Citation Nr: 21066221 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 16-15 156A DATE: October 29, 2021 REMANDED Entitlement to service connection for a disability manifested by dizziness, headaches, double vision, and unsteadiness (to include Meniere's disease, any other vestibular disorder, any neurological disorder, or residuals of anoxic brain damage) is remanded. REASONS FOR REMAND The Veteran had active duty for training (ACDUTRA) from November 1969 to March 1970. He also served in the Army Reserves until June 1971. He is service-connected for disabilities found to have been incurred in the line of duty during his ACDUTRA service, and therefore he meets the definition of a Veteran pursuant to 38 U.S.C. § 101(24) and 38 C.F.R. § 3.6(a). In June 2018, the Board issued a decision by another Veterans Law Judge that (in pertinent part) denied service connection for Meniere's disease. The Veteran appealed that portion of the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In February 2020, the Court issued a Mandate that vacated the June 2018 Board decision with regard to the issue of service connection for Meniere's disease, and remanded that matter for readjudication consistent with instructions outlined in its February 2020 Memorandum Decision. In October 2020, the Board recharacterized the issue on appeal as entitlement to service connection for a vestibular disorder, and remanded that issue for additional development. In April 2021, the Board again recharacterized the issue on appeal as entitlement to service connection for a vestibular disorder identified with symptoms of dizziness, headaches, double vision, and unsteadiness, and remanded that issue for additional development. The case has now been assigned to the undersigned Veterans Law Judge. To afford the Veteran the broadest and most favorable review possible, the Board has once again recharacterized the issue on appeal as entitlement to service connection for a disability manifested by dizziness, headaches, double vision, and unsteadiness (to include Meniere's disease, any other vestibular disorder, any neurological disorder, or residuals of anoxic brain damage), so as to include any disability that may reasonably be encompassed by the Veteran's description of the claim, reported symptoms, and the information submitted or developed in support of the claim. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). Entitlement to service connection for a disability manifested by dizziness, headaches, double vision, and unsteadiness (to include Meniere's disease, any other vestibular disorder, any neurological disorder, or residuals of anoxic brain damage). The Veteran contends that he currently has a disability manifested by dizziness, headaches, double vision, and unsteadiness related to events that occurred during his ACDUTRA service, including an in-service fall as well as being exposed to the shooting of machine guns and cannons. He alternatively contends that his claimed disability may be secondary to one or more of his service-connected disabilities (i.e., tinnitus, bilateral hearing loss, and depression with alcohol use disorder). Pursuant to the Board's October 2020 remand, the Veteran underwent a VA vestibular disorders examination in January 2021. At that examination, the Veteran reported symptoms only of tinnitus and hearing loss, and the VA examiner concluded that the Veteran did not have (and had never been diagnosed with) an ear or peripheral vestibular condition. In a January 2021 addendum, the VA examiner opined that it did not appear that the Veteran had a vestibular condition or Meniere's disease. For rationale, the VA examiner noted that while the Veteran endorsed hearing loss and tinnitus at the current examination, he did not endorse vertigo at the current examination, and he had also denied symptoms of vertigo at a September 2015 private audiology examination. Pursuant to the Board's April 2021 remand, the January 2021 VA vestibular disorders examiner provided an addendum medical opinion in June 2021, reiterating therein that the Veteran had never had a vestibular disorder or Meniere's disease diagnosis, and further noting that the Veteran's first documented complaint of dizziness was in April 1999 (i.e., approximately 30 years after his service separation) which did not provide a nexus between any in-service injury or event and the complaints beginning in 1999 and thereafter. However, the VA examiner did not address whether the Veteran's currently claimed disability (with symptoms of dizziness, headaches, double vision, and unsteadiness) may be diagnosed as residuals of anoxic brain damage after an opiate overdose resulted in respiratory failure in June 2014 and did not adequately address whether symptoms may be related to his service-connected depression with alcohol abuse, as requested by the Board remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). Furthermore, the record reflects that the Veteran has not yet been afforded a neurological examination to determine whether his symptoms of dizziness, headaches, double vision, and unsteadiness may be diagnosed as any type of neurological disorder. On remand, after any outstanding treatment records have been associated with the claims file, a neurological examination with medical opinion should be obtained in order to adequately address the theories of service connection raised with regard to any current disability manifested by dizziness, headaches, double vision, and unsteadiness (to specifically include any neurological disorder or residuals of anoxic brain damage). The matter is REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated him for his claimed disability on appeal. Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records for the period from July 2021 to the present. 3. After all requested records have been associated with the claims file, schedule the Veteran for a neurological examination by an appropriate clinician (or a telehealth interview if an in-person examination is not feasible), and with an examiner other than the January and June 2021 examiner, to determine the nature and etiology of any current disability manifested by dizziness, headaches, double vision, and unsteadiness. The electronic claims file must be made available to the examiner for review in conjunction with the examination. All necessary tests should be performed, and the results reported. For any disability manifested by dizziness, headaches, double vision, and unsteadiness diagnosed during the pendency of the appeal period (to specifically include any neurological disorder or residuals of anoxic brain damage) or that has caused functional impairment of earning capacity, the examiner must provide an opinion as to each of the following: (a) Whether it is at least as likely as not that each such disability is related to any disease or injury incurred or aggravated in the line of duty during the Veteran's ACDUTRA service (with specific consideration given to the Veteran's history of an in-service fall as well as being exposed to the shooting of machine guns and cannons, and his allegations of continuity of symptomatology since service); and (b) Whether it is at least as likely as not that each such disability is either caused by or aggravated beyond its natural progression (i.e., any increase in severity beyond the natural progression of the condition) by his service-connected tinnitus, bilateral hearing loss, or depression with alcohol use disorder. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. B. Yantz, Counsel The Board's decision in this case is binding only with respect to the instant matter(s) decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.