Citation Nr: 21069071 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 17-31 989 DATE: November 17, 2021 ORDER Entitlement to service connection for Meniere's disease is granted. Entitlement to service connection for vestibular migraines is granted. FINDINGS OF FACT 1. The Veteran's Meniere's disease is related to an in-service injury. 2. The Veteran's vestibular migraines are related to an in-service injury. CONCLUSIONS OF LAW 1. The criteria for service connection for Meniere's disease have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for vestibular migraines have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1987 to August 1991, with service in Southwest Asia from December 1990 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 1. Entitlement to service connection for Meniere's disease The Veteran contends that his Meniere's disease is related to his service, specifically his close proximity to a land mine explosion in 1991. The Board finds the preponderance of the evidence supports finding that the Veteran's Meniere's disease is related to his service. The Veteran was diagnosed with Meniere's disease by neurologist Dr. M.W. in 2015. Therefore, the first element of service connection has been met. The Veteran's military occupational specialty was a field artillery surveyor. At the July 2021 Board hearing the Veteran testified that in early 1991 he went into Iraq to survey an area and an armored personnel carrier in his convoy hit a land mine. He stated that the destruction from the explosion blew out the windshield of the Humvee he was driving and he hit his head vigorously against the roll bar. Following the hearing, the Veteran submitted a copy of a 1991 journal entry and a letter to a friend detailing this incident. In the letter he stated that he was still dizzy, and his left ear wouldn't stop ringing after the incident. The Veteran testified that after the explosion he had very loud ringing in his ears, and he was dizzy and nauseous. He stated that migraines and vertigo started in service after this incident and have continued since. The Veteran also testified to significant in-service noise exposure due to being in close proximity to field artillery guns where they were firing. Of note, the Veteran is service connected for tinnitus and VA has conceded in-service noise exposure. The Board finds the Veteran's statements regarding the in-service event and injury credible and probative. Accordingly, the second element of service connection has been met. Therefore, the issue in this case is whether the Veteran's currently diagnosed Meniere's disease is related to this in-service incident and injury. Following the hearing, the Veteran's representative submitted an August 2021 independent medical evaluation from Dr. V.Z who detailed the Veteran's symptoms of vertigo, ringing in his ears, hearing loss, and dizziness, as reported in his medical records after service. The doctor opined that the Veteran's Meniere's disease is secondary to his in-service acoustic trauma. The doctor provided rationale as to why the Veteran's Meniere's disease was not diagnosed until 2015. She stated that this was not uncommon as Meniere's disease is a differential diagnosis and can be extremely difficult to establish. Additionally, the symptoms are not always consistent, and attacks may be separated by long periods of time. Along with the independent medical evaluation, the Veteran's representative also submitted January 2021 opinions from otolaryngologists Dr. C.K. and Dr. R.M. Both doctors found that the Veteran's Meniere's disease was most likely caused by or a result of (a 51 percent probability or greater) of his acoustic trauma during service. The Veteran attended a VA examination in October 2015. The examiner found that the Veteran did not have treatment for Meniere's disease in service, and stated that there was not enough documentation in the record to make a diagnosis of Meniere's disease. While the examiner noted that the Veteran's medical records showed a diagnosis of Meniere's disease, he stated that Meniere's is only diagnosed if patients complain of episodic vertigo and hearing loss. The Board finds the VA examiner's rationale inadequate to support his opinion. First, the examiner did not address the diagnosis of Meniere's disease made by M.W., M.D., in the September 2015 private disability benefits questionnaire. In addition, while the examiner discussed the diagnostic criteria for Meniere's disease, he did not provide any specifics as to how the criteria was, or was not, demonstrated by the Veteran. Notably, the examiner noted that Meniere's disease requires complaints of hearing loss, but he did not mention that the Veteran complained of hearing loss at the 1998 audiology VA examination. Therefore, the Board assigns little probative weight to this opinion. The Board finds the opinion from Dr. V.Z. the most probative evidence of record regarding whether the Veteran's Meniere's disease is related to his military service. Therefore, the preponderance of the evidence supports a grant of entitlement to service connection for Meniere's disease. There is no reasonable doubt to be resolved as to this issue. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for vestibular migraines The Veteran contends that his vestibular migraines are related to his service, specifically his close proximity to a land mine explosion in 1991. The Board finds the preponderance of the evidence supports finding that the Veteran's vestibular migraines are related to his service. The Veteran was diagnosed with vestibular migraines by neurologist Dr. M.W. in 2015. Therefore, the first element of service connection has been met. As noted above, the Veteran testified to an in-service incident of close proximity to a land mine explosion, which caused him to hit his head on the roll bar of a Humvee he was driving. Additionally, the Veteran also testified to in-service noise exposure, which has previously been conceded by VA. As noted above, the Board finds this evidence credible and probative. Accordingly, the second element of service connection has been met. Therefore, the issue in this case is whether the Veteran's currently diagnosed vestibular migraines are related to this in-service incident and injury. The Veteran testified that his migraines began in service after the land mine explosion and have continued since service. The Veteran additionally reported his migraines began in service and have continued since in a 1998 VA examination. The examiner stated that the migraines appear to be stress related and may be related to posttraumatic stress disorder. A significant amount of medical evidence has been added to the claims file since this examination, to include a 2015 diagnosis of vestibular migraines. As such, the opinion has little probative value. Following the hearing, the representative submitted a January 2021 opinion from Dr. C.K., whose specialty is otolaryngology. The doctor stated that the Veteran's vestibular migraines were most likely caused by or a result of (a 51 percent probability or better) the Veteran's event while in service. The doctor provided rationale and stated that the Veteran's history of acoustic trauma during service likely caused or worsened his endolymphatic hydrops, which can manifest as Meniere's disease and/or as vestibular migraines. Additionally, Dr. R.M. separately opined that the Veteran's vestibular migraines were most likely caused by or a result of his noise trauma during service. (Continued on the next page) The October 2015 VA examiner stated that the Veteran's vestibular migraines were less likely than not incurred in or caused by service. However, the rationale provided in the opinion largely discusses Meniere's disease and not vestibular migraines. The only rationale given for migraines is that military treatment records only show symptoms of migraines as related to an upper respiratory infection. However, the examiner does not discuss the Veteran's contentions that his migraines began in service after a land mine explosion and have continued since. As such, the Board finds this opinion has little probative value. Accordingly, the medical opinions from C.K. and R.M. are the most probative evidence regarding whether the Veteran's vestibular migraines are related to service. Therefore, the preponderance of the evidence supports a grant of entitlement to service connection for vestibular migraines. There is no reasonable doubt to be resolved as to this issue. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Patrick, 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.