Citation Nr: 21010326 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 10-07 721 DATE: February 24, 2021 REMANDED Entitlement to service connection for syncope, claimed as dizziness or vertigo, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from April 1973 to July 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2007 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board has previously remanded the case for further development in June 2017, January 2018, August 2019, and September 2020. There has not been substantial compliance with the September 2020 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for syncope, claimed as dizziness or vertigo, is remanded. In September 2020, the Board remanded claim for an addendum opinion on whether the Veteran’s claimed condition is at least as likely as not aggravated by the Veteran’s service-connected disabilities, or aggravated by treatment for such. An addendum opinion was received in October 2020. The VA examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted, “Syncope is not an otologic diagnosis. It is usually related to cardiovascular pathology. There is no medical evidence of a causal relationship between the symptom of syncope and tinnitus, hearing loss or depression, nor is there any such relationship between syncope and acoustic trauma.” The U.S. Court of Appeals for Veterans Claims has indicated that findings of “not due to,” “not caused by,” and “not related to” a service-connected disability are insufficient to address the question of aggravation under 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). As the October 2020 VA opinion does not address aggravation sufficiently, a remand is required for an addendum opinion. Stegall, 11 Vet. App. at 268. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate VA clinician regarding whether the Veteran’s syncope is at least as likely as not aggravated beyond its natural progression by the Veteran’s service-connected hearing loss, tinnitus, and depression or the treatment for these conditions. A complete rationale for the requested opinion should be provided. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jake Choi, 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.