Citation Nr: 21071217 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-10 712 DATE: November 30, 2021 REMANDED The claim of entitlement to service connection for a blood clot on the brain is remanded. The claim of entitlement to a temporary total evaluation because of treatment requiring convalescence or because of hospital treatment in excess of 21 days due to a blood clot on the brain is remanded. The claim of entitlement to a temporary total evaluation because of hospital treatment in excess of 21 days for a condition under 38C.F.R. §4.29 is remanded. Entitlement to a temporary total evaluation because of treatment for a condition requiring convalescence under 38C.F.R. §4.30 is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from July 1962 to July 1965. In May 2018, the Veteran testified at a video conference hearing before the undersigned Veteran's Law Judge. A transcript of that proceeding has been associated with the claims file. In June 2021, the Board remanded this claim for additional development. 1. The claim of entitlement to service connection for a blood clot on the brain is remanded. The Veteran asserts that his blood clot on the brain was caused or aggravated by his service-connected low back disorder and bilateral lower extremity radiculopathy. He essentially contends that his service-connected low back disorder with bilateral lower extremity radiculopathy caused him to fall, which caused or aggravated his blood clot on the brain. An August 8, 2014, VA treatment record documented the Veteran's complaints of headaches, tiredness, and sleepiness since last autumn. It was noted that the Veteran's family denied any recent falls, focal neurological complaints, and "spells." A computed tomography scan of the brain showed a stable small left acute-on-chronic subdural hematoma with obliteration of sulci, but no significant mass defect. It was determined that the Veteran did not require any intervention at that time and an electroencephalography was scheduled to get a baseline. On August 21, 2014, the Veteran presented to the VA with complaints of dizziness, weakness, and difficulty walking. He reported that he fell that morning but denied hitting his head. A neurology surgery note showed that his left acute-on-chronic subdural hematoma worsened as it was more subacute and symptomatic. He underwent a left craniotomy with evacuation of the left subdural hematoma. The Veteran was afforded a VA examination in July 2021. The VA examiner provided an opinion against the claim and explained that medical literature did not support a pathophysiological or anatomical relationship between the Veteran's service-connected low back disorder and his subdural hematoma. The VA examiner also listed several risk factors for subdural hematoma. The VA examiner also found that his subdural hematoma was less likely caused by his low back disorder because there was no head trauma reported when the subdural hematoma was initially diagnosed. Unfortunately, the VA examiner did not discuss whether the Veteran's low back disorder aggravated his left subdural hematoma. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The VA examiner stated that there was no head trauma when the subdural hematoma was initially diagnosed on August 8, 2014. However, there was no discussion of whether the Veteran's fall that occurred after the initial diagnosis aggravated his subdural hematoma. As discussed above, on August 21, 2014, he reported weakness, difficulty walking, and a recent fall. At that time, it was noted that his subdural hematoma had worsened. Therefore, the Board finds that the July 2021 VA medical opinion is inadequate to the extent that it did not discuss whether the Veteran's service-connected low back disorder aggravated the left subdural hematoma. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, a remand is required to obtain another VA medical opinion. 2. The claim of entitlement to a temporary total evaluation because of treatment requiring convalescence or because of hospital treatment in excess of 21 days due to a blood clot on the brain is remanded. As the Board's finding on the claim listed above is inextricably intertwined with the pending claim listed in Section 1, the appropriate remedy is to defer this claim pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1Vet. App.180 (1991). Accordingly, this issue is remanded for re-adjudication following evidentiary development. 3. The claim of entitlement to a temporary total evaluation because of hospital treatment in excess of 21 days for a condition under 38C.F.R. §4.29 is remanded. As the Board's finding on the claim listed above is inextricably intertwined with the pending claim listed in Section 1, the appropriate remedy is to defer this claim pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1Vet. App.180 (1991). Accordingly, this issue is remanded for re-adjudication following evidentiary development. 4. Entitlement to a temporary total evaluation because of treatment for a condition requiring convalescence under 38C.F.R. §4.30 is remanded. As the Board's finding on the claim listed above is inextricably intertwined with the pending claim listed in Section 1, the appropriate remedy is to defer this claim pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1Vet. App.180 (1991). Accordingly, this issue is remanded for re-adjudication following evidentiary development. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, the AOJ should obtain an addendum medical opinion from the examiner who conducted the Veteran's July 2021 VA examination. If this examiner is no longer available, then the claims file must be returned to a physician of similar expertise. Another examination of the Veteran should only be performed if deemed necessary by the person providing the opinion. All pertinent evidence of record must be made available to and reviewed by the examiner. Following a review of the relevant records and lay statements, the examiner must state an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's left subdural hematoma/blood clot of the brain was caused or aggravated by his service-connected low back disorder and bilateral lower extremity radiculopathy. In so opining, the examiner must consider and discuss the following: (1) the Veteran's reports that his low back disorder/radiculopathy caused him to fall, which led to his subdural hematoma; (2) the August 8, 2014, diagnosis of a subdural hematoma that did not require intervention a that time; (2) the August 21, 2014, VA treatment record showing that the Veteran presented with weakness, difficulty walking, and had recently fell; and (3) the August 21, 2014, VA treatment record that the Veteran's left subdural hematoma worsened and was symptomatic. 3. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. (Continued on the next page) 4. Then, the AOJ should readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.