 percent or greater) that the arteriovenous malformation is related to his service or aggravated by service. 

(d.) Is it as least as likely as not (a probability of 50 percent or greater) that the Veteran's current headache and/or seizure disorder is the result of arteriovenous malformation. 

(e.) If the Veteran has a headache or seizure disorder unrelated to arteriovenous malformation, is it at least as likely as not (a probability of 50 percent or greater) that such disorder is related to service.

In rendering these opinions, the examiner is asked to consider the Veteran's report of an in-service head injury.  While service treatment records do not document such an injury, under the provisions of 38U.S.C. §1154 (b) the Board accepts that the Veteran hit his head during service while falling from a helicopter.

In addition, the examiner is asked to consider the June 1993 VA examination of record in which the examiner suggests a possible aggravation of arterial venous malformation by the in-service head injury.

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A complete rationale for any opinion expressed should be provided.

 

S. L. Kennedy

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Costello, 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.