Citation Nr: 21016200 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 14-20 992 DATE: March 22, 2021 REMANDED Service connection for a disability manifested by dizziness/vertigo is remanded. Service connection for a disability manifested by nose bleeds, to include as secondary to dizziness/vertigo, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1965 to January 1969. The Veteran testified before the undersigned Veterans Law Judge during a June 2017 hearing. A transcript of the hearing is in the record before the Board. The Board remanded the claims on appeal, along with the issues of service connection for prostate cancer and a skin disability, in May 2018. Subsequent rating decisions granted service connection for prostate cancer and chronic skin lesions, and those issues are no longer before the Board. 1. Service connection for dizziness/vertigo is remanded. This issue is remanded to obtain an adequate medical opinion. The Veteran generally contends that while serving as a fire-fighter during active duty, he was exposed to toxic smoke and fire suppressive chemicals that caused dizziness. He stated that he did not complain of the dizziness during active duty out of fear of reprisals and in order to show leadership. See August 2016 VA Form 21-4138, August 2016 correspondence, and August 2016 VA Form 21-4138. A September 2019 VA Medical Opinion provides that it was less likely than not that the Veteran's dizziness/vertigo was incurred in or caused by the Veteran's service. The examiner acknowledged the Veteran’s report that he has had dizziness ever since fighting a fire in 1966. However, the examiner did not address the significance of this reported history or whether it supported the Veteran's claim. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). The examiner also explained that there was no documentation of dizziness or vertigo in the Veteran's service treatment records. However, the examiner did not acknowledge the Veteran's report that he did not report his dizziness/vertigo during active duty out of fear of reprisals and in order to show leadership. On remand, a medical opinion considering the Veteran's testimony must be obtained. 2. Service connection for nose bleeds, to include as secondary to dizziness/vertigo, is remanded. During the June 2017 hearing, the Veteran argued as an alternative to direct service connection that his nose bleeds are secondary to medication for his dizziness/vertigo. Transcript at page. 10. The Veteran’s claim for service connection for nose bleeds, to include as secondary to dizziness/vertigo, is inextricably intertwined with the dizziness/vertigo claim being remanded. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician responding to the following questions. The opinion provider must review the eFolder. (a.) Is the Veteran’s dizziness/vertigo at least as likely as not (50% or greater probability) related to active service, to include fire-fighting? (b.) Is there any medical reason to accept or reject the proposition that, given the Veteran was exposed to toxic smoke and fire suppressive chemicals in-service, such exposures could have led to the current disorder? (c.) Please explain whether the Veteran’s lay statements (toxic smoke and fire suppressive chemicals caused dizziness) align with how vertigo/dizziness is known to develop. In rendering the opinion, the examiner should consider the Veteran’s report that while serving as a fire-fighter during active duty he was exposed to toxic smoke and fire suppressive chemicals that caused dizziness, but he did not report the dizziness during active duty out of fear of reprisals and in order to show leadership; and that he has had dizziness ever since separation. A complete rationale must be provided for any opinion offered. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the inextricably intertwined issues of entitlement to service connection for dizziness/vertigo and service connection for nose bleeds, to include as secondary to dizziness/vertigo. If either benefit sought on appeal is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Davitian, 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.