Citation Nr: 21028032 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 19-34 431 DATE: May 10, 2021 REMANDED Entitlement to service connection for vertigo, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for disorder manifested by nosebleeds, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1964 to June 1967. This matter comes before the Board of Veterans Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that an October 2020 Board decision issued under the modernized appeals system known as the Appeals Modernization Act (AMA) remanded the issues of entitlement to service connection for asbestosis, bilateral lower extremity peripheral neuropathy, bilateral upper extremity peripheral neuropathy, bilateral hip disorder, bilateral shoulder disorder, bilateral knee disorder, headaches, sinusitis, skeletal arthritis (degenerative joint disease), and a psychiatric disorder. However, such claims are still being developed, and if returned to the Board, will be the subject of a separate Board AMA decision, if otherwise in order. The case was remanded in November 2020 and now returns for further appellate review. 1. Entitlement to service connection for vertigo, to include as secondary to service-connected disability. 2. Entitlement to service connection for disorder manifested by nosebleeds, to include as secondary to service-connected disability. 3. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disability. The Veteran contends his vertigo, a disorder manifested by nosebleeds, and obstructive sleep apnea either had their onset in service or, in the alternative, are caused or aggravated by his service-connected disabilities. Specifically, he contends such disorders are due to his residuals of a facial fracture, sustained after a blow to the head during service. Additionally, he claims his vertigo disorder is also due to his tinnitus. As an initial matter, the Board notes the Veteran has current diagnoses of epistaxis (nosebleeds), Benign Paroxysmal Positional Vertigo (vertigo), and obstructive sleep apnea (OSA). See March 2021 VA examinations, and March 2013 Sleep Study. Pursuant to the November 2020 remand, the Veteran was afforded a VA examination to determine the nature and etiology of such disorders. After a review of the record and in-person examinations, the examiner offered unfavorable nexus opinions. In this regard, she reiterated the same rationale for each opinion, noting the Veteran's service treatment records (STRs) were silent for any nosebleed, vertigo, or sleep apnea condition, and finding there was no nexus of evidence linking any nosebleed, vertigo, or OSA condition in service to his conditions today. Specific to the Veteran's nosebleeds, she stated there are numerous causes, to include digital trauma as the primary cause. Thus, she opined, there is no medical or scientific evidence to support the Veteran's claims. Similarly, as to the claims of secondary service connection, the examiner reiterated the same opinion, stating, after a review of the medical and scientific evidence in the electronic file, the claimed conditions of nosebleed, vertigo, and sleep apnea were less likely than not proximately due to or the result of or aggravated beyond their natural progression by the Veteran's [service-connected] bilateral hernias (to include repair), tinnitus, painful hernia scars, residuals of facial bone fractures to include trigeminal neuralgia, or bilateral hearing loss. The examiner found such are all separate and distinct conditions and explained that there must be documented pathology to support the claims. The examiner further found there is no medical or scientific evidence linking any nosebleed, vertigo, or OSA conditions to any of the above listed [service-connected] conditions. Thus, she opined, there is no medical or scientific evidence to support the Veteran's claims. Upon review, the Board finds that an addendum opinion is necessary to decide the Veteran's claims as the opinions regarding secondary service connection are inadequate. Specifically, the examiner provided a conclusory rationale as she states each of his service-connected disabilities are separate and distinct conditions, and there is no link between such conditions and the Veteran's nosebleeds, vertigo, or OSA disorders. In this regard, the examiner did not address the Veteran's contentions that his current nosebleeds, dizziness (vertigo), and OSA are due to his facial fractures, to include a broken jaw and nose, which are facial fractures documented in his STRs. See November 1965 STR, May 1975 Medical Examination for Disability, Veteran's March 21, 2021, and May 2014 letters. Further, the Veteran also contends his vertigo is the result of his service-connected tinnitus. The examiner failed to discuss this specific contention, although the link between imbalance and tinnitus/hearing loss is well-established. Thus, the Board finds that a remand is necessary to obtain an adequate addendum opinion addressing such matters. The matters are REMANDED for the following action: Forward the record to an appropriate clinician(s) other than the VA examiner who provided the March 2021 VA examination. The record, to include a copy of this Remand, must be made available to and be reviewed by the clinician(s). The need for additional examination of the Veteran is left to the discretion of the clinician(s) selected to write the addendum opinion. Following a review of the record, to include the Veteran's lay statements, the clinician(s) should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's currently diagnosed nosebleeds, vertigo, and/or OSA disorders had their onset in, or are otherwise related to, the Veteran's military service, to include the documented November 1965 reports of a broken jaw and nose. The clinician(s) should also provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's currently diagnosed nosebleeds, vertigo, and/or OSA disorders are proximately due to and/or aggravated by a service-connected disability. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. (Continued on the next page) In rendering such opinion, the examiner must address the Veteran's specific lay statements regarding the onset, history, and etiology of his associated symptomatology. A complete rationale should be provided for any opinion offered. M. M. Celli Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly 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.