Citation Nr: 21023197 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-43 762 DATE: April 20, 2021 REMANDED Entitlement to service connection for vertigo, to include as secondary to service-connected hearing loss and/or tinnitus, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from November 1958 to May 1981. He died in June 2017, and the Appellant is his surviving spouse. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). This case was initially before the Board in May 2018. In May 2018, the Board reopened the claim for entitlement to service connection for vertigo and remanded the reopened claim for further development. In May 2018, the Board also remanded entitlement to a TDIU. The Board again remanded both claims in June 2020 for further development. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for vertigo, to include as secondary to service-connected hearing loss and/or tinnitus, is remanded. In June 2020 the Board remanded for a VA opinion regarding direct service connection. The January 2021 VA examiner opined against relation to service, relying on the lack of documentation of continuity of care after the 1978 in-service diagnosis of viral dizziness. The examiner did not address the Veteran’s reports of intermittent vertigo since service. See, e.g., Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Accordingly, this opinion is inadequate. The Board notes that, despite the January 2019 VA opinion’s deficiencies, the examiner indicated that the Veteran’s vertigo was most likely caused by vestibular neuronitis, which is most commonly caused by a viral type infection. However, no examiner has yet directly addressed the Appellant’s contention that the documented in-service viral dizziness caused the Veteran’s vertigo. Accordingly, another remand is required to obtain an opinion regarding this question. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Because a decision on the issue of entitlement to service connection for vertigo could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. Accordingly, a remand of the claim for a TDIU is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s vertigo was at least as likely as not related to an in-service injury, event, or disease, with consideration of an August 1978 service treatment which documented a diagnosis of viral dizziness syndrome. The examiner should address the January 2019 VA examiner’s opinion that the Veteran’s vertigo was most likely caused by vestibular neuronitis, which is most commonly caused by a viral type infection. Further, the examiner is asked to address the Veteran’s statements regarding having intermittent vertigo in the years since service. The examiner is advised that the absence of documentation of treatment, alone, is not a sufficient basis upon which to opine against relation to service. A complete rationale must be provided for the opinion proffered. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. Amanda E.H. Gibson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, 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.