Citation Nr: 21042163 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 15-42 596 DATE: July 12, 2021 REMANDED Entitlement to service connection for a left carotid artery aneurysm, to include as secondary to service-connected left and right hip disabilities, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February to June 1969. This matter is before the Board of Veterans' Appeals (the Board) on appeal from a June 2012 rating decision. In August 2016, a Travel Board hearing was held before the undersigned; a transcript is in the record. In August 2018, the Board dismissed a claim of service connection for a brain aneurysm, declined to reopen a claim of service connection for a left knee disability, and denied service connection for a bilateral hip disability. The Veteran appealed the August 2018 Board decision to the U.S. Court of Appeals for Veterans Claims (CAVC). A November 2019 CAVC Memorandum Decision vacated the Board's decision and remanded the matters seeking to reopen a claim of service connection for a left knee disability, and entitlement to service connection for a bilateral hip disability and a brain aneurysm for further development and readjudication. In a May 2020 statement, the Veteran clarified that the claim of service connection for a brain aneurysm should actually be a claim for a left carotid artery (neck) aneurysm; the characterization of the issue was therefore revised in a July 2020 Board decision. The July 2020 Board decision reopened the claim of service connection for a left knee disability, and remanded that claim on de novo review, along with the matters of service connection for a bilateral hip disability and a left carotid artery aneurysm, for additional development. An interim (November 2020) rating decision, in relevant part, granted service connection for left knee, right hip disability, and left hip disabilities. Accordingly, those matters are no longer before the Board. Entitlement to service connection for a left carotid artery aneurysm, to include as secondary to service-connected left and right hip disabilities The Veteran contends that his left carotid artery aneurysm was caused by (is a complication of) the multiple hip surgeries he underwent in 2011. See May 2020 statement. In July 2020, the Board found this matter was intertwined with the claim of service connection for a bilateral hip disability and remanded it for additional development contingent on an award of service connection for a hip disability. [As noted above, a November 2020 rating decision granted service connection for right and left hip disabilities.] The Board directed development to ascertain the likely etiology of the left carotid artery aneurysm, to specifically include whether it at least as likely as not was caused or aggravated by the service-connected hip disability (to include the surgical treatment for such, i.e., whether his left carotid artery aneurysm was caused by/a complication of such treatment). On April 2021 VA (fee basis) artery and vein conditions examination, left cavernous internal carotid artery (ICA) aneurysm was diagnosed. The Veteran reported that he has no current symptoms, but is followed by a VA physician for continued monitoring every 6 12 months. Following interview/examination of the Veteran and review of his record, the examiner checked the appropriate box to opine that the Veteran's left cavernous ICA aneurysm is less likely than not related to his service. She explained that such was an "incidental finding preoperatively in preparation of hip surgery." She wrote that "there is no causal relationship to the the (sic) Veteran's musculoskeletal conditions or surgical procedures." She opined that the likely etiology of the aneurysm "is likely secondary to hypertension and smoking." The opinion is not fully adequate for rating purposes; the rationale does not address whether the Veteran's left carotid artery aneurysm has been aggravated by his service-connected hip disabilities, including the surgical treatment for such. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-141 (2013) (findings of "not due to," "not caused by," and "not related to" a service-connected disability are insufficient to address the question of aggravation). Accordingly, development for an addendum advisory medical opinion is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following: 1. Secure for the record updated (to the present, any not already associated with the record) complete clinical records of all VA evaluations and treatment the Veteran has received for his left carotid artery aneurysm. 2. After the development requested above is completed, arrange for the Veteran's record to be returned to the April 2021 artery and vein conditions examiner for review and an addendum opinion regarding the likely etiology of the Veteran's left carotid artery aneurysm. [If that provider is unavailable or unable to provide the addendum opinion sought, arrange for the record to be forwarded to another appropriate clinician for review and the opinions sought. If that occurs, and further examination of the Veteran is deemed necessary, such should be arranged.] The Veteran's entire record (to include this Remand, the April 2021 artery and vein conditions examination report, and any records received pursuant to the development ordered above) must be reviewed by the examiner. The examiner should provide opinions that respond to the following: Is it at least as likely as not (a 50% or greater probability) that the Veteran's left carotid artery aneurysm was caused or aggravated by his service-connected right and left hip disabilities, to specifically include surgical treatment for the service-connected hip disabilities (i.e. was caused by/a complication of such treatment)? [The opinion must address aggravation.] All opinions must include rationale, with citation to supporting clinical data and medical literature/principles, as deemed appropriate. 3. Before returning the case to the Board ensure there are complete responses to all questions presented (to forestall yet under remand under Stegall). GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.