Citation Nr: 21023408 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-38 739A DATE: April 20, 2021 REMANDED Entitlement to service connection for an aneurysm is remanded. REASONS FOR REMAND The Veteran is well decorated and served active duty in the United States Marine Corps from November 1983 to November 2003, including service to Southwest Asia. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). A hearing was held before the undersigned Veterans Law Judge in February 2021. A transcript of that hearing is associated with the record. Initially, the Board notes that the Veteran is already service-connected for headaches. The Veteran has been diagnosed with a left intracranial carotid fusiform aneurysm. See August 2018 treatment record. In a February 2021 Board hearing, the Veteran testified that he believes his condition is related to his military service, including the stress he endured and the environmental effects. See Board hearing transcript. Service treatment records show the Veteran experienced tension headaches. See April 1989 record. A February 2001 record shows the Veteran had a loss of motor skills on his left side. An April 2003 record indicates the Veteran has a history of an aneurysm. The Veteran was afforded a VA examination related to his headaches in December 2012. At that time, the examiner indicated the Veteran had undergone a brain MRI and angiogram that were both normal with no evidence of a cerebral aneurysm. However, several treatment records indicate otherwise. See April 2001, June 2004, August 2008, and February 2021 treatment records. A May 2004 treatment record indicates the Veteran has headaches associated with his left carotid aneurysm. There is no VA examination currently in the file that speaks directly to the Veteran’s diagnosed aneurysm. Additionally, the findings in the headaches VA examination conducted in December 2012 are contrary to the numerous records in the file that indicate the Veteran indeed has a left intracranial carotid fusiform aneurysm. The Board notes that a February 2021 private opinion from Dr. J.B. indicated that the Veteran has been diagnosed with a fusiform aneurysm in his left carotid artery. Additionally, he opined that the aneurysm is likely as not the root cause of the Veterans headaches and other issues linked to the condition. Lastly, he indicated that he believed the stress and exertion experienced by the Veteran while on his tour in Japan led to the strokes he experienced. For the reasons above, remand is necessary for another VA examination and opinion and to obtain any outstanding private treatment records. The matters are REMANDED for the following action: 1. Request the Veteran to identify and provide authorization for VA to obtain all outstanding private treatment records. Specifically, during the February 2021 hearing, the Veteran indicated that he was referred to a local neurologist, Dr. “Harry Kerasidis” for continued treatment for the aneurysm. Please request the Veteran to identify and provide authorization for VA to obtain the treatment records from this physician. 2. After completing the foregoing development, the Veteran should be afforded a VA examination, by a neurologist (M.D.) to determine the nature and etiology of the aneurysm disorder that is noted in the Veteran’s treatment records, even if such disability has since resolved.sent. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should be given a copy of this remand. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment and personnel records, post-service medical records, and statements. The examiner is requested to opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran has an aneurysm disorder that manifested in or is otherwise related to his military service, including any symptomatology therein. In providing this opinion, the examiner should reconcile his or her opinion with that provided in a February 2021 private opinion from Dr. J.B. The examiner should also consider the Veteran’s assertions that he has an aneurysm caused by the stress and environmental impacts that he experienced while in service. See February 2021 Board hearing transcript. Service treatment records also show the Veteran had a history of an aneurysm while in service, as well as, numerous treatments associated with headaches. Post-service treatment records show the Veteran has undergone continuous treatment for an aneurysm. It should be noted that the Veteran is competent to attest to factual matters of which she has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.M. Walker 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.