Citation Nr: 21014275 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 08-22 307 DATE: March 11, 2021 REMANDED The claim for service connection for vertigo on an accrued benefits basis is remanded. The claim for a total disability rating based on individual unemployability (TDIU), due to service-connected disabilities, on an accrued benefits basis, prior to September 17, 2010, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1969. He died in November 2010, and the Appellant is his surviving spouse. 1. Service connection for vertigo is remanded. As stated in the prior Board remand, prior to his death, the Veteran initiated a claim for service connection for vertigo. A review of his private treatment records from the ENT Associates of Greater Kansas City revealed he was diagnosed with benign positional vertigo. The Veteran asserted his vertigo was consequentially related to his service-connected bilateral hearing loss and tinnitus. In the course of his May 2010 VA examination, the examiner found the Veteran’s vertigo was less likely than not caused by his service-connected disabilities, because his service-connected hearing loss and tinnitus began in the 1960s, and he did not experience vertigo until 2005. The Appellant’s representative provided medical journal articles which described a phenomenon known as ipsilateral vertigo. These articles indicated that delayed onset vertigo can occur in people with pre-existing sensorineural hearing loss. In particular, the articles indicated ipsilateral vertigo can occur from 1-60 years after the development of hearing loss. As these articles called into question the basis of the May 2010 and September 2017 VA examiner’s conclusions, and as such, the Board found that an addendum medical opinion addressing these articles was necessary. Pursuant to the November 2019 Board remand, the VA addendum opinion was obtained in June 2020. Where the VA examiner opined that the Veteran’s opinion was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness as the symptoms of vertigo did not arise until 35 years after military noise exposure and was unrelated. Furthermore, the VA examiner opined it was less likely than not proximately due to or the result of the Veteran’s service-connected condition. The VA examiner explained that “[t]he conditions of vertigo and not service connected [disabilities] are not medical related. The vertigo is a separate entity entirely from the not service connected [disabilities] and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established.” The Board finds that this opinion was inadequate and did not substantially comply with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). It failed to acknowledge and address the Veteran’s service-connected hearing loss and tinnitus in consideration of the opinion and the medical journal articles submitted in support of the Appellant’s claim. As such, a new VA addendum opinion is warranted. 2. TDIU is remanded. With respect to the claim for a TDIU rating, the Board finds that this claim is inextricably intertwined with the pending development for the service connection claim. The TDIU claim cannot be reviewed while the pending claim remain unresolved. Thus, adjudication of the TDIU claim must be held in abeyance pending further development of the Veteran’s increased rating and service connection claims. The matters are REMANDED for the following action: Obtain an addendum medical opinion from a VA Otolaryngologist as to the etiology of the Veteran’s vertigo. The VA examiner should answer the following questions: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s vertigo originated during his period of active service or was otherwise caused by his active military service, to specifically include his conceded military noise exposure? why or why not? b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s vertigo was caused by his service-connected hearing loss or tinnitus? Why or why not? c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s vertigo was aggravated (made worse) by his service-connected hearing loss or tinnitus? Why or why not? The VA examiner is asked to consider an address the Veteran and Appellant’s lay statements, the prior May 2010 and September 2017 VA examination reports, as well as any relevant treatment records. The examiner should also specifically review and discuss the above-noted articles provided by the Appellant’s representative regarding the possible delayed onset of vertigo (see “correspondence” received April 12, 2018). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Yoo, 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.