Citation Nr: 21007915 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 18-50 539 DATE: February 11, 2021 REMANDED Entitlement to service connection for traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1989 to December 1990. This claim was previously before the Board of Veterans’ Appeals (Board) in August 2019 and denied essentially on the premise the Veteran had not met the most fundamental requirement for service connection – that being at least showing she has this claimed disability, such as in the way of a diagnosis. The Veteran appealed that decision to the higher U. S. Court of Appeals for Veteran’s Claims (Veterans Court/CAVC). And, in July 2020, the CAVC granted a Joint Motion for Partial Remand (JMPR), vacating the portion of the Board’s decision denying entitlement to a TBI and remanding this claim back to the Board for further development and readjudication pursuant to agreement in the JMPR. In granting the July 2020 JMPR, the CAVC agreed the Board had erred in its decision in failing to adequately discuss evidence in the file possibly suggestive of a TBI during the Veteran’s service – which, in turn, may meet the requirements for having her undergo a VA examination for a medical opinion concerning this.   Entitlement to service connection for TBI is remanded. The Veteran contends that she has residuals of a head injury (so a TBI), primarily owing to a grenade explosion during her service. The Veteran’s service treatment records (STRs) reflect that, in September 1989, she was involved in a training accident that resulted in a grenade explosion. Additionally, in March 1990, she was involved in a motor vehicle accident (MVA), and the examiner noted that she had hit her forehead on the steering wheel. During a November 2017 VA examination, the Veteran reported having a long history of being agitated easily, particularly when around crowded areas. She also reported being impatient. As well, she reported being weepy for a period after the grenade blast in 1990 and was hypervigilant to blasts around the Marine base at the time. In her December 2017 Notice of Disagreement (NOD), the Veteran reported having a significant auditory impact from the blast. To substantiate her claim, in November 2019 she submitted a medical article associating TBI with auditory processing changes. She maintained in her October 2019 Substantive Appeal to Board (on VA Form 9) that her grenade injury in service has affected her brain, nerves, and hearing. The Board’s August 2019 decision, in part, determined the Veteran did not have an acquired psychiatric disability – including posttraumatic stress disorder (PTSD), or deafness/nerve disability because of her military service, and she did not appeal the denial of those other claims to the Court (CAVC). Thus, the Court determined she had abandoned those other claims. Nevertheless, in conversely vacating the portion of the Board’s decision that, instead, had denied the claim for service connection for TBI, the Court indicated the Board had neglected to discuss whether some or all of these symptoms the Veteran has complained about since her service may be suggestive of a TBI during her service, including owing to the blast mentioned. To better address this question, the Board finds that a medical examination and medical opinion are needed. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Accordingly, this claim is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine: (a.) whether she has persistent or recurrent symptoms suggestive of a prior TBI, including when considering her report that she is easily agitated and irritated (November 2017 VA examination), that she believes she continues to suffer from PTSD and other effects of the grenade incident (December 2017 NOD), and that her physician informed her that her additionally claimed hearing loss was a nerve problem, which is a symptom of TBI (October 2018 VA Form 9). The examiner also should consider the several articles the Veteran has submitted regarding TBI symptomatology, including behavioral symptoms and auditory dysfunction. *In its August 2019 decision, the Board determined the Veteran was not entitled to service connection for an acquired psychiatric disability, including PTSD, or for deafness/nerve disability, so her mention of her symptoms since service should be considered in the context, instead, of determining whether suggestive of a prior TBI.   (b.) If there is suggestion of a prior TBI, the examiner is additionally asked to indicate whether it is at least as likely as not (50 percent probability or greater) the TBI or any associated residual is the result of the grenade explosion during the Veteran’s service in September 1989 or the motor vehicle accident in March 1990. Rationale for the responses is essential, regardless of whether favorable or unfavorable to the claim, preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. If the examiner cannot provide any opinion without resorting to mere speculation, he/she must provide explanation of why a response would require speculation. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hamm, 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.