Citation Nr: 21069668 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 14-40 225 DATE: November 19, 2021 REMANDED Entitlement to service connection for a traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran had active military service from March 1969 to March 1971. He is in receipt of numerous awards and decorations, to include the Combat Infantryman Badge and the Purple Heart. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In his November 2014 substantive appeal, the Veteran requested that he be afforded a hearing before the Board. The Veteran was scheduled for his requested hearing in November 2019. The Veteran failed to report for his scheduled hearing without explanation. Therefore, the Veteran's hearing request is deemed to have been withdrawn. The Board finds that additional development is required before the claim on appeal is decided. In an April 2011 VA medical opinion, the examiner opined that it was less likely than not that the Veteran experienced an in-service TBI. In reaching this conclusion, the examiner commented that the Veteran's service treatment records were silent for complaints or treatment of a brain injury, and that the Veteran did not seek treatment for residuals of a traumatic brain injury until several years following his separation from service. The Board finds that the April 2011 VA opinion is inadequate for adjudication purposes. In this regard, the examiner relied on the fact that the Veteran's service treatment records were silent for treatment of a traumatic brain injury; however, the Board notes that the Veteran is in receipt of the Purple Heart and an April 2010 VA treatment note indicates that the Veteran could not be given an magnetic resonance imaging (MRI) scan because he had shrapnel in his head. See Reonal v. Brown, 5 Vet. App. 460, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran's claimed residuals of a TBI. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed residuals of a head injury. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. The examiner should respond to the following: Is it at least as likely as not (50 percent or better probability) that any currently present residuals of head injury had its onset during his active service, or is otherwise etiologically related to such service? The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. The examiner should also address the April 2010 report that the Veteran had shrapnel in his head and his contentions that he was exposed to multiple blast injuries while serving in Vietnam. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.