Citation Nr: 21027398 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 15-26 559 DATE: May 5, 2021 REMANDED Entitlement to service connection for a fainting disability is remanded. Entitlement to service connection for a dizziness disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1994 to June 2008. This matter came before the Board of Veterans Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during a December 2018 hearing. The transcript of the hearing is of record. December 2018 and August 2020 Board decisions remanded the issues on appeal for further development. 1. Entitlement to service connection for a fainting disability 2. Entitlement to service connection for a dizziness disability The August 2020 Board decision requested a new VA examination conducted by a neurologist to determine the nature and etiology of the Veteran's claimed dizziness and fainting disabilities. A VA examination was provided by a neurologist in October 2020. The examiner found no central nervous system disabilities but diagnosed benign paroxysmal positional vertigo (BPPV). The examiner found that there was no current fainting diagnosis. Regarding BPPV, the examiner said that it was not due to service as there were no in-service records to show evaluation or treatment for dizziness in service and no records to show chronicity. The Board notes that the Veteran's service treatment records contain numerous episodes of treatment for dizziness and passing out, a May 2002 statement that the Veteran underwent a "very extensive" workup for vertigo, and a diagnosis of vestibular neuritis, and therefore finds that this opinion is inadequate as it is based on an inaccurate medical history. The same examiner then provided a December 2020 addendum opinion which stated that the Veteran's fainting/dizziness were separate and distinct disabilities that were likely due to service, noting the episodes of fainting/dizziness when in service. The opinion did not discuss the diagnosis of BPPV or reconcile the opinion with the finding that there was no current fainting disability. The same examiner then provided a second addendum opinion in January 2021, stating that BPPV was not likely incurred in or due to service. As a rationale, the examiner stated that there were no in-service records indicating BPPV occurred in or was caused by service. The examiner did not reconcile this finding with in-service notations of vertigo or dizziness/fainting, the diagnosis of vestibular neuritis, or with his own prior opinion that the fainting/dizziness disabilities began in service. The basis of the opinion that BPPV not due to service is therefore unclear. As the October 2020 opinion is inadequate and the two addendum opinions are contradictory and unclear regarding their rationales, additional clarification is needed regarding both the nature of the Veteran's current disability and whether BPPV began in or is otherwise related to his in-service symptoms and diagnoses, Remand for a new opinion is therefore required. That opinion should clarify both BPPV's onset and etiology and whether the Veteran has a separate and distinct fainting disability or if his fainting symptoms are symptoms of BPPV. The matters are REMANDED for the following action: 1. Obtain a VA opinion from an appropriate provider regarding the nature and etiology of any current fainting and dizziness disabilities, to include BPPV. An in-person examination is only required if the provider deems it to be necessary. The provider should review the file and provide a complete rationale for all opinions expressed. The following opinions are requested: a) Does the Veteran have a current separate and distinct fainting disability or is it a symptom of his diagnosed BPPV? Please explain why or why not. b) Is it at least as likely as not (50 percent or greater probability) that BPPV and any separate and distinct fainting disability found began in service or are related to active service? The opinion should address in-service episodes of dizziness and fainting, May 2002 records noting a workup for vertigo, and the in-service diagnosis of vestibular neuritis. The opinion should also consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Arnold 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.