Citation Nr: 22010538 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 20-18 227 DATE: February 23, 2022 REMANDED Entitlement to service connection for residuals of a traumatic brain injury (TBI) is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depression and/or anxiety, is remanded. Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty for training (ACDUTRA) from April 1964 to October 1964, as well as other short periods of ACDUTRA with the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in August 2021. 1. Entitlement to service connection for residuals of a TBI is remanded. 2. Entitlement to service connection for headaches is remanded. 3. Entitlement to service connection for an acquired psychiatric disorder, to include depression and/or anxiety, is remanded. The Veteran contends that he experienced a TBI during ACDUTRA from the cumulative effect of firing four-inch mortars without hearing protection at least 600 times, which also led to his headaches and psychiatric disorders. Alternatively, the Veteran's representative asserted at the August 2021 Board hearing that the psychiatric disorders might be secondary to bilateral hearing loss, or a neurocognitive disorder. The Veteran's service personnel records indicate a military occupational specialty of heavy weapons infantry and several weapons qualifications and trainings during ACDUTRA. He has not been afforded a VA examination to assess this contention, and he has not provided a nexus opinion from any private health care provider. Separately from this appeal, the Veteran has also claimed service connection for bilateral hearing loss. In support of that claim, he submitted an opinion from a private audiologist, who stated that acoustic trauma results in progressive underlying neuropathology that affects the auditory process. The Board notes that neuropathology is the study of diseases of the nervous system, which includes the brain. The Board finds that the record is sufficient to trigger the duty to assist in providing a VA examination, as there is an indication the in-service weapons firing might be associated with current disabilities, given the possibility of effects on the nervous system from acoustic and/or repeated concussive trauma. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (VA is obliged to provide an examination where there is insufficient information to decide the claim and there is an indication the current disability may be associated with service). The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician to determine whether any TBI residual is related to the Veteran's active duty military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the Veteran experienced a TBI while on active duty for training, including but not limited to TBI caused by the cumulative effect of repeated firing of heavy weapons in his military occupational specialty of heavy weapons infantry. The examiner should also identify all TBI residuals currently found. The examiner should elicit and address the Veteran's lay statements regarding continuity of symptomatology since onset and/or since separation from active duty service. The examiner should address relevant medical literature regarding any neuropathologic or other effect of repeated firing of heavy weapons or similar activity. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Forward the claims file to an appropriate clinician to determine whether the current headaches are related to the Veteran's active duty military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the headaches disability began in or is otherwise caused by the Veteran's active service, to include but not limited to any possible TBI incurred during active duty for training. The examiner should specifically elicit and address the Veteran's lay statements regarding headaches since service. The examiner should address any other pertinent evidence of record. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 3. Forward the claims file to an appropriate clinician to determine whether any current psychiatric disorder is related to the Veteran's military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should identify all current psychiatric and/or neurocognitive disorders found. For each disorder identified, the examiner should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the disorder began in or is otherwise caused by the Veteran's active service, to include but not limited to any possible TBI experienced during active duty for training. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Josey, 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.