Citation Nr: 21075713 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 20-10 036 DATE: December 21, 2021 REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for anosmia (loss of sense of smell) is remanded. Entitlement to compensation under 38 U.S.C. § 1151 for ageusia (loss of sense of taste) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1962 to June 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an October 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified at a hearing conducted by the undersigned Veterans Law Judge. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). The Veteran contends that his anosmia and ageusia are the result of VA-prescribed medication (simvastatin). Alternatively, he contends that he did not provide his informed consent for the medication prescribed. To help fully inform VA adjudicators, the RO sought a medical opinion addressing the issue. In September 2020, the examiner rendered a negative opinion on the claim. He based his opinion on two things: (1) "the [V]eteran developed ageusia over time," and (2) "[m]edical drug references do not associate ageusia with the prescription of simvastatin." He supported his findings by citing a medical article on taste and smell disorders in adults. The examiner's opinion for anosmia is similar. The Board finds remand necessary for medical clarification because it's unclear what the examiner means when he writes that "the medical record shows the veteran developed ageusia over time." Before October 2012 (when the Veteran started simvastatin), his medical records were negative for complaint of or treatment for loss of sense of taste or smell. For his part, the Veteran recalls that it happened " within days," "three or four days," "two to three weeks" after starting the medication, not "over time." See the November 2020 VA examination, May 2021 hearing transcript, and August 2018 Statement in Support of Claim. It's true the evidence of record is conflicting on this point. For instance, the VA healthcare provider who discontinued his medication in October 2013 after he reported his symptoms noted that the Veteran lost his sense of smell three months ago (i.e., sometime in July). So perhaps the examiner found the Veteran's statements or recollection inconsistent with the evidence in the case or the medical principles relating to the onset and progress of the disease. It's difficult to say without further explanation. Remand is also warranted for the examiner to address the favorable medical evidence of record. In October 2018, the Veteran submitted a trio of medical articles, including one from a privately-owned drug monitoring company (eHealthMe) and another from the Netherlands Pharmacovigilance Centre Lareb. The former states that "[l]oss of smell is found among people who take Simvastatin" and the latter concludes that "[patient] reports support a causal relationship between simvastatin and taste disorders." The examiner does not address either article. When "the report does not contain sufficient detail," the Board must return it for a supplemental opinion. 38 C.F.R. § 4.2. Finally, as the case is being remanded for additional development, any outstanding VA treatment records should be associated with the claims file. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (per curiam). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Arrange for an appropriate the September 2020 examiner, or a qualified health care provider, to review the Veteran's claims file and provide an addendum opinion on: (a.) whether it is at least as likely as not that the Veteran's anosmia and ageusia were caused by VA-prescribed medication. (b.) If so, whether it is at least as likely as not that the Veteran's anosmia and ageusia were proximately caused by carelessness, negligence, lack of proper skill, error in judgment or similar instance of fault on the part of VA or an event not reasonably foreseeable. In providing the requested opinion, the Board draws the examiner's attention to a May 2009 Primary Care Note where the VA healthcare provider assessed lipidemia and noted "on zocor[,] no complaints." The examiner must address the eHealthMe and the Netherlands Pharmacovigilance Centre Lareb medical articles. If the reviewing healthcare provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Canedy, Associate 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.