Citation Nr: 21072200 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 19-32 572A DATE: December 2, 2021 ORDER The claim of entitlement to service connection for dementia, also identified as Alzheimer's disease, has been withdrawn. REMANDED Entitlement to service connection for hypothyroidism is remanded. Entitlement to service connection for a cerebral vascular accident (CVA) is remanded. Entitlement to service connection for carotid bruit is remanded. FINDING OF FACT The Veteran withdrew his claim of entitlement to service connection for dementia or Alzheimer's disease. CONCLUSION OF LAW The criteria for withdrawal of the claim of entitlement to service connection for dementia or Alzheimer's disease have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1962 to May 1965. He had additional service in the National Guard. This matter is before the Board of Veterans' Appeals (Board) on appeal of an October 2018 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2021, the Veteran testified at a hearing before the undersigned. WITHDRAWAL OF CLAIM Entitlement to service connection for dementia, also identified as Alzheimer's disease The Board may dismiss any appeal that fails to allege a specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn by the appellant or his or her authorized representative as to any or all issues involved in the appeal. 38 C.F.R. § 19.55(a). Appeal withdrawals must include the name of the appellant, the file number, and a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify the issues withdrawn or specify that the appeal is withdrawn in its entirety. 38 C.F.R. § 19.55(b). During the July 2021 hearing, the Veteran and his representative requested the withdrawal of the issue of entitlement to service connection for dementia or Alzheimer's disease. The request for withdrawal included the Veteran's name and file number. Per this request, this issue is withdrawn. There remain no allegations of errors of fact or law for appellate consideration with regard to the issue. Accordingly, the Board does not have jurisdiction to review this appeal and it is dismissed. REASONS FOR REMAND VA is required to make reasonable efforts to assist the Veteran in obtaining private medical records that are relevant to his claims. See 38 U.S.C. § 5103A; 38C.F.R. § 3.159. VA's duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.§ 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 1. Entitlement to service connection for hypothyroidism is remanded. In July 2021, the Veteran testified that he received private treatment from several private physicians. His private doctors included Dr. K., Dr. P., and Dr. B. who all had offices in Beaumont, Texas. He also reported private treatment from Dr. M. A. I., whose office is in Port Arthur, Texas. The Veteran's testimony indicated these physicians may have treatment records relevant to his claims for service connection for hypothyroidism, CVA, and carotid bruit. The Veteran's representative requested that the record be held open to submit outstanding private treatment records. No additional private treatment records were submitted following the hearing. As there may be outstanding relevant private treatment records, VA must make additional reasonable efforts to assist the Veteran in obtaining them. See 38 U.S.C. § 5103A; 38C.F.R. § 3.159. 2. Entitlement to service connection for a cerebral vascular accident (CVA) is remanded. The Veteran seeks entitlement to service connection for a cerebral vascular accident (CVA). He testified that he initially experienced seizures in the military. Service connection is currently established for heart disease and for hypertension. December 2016 treatment records from the Medical Center of Southeast Texas show the Veteran was treated for and diagnosed with an acute thalamic ischemic infarct of the right. These records include a neurological consultation which was conducted because the Veteran had a "stroke." The neurologist stated the Veteran's diagnosed conditions of coronary artery disease and hypertension were significant past medical history in evaluating his CVA condition. The issue of secondary service connection is raised by this evidence. A September 2018 VA central nervous system examination was provided to evaluate the Veteran's claim. The examiner confirmed a diagnosis of a CVA. She opined the CVA was less likely than not directly related to the Veteran's active service because the condition was caused by a buildup of fatty plaque in the arteries which limited blood flow to the brain. She did not discuss the Veteran's reports that he had seizures during his active service. The examiner did not provide any opinion as to whether the CVA was secondary to the service-connected heart disease or hypertension disabilities. The VA examination and etiology opinion are inadequate to fully evaluate the claim. A new examination and opinion must be obtained. See Stefl, supra. 3. Entitlement to service connection for carotid bruit is remanded. The Veteran seeks service connection for carotid bruit. He submitted a May 2018 letter from his private physician, Dr. M. A. I., which noted a diagnosis of carotid bruit. May 2017 and March 2017 VA neurology notes, following the December 2016 stroke discussed above, shows carotid bruits were not present. A March 2017 VA cardiology consult also documents "no carotid bruits." The private physician's report shows carotid bruits may be present and the VA treatment records indicate, if present, they may be associated with a stroke and/or a heart disability. A VA examination must be provided to evaluate whether any carotid bruit disability is secondary to a service-connected heart disability, a service-connected hypertension, or, if indicated, a service-connected CVA or stroke disability. See McLendon, supra. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment provider who may have records which are relevant to his claims (service connection for hypothyroidism, CVA, and carotid bruit) and which are not yet associated with the claims file (including Dr. M. A. I, Dr. K., Dr. P, and Dr. B). Make two requests for the authorized records from any treatment provider identified, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for a VA examination to evaluate his claimed CVA and carotid bruit. The examiner must review the claims file. The examiner should first determine if a diagnosis of any CVA, stroke condition, or the residuals of a CVA or stroke condition, and/or carotid bruit have been present at any time over the appeal period (from July 2018). If they have not been present during the appeal period, the examiner must explain why the notations of the conditions in the record during the appeal period do not constitute a diagnosis of the condition during the appeal period. The examiner is asked to provide a response to the following: Is any CVA, stroke, or carotid bruit disability or disability residuals at least as likely as not related to service, including the Veteran's report of in-service seizures (noted in his July 2021 testimony)? The examiner is advised the Veteran is competent to report his experience of observable symptoms. If the examiner dismisses any such report, a complete rationale for doing so must be provided. Noting the symptoms are not confirmed by contemporaneous medical records, without additional rationale, is an inadequate rationale for dismissing a report of observable symptomatology. The examiner should also provide a response to these additional questions: Is a CVA, stroke, or carotid bruit disability at least as likely as not proximately due to the Veteran's service-connected heart disability or service-connected hypertension? Is a CVA, stroke, or carotid bruit disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran's service-connected heart disability or service-connected hypertension? The opinion must address both causation and aggravation to be deemed adequate. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation If the examiner opines a CVA or stroke disability is at least as likely as not directly related to the Veteran's active service or secondary to a service-connected disability and that carotid bruits is less likely than not directly related to service or secondary to service-connected heart or hypertension disability, the examiner is asked to respond to the following: Is a carotid bruit disability at least as likely as not proximately due to the Veteran's CVA or stroke disability? Is a carotid bruit disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran's CVA or stroke disability? The opinion must address both causation and aggravation to be deemed adequate. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeanne Celtnieks 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.