Citation Nr: 21008649 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 13-01 108 DATE: February 17, 2021 REMANDED Entitlement to service connection for trigeminal neuralgia, to include as secondary to service connected optic nerve atrophy of the right eye, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1969 to April 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an October 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for trigeminal neuralgia, claimed as a nerve disability on the right side of the face, is remanded. By way of background, the Veteran’s claim for service connection for trigeminal neuralgia was first remanded by the Board in April 2015 and October 2017, and then denied in November 2019. This November 2019 Board decision was subsequently vacated, pursuant to a Joint Motion for Remand (JMR) that was granted by the United States Court of Appeals for Veterans Claims (Court) on July 27, 2020. The July 2020 JMR determined that the November 2019 Board decision failed to ensure that the VA examination of record was adequate. Specifically, the JMR determined that the December 2018 VA examination was based upon an inaccurate date of diagnosis and did not provide a rationale for the opinion. See D’Aries v. Peake, 22 Vet. App. 97, 104 (2008), see also Stefl v. Nicholson, 21 Vet. App. 120, 124-5 (2007). For these reasons alone, the Board would be required to remand for addendum opinions accordingly, because the Veteran is entitled to substantial compliance with previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); McKinney v. McDonald, 28 Vet. App. 15, 30 (2016); Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990). Furthermore, the Court noted that the Agency of Original Jurisdiction (AOJ) failed to fully consider all theories of entitlement that are either raised by the claimant or reasonably raised by the record. See Robinson v. Mansfield, 21 Vet. App. 545, 553 (2008) (“The Board commits error only in failing to discuss a theory of entitlement that was raised either by the appellant or by the evidence of record.”), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). The Veteran is service connected for optic nerve atrophy of the right eye effective May 28, 2009, by virtue of an October 2018 rating decision. Meanwhile, the Veteran has asserted since January 2013 at the very latest that “logic dictates, that if you have nerve damage to your right ear, eyes, than [sic] to the right side [of] face, is one and the same.” See VA Form 9 (rec’d Jan. 2013). There is no opinion of record developing the Veteran’s claim for service connection for nerve damage to the right side of his face as secondary to the service-connected optic nerve atrophy of the right eye. On remand, an opinion as to secondary service connection should also be obtained. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. After the receipt of any outstanding records, obtain a VA etiology opinion from an appropriate medical professional to determine the nature and etiology of the Veteran’s claimed trigeminal neuralgia. All pertinent evidence of record must be made available to and reviewed by the examiner. The examiner must review the claims file and note that review in the examination report. The examiner must provide an opinion regarding the following questions: (A) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s trigeminal neuralgia had its onset during service, or is otherwise related to service? The examiner should specifically address whether this condition was incurred or is the result of the Veteran’s reported exposure to an explosion of a rocket propelled grenade during active service, a boxing injury sustained during active duty service, and/or as due to herbicide exposure that is presumed to have occurred during service in Vietnam. (B) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s trigeminal neuralgia is caused or aggravated by his service connected optic nerve atrophy of the right eye? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page)   The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael B. Engle, 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.