Citation Nr: 21065265 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-41 526 DATE: October 25, 2021 REMANDED Entitlement to service connection for grand mal seizures is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1978 through March 1979 and from April 1989 through June 1989. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claim in March 2019 for further development by the RO. The case has been returned to the Board for further appellate action. The Board notes that the March 2019 Board remand also included claims for entitlement to service connection for radiculopathy and a total disability rating based on individual unemployability (TDIU). The RO granted both claims in a January 2020 rating decision. As this is a full grant of these issues, they are no longer in appellate status. The Board also notes that prior to the certification of the present claim to the Board in November 2020, the Veteran's representative of record submitted correspondence indicating that he withdrew his representation and had informed the Veteran of his withdrawal. See March 2020 correspondence. The Board finds that the withdrawal is valid and, accordingly, will consider that the Veteran is presently unrepresented. 38 C.F.R. §§ 14.631, 20.6. Entitlement to service connection for grand mal seizures is remanded. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. Specifically, a remand is warranted in order to obtain an addendum medical opinion regarding the etiology of the Veteran's grand mal seizure disability. The Board notes at the outset that the March 2019 Board remand directed the RO to schedule the Veteran for a VA examination to address the nature and etiology of any seizure disorder and directed the examiner to address the Veteran's lay statements in the medical opinion. Following remand, the RO obtained a medical opinion in lieu of a VA examination in September 2020. The September 2020 medical opinion indicated that it was not possible to obtain a VA examination due to COVID-19 protocol. The Board finds that the examination report and medical opinion indicate a highly detailed and thorough review of the file and that this includes consideration of the Veteran's lay statements. Therefore, the Board finds that the RO's action in obtaining a medical opinion in lieu of a VA examination was in substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that the September 2020 VA medical opinion regarding direct service connection is adequate. The opinion regarding aggravation of a pre-existing disability is also adequate. However, the opinion regarding secondary service connection is inadequate, as it does not address whether the seizure disability was aggravated by her service-connected back disability. El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The Veteran contends that her seizures began following separation from service after a back injury. See September 2013 statement. The record shows that the Veteran injured her back in 1989, and that the Veteran is presently service connected for a back condition. Thus, the case must be returned for an addendum opinion to address secondary service connection. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain an addendum opinion from the examiner who authored the September 2020 medical opinion or, if the September 2020 VA examiner is unavailable, from an appropriate medical professional, to determine the nature and etiology of the Veteran's grand mal seizure disability. After reviewing the claims folder in its entirety, the examiner should address the following: (a) Is the Veteran's grand mal seizure disability at least as likely as not (50 percent or greater probability) caused by her service-connected back disability; and (b) Is it at least as likely as not that the Veteran's grand mal seizure disability has been aggravated by her service-connected back disability? A new examination of the Veteran is only necessary if deemed so by the examiner. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.