Citation Nr: 21076518 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-51 856 DATE: December 27, 2021 REMANDED Service connection for residuals of a traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1983 to April 1991, including service in Southwest Asia and at Camp Lejeune. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In the December 2019 decision, the Board denied service connection for TBI. The Veteran appealed the Board's December 2019 decision to the United States Court of Appeals for Veterans Claims (Court), which in a May 2021 order, granted the parties' joint motion for partial remand, vacating the Board's December 2019 decision to the extent that the Board denied service connection for TBI and remanding the case for compliance with the terms of the joint motion. On August 2021, the Board remanded this issue in compliance with the JMPR instructions. This case was previously before the Board in August 2021 and remanded for additional development. The Veteran seeks service connection for his TBI residuals condition. In support the Veteran reports that his TBI condition had its onset in service after a helicopter crash while he was deployed in the Persian Gulf. The evidence shows that the Veteran has been diagnosed with TBI and neurocognitive disorder. See VA medical examination (November 2016); VA medical record (August 2009, April 2011 and July 2016). Additionally, the November 2016 examiner opined that his cognitive impairment was due to his head injuries. The record also shows diagnoses of possible major neurocognitive disorder related to his TBIs and other residuals of dizziness, judgement, headaches, seizure, hemorrhage in brain, sleep impairment, vision problems, and mood changes. Indeed, the Veteran served in Southwest Asia and his medical records shows that he suffers from TBI and such injury is consistent with the circumstances, conditions and hardships of that service. 38 C.F.R. § 3.303(a). The Board remanded this issue for a medical examination to determine the nature and etiology of the Veteran's TBI. The Veteran was afforded a VA examination in October 2021. The examiner stated that the claim condition was less likely than not related to service. The rationale was that "based on the provided information and review of STR, I am not able to make a diagnosis of TBI sustained during service. The lack of STR to confirm he had a head injury during service makes it difficult to make a diagnosis. The fact that he developed a seizure disorder after service and the deterioration from the seizure disorder makes it even more difficult to know what is responsible for his progressive cognitive decline. It will be difficult making a diagnosis except current diagnosis if major neurocognitive disorder due to multiple etiologies, as identified in the report." The Board observes that the findings and conclusions set forth in the most recent VA examination report are inconsistent and inconclusive. The examiner did not discuss the TBI diagnosis in the Veteran's medical records. Also, a complete rationale was not provided addressing the medical and lay evidence regarding the nature, cause and etiology of his TBI. Moreover, the examiner did not discuss the medical evidence of neurocognitive disorder, functional impairment, numerous symptoms and TBI residuals in record. Thus, the Board finds the latest examination inadequate, and another examination that to determine the onset, etiology and etiology of his TBI condition is needed to adjudicate this claim. In addition, the record shows that the Veteran served for more than 30 days at Camp Lejeune in 1984 and has a neurobehavioral problem. Given the Veteran's Camp Lejeune service, the Board notes that VA hospital care and medical services are available for Camp Lejeune Veterans for covered diseases that include neurobehavioral effects. See 38 C.F.R. §§ 3.307 (7)(iii) and 38 C.F.R. § 17.400. As there is no adequate examination to determine the onset, nature and etiology of his TBI residuals and neurocognitive disorder, a remand is necessary to have the Veteran examined and for an examiner to review his claims folder and provide opinions necessary to adjudicate this appeal. The matters are REMANDED for the following action: Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service TBI symptoms, to include all neurocognitive symptoms. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). Whether an in-person examination is necessary should be determined by the examiner. The examiner must opine as to whether it is at least as likely as not that the Veteran's TBI is related to or had its onset in service. Moreover, the examiner must review all the credible and competent medical and lay evidence, about the Veteran's TBI onset, etiology, etiology and symptoms in and after service. Additionally, the examiner must review and provide a complete rationale about any relation of the injuries in service, to his current TBI condition, to include neurocognitive symptoms, headaches, seizures and any other residuals or symptoms presented by the record. The examiner is asked to review the pertinent evidence, including the Veteran's lay assertions regarding his symptomatology, and undertake any indicated studies. Then, based on the results of the examination, the examiner is asked to address each of the following questions: (a) Please opine whether it is at least as likely as not that the Veteran has a TBI that is related to his service in the Persian Gulf. (b) Please opine as to whether it is at least as likely as not that the Veteran has a neurocognitive disorder that is related to his presumed environmental exposures while serving at Camp Lejeune. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.