Citation Nr: 21015312 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-40 038 DATE: March 17, 2021 REMANDED Entitlement to service connection for recurrent epistaxis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1992 to February 2000 and the Army Reserves from August 2002 to June 2003 and from January 2004 to November 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. In December 2018, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In May 2019, the Board remanded the claim to obtain VA examinations with etiological opinions. Entitlement to service connection for recurrent epistaxis. The Veteran contends that his recurrent epistaxis is related to service. The Veteran’s November and December 2009 VA treatment records indicate that he reported suffering a concussion after he was struck in the head by a bird while he was a gunner on a Humvee. The Veteran reported that he has had frequent epistaxis and monthly headaches since the incident. The physician assessed the Veteran with mild TBI and recurrent epistaxis. Upon remand, a VA examiner was asked whether the Veteran has a diagnosis of (a) recurrent epistaxis that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) that a disability manifested by epistaxis was incurred in or is otherwise etiologically related to service. During the November 2019 VA examination, the examiner noted a 2009 diagnosis of epistaxis and confirmed recurrent reports and treatment for such. However, the examiner opined that the condition claimed was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner further opined that there is no aggravation of epistaxis and records do not support aggravation. No additional rationale regarding aggravation was provided. Additionally, the Board notes that since the date of the November 2019 examination, the Veteran has become service connected for TBI. As noted above, the Veteran complained of epistaxis and TBI as having a shared onset. Although the opinion addresses whether epistaxes stems from the bird incident, it is unclear whether there is a relationship or association between the epistaxis and TBI. However, the opinion does not provide sufficient rationale regarding secondary service connection, which has been raised by the record particularly since service connection is in effect for TBI. On this basis, the Board finds that there remains question as to whether the epistaxis is proximately due to or aggravated beyond its natural progression by service-connected TBI. The Board regrets the further delay but finds that a remand is necessary to afford the Veteran full consideration of his claim. Specifically, a supplemental opinion addressing secondary service connection with TBI is needed prior to adjudication of the appeal. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Following a review of the record and copy of this remand, an examiner is asked to provide a supplemental opinion on secondary service connection as follows: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s epistaxis is proximately due to or the result of service-connected TBI? b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s epistaxis is aggravated beyond its natural progression by service-connected TBI? The examiner must review the entire record in conjunction with the rendering of the requested opinion. A complete rationale must be provided for any opinion offered. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and indicate what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.