Citation Nr: 21069868 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 15-13 382 DATE: November 22, 2021 REMANDED Entitlement to service connection for dizzy spells, to include trouble with motion and movement is remanded. Entitlement to service connection for a cervical disorder is remanded. Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1984 to August 1986. The Veteran's claim was most recently before the Board in January 2019 wherein it was remanded for additional development. Unfortunately, another remand is required as explained below. 1. Entitlement to service connection for dizzy spells, to include trouble with motion and movement is remanded. The Veteran seeks service connection for dizzy spells, a cervical condition, and headaches. The Veteran contends that he experienced dizzy spells during service and has experienced dizziness since service. Further, he contends that he has a cervical condition and headaches that are related to this dizziness. The Board remanded the Veteran's claims to obtain examinations and medical opinions in support of his contentions. As it pertains to the Veteran's dizziness, the April 2021 VA clinician did not find that the Veteran had any diagnosis related to dizziness. The Veteran reported current symptoms of dizzy spells and vertigo however the clinician found the condition has resolved. The clinician also found that the Veteran's dizziness was not related to service because there were no supporting clinical findings or testing results. Further, the Veteran had a significant psychiatric history that should be explored further as an explanation of his symptoms. The Board finds the examination and opinion to be inadequate for several reasons. First, the clinician found that the Veteran does not have any current diagnosis to account for his dizziness finding that it had resolved, but the clinician did not address what, if any, condition the Veteran had prior to resolution and when it resolved. The Veteran's claim has been on appeal since October 2013. Further, the clinician did not address the assessments made by the February 2014 neurologist as directed by the prior Remand. See VBMS, document labeled Medical Treatment Record-Non-Government Facility, receipt date July 19, 2016, page 19 of 55. Further, in reviewing the Veteran's May 2014 VA examination by an audiologist, the clinician stated that the Veteran's complaints should be evaluated by an otolaryngologist. The April 2021 clinician that evaluated the Veteran's complaints was an occupational medicine specialist. 2. Entitlement to service connection for a cervical disorder is remanded. 3. Entitlement to service connection for headaches is remanded. Because the Veteran contends that his cervical and headache conditions are related to his dizziness, a decision on that remanded issue above could significantly impact a decision on the issues of entitlement to service connection for headaches and a cervical condition. Thus, the issues are inextricably intertwined and a remand of those claims are required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). The Board finds the opinions related to the Veteran's cervical disorder and headache conditions to be inadequate as well. In response to the question of whether the Veteran's dizziness caused or aggravated his cervical condition, the clinician stated "there is no records or clinical evidence to support pathology on my review or examination." However, the clinician found the Veteran to have degenerative arthritis in his neck (consistent with his age) as a reason why the Veteran's neck condition could not be directly related to service. Thus, it is unclear to the Board what the examiner meant when there was no evidence to support "pathology" because the Veteran has degenerative changes that could be caused or aggravated by the a dizziness condition. Turning to the Veteran's headaches, as to whether the headaches were directly related to service, the clinician did not find support for the Veteran's subjective claims of headache pain, found the complaints to not be "believable", and to be more likely than not a manifestation of a psychiatric condition. The clinician provided the same answers when responding to the questions on whether the headaches could be caused or aggravated by the dizziness condition. It is the Board's responsibility to determine the credibility and probative value of the evidence, to include the Veteran's statements. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1977). It is improper for an examiner to provide any opinion on credibility. Given the above, and the possibility that the clinician's findings were tainted by a finding of incredibility, the Board finds that a remand for new examinations on all claims is required. Further, the clinician raised the possibility that the Veteran's claims are psychiatric manifestations; thus, the claims must be considered by a mental health professional. While the Board declines to expand the Veteran's claims to include service connection for an acquired psychiatric disability, as the record raised the possibility that the symptoms may be manifestations of an acquired psychiatric disability, a clearer picture as to the etiology of the Veteran's symptoms is useful for the Board's review. The matters are REMANDED for the following action: 1. Obtain an examination by an otolaryngologist (as specified by the May 2014 VA examiner), to the extent possible, to evaluate the Veteran's claims. While the clinician should review the entire file, the clinician's attention is invited to the following: The Veteran's June 1986 report of medical history at the time of separation. He reported dizziness, but no diagnosis was provided. The Veteran's STRs do not contain an incident and the Veteran has not reported one, just that the symptoms started during service; The two May 2014 VA examinations; The report by the February 2014 neurologist. See VBMS, document labeled Medical Treatment Record-Non-Government Facility, receipt date July 19, 2016, page 19 of 55. After review of the above, the clinician should address the following: a) What, if any, diagnoses does the Veteran have since October 2013 for his reported: a. Dizziness condition, to include vestibular disorder; b. Headache disorder; c. Cervical disorder? b) Is it at least as likely as not that any of the above disorders are at least as likely as not related to the Veteran's service? The clinician should note that the absence of contemporaneous records showing complaints of or treatment for the conditions, ALONE, is insufficient rationale for a nexus opinion." Furthermore, the Board finds the Veteran's contentions that he complained of dizziness several times, his pain started in service, and that it has continued ever since to be credible (as stated in the January 2019 remand). c) Is it at least as likely as not that the Veteran's headache disorder is (a) caused or (b) aggravated by the Veteran's cervical spine and/or dizziness disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. d) Is it at least as likely as not that the Veteran's cervical spine disorder is (a) caused or (b) aggravated by the Veteran's dizziness disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. e) Is it at least as likely as not that the Veteran's dizziness disorder is (a) caused or (b) aggravated by the Veteran's cervical spine and/or headache disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. The examiner is asked to provide the underlying reasons for all opinions expressed and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. M. Hitchcock 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.