Citation Nr: 22010761 Decision Date: 02/24/22 Archive Date: 02/24/22 DOCKET NO. 20-02 990 DATE: February 24, 2022 REMANDED Entitlement to service connection for benign paroxysmal positional vertigo (BPPV), to include as secondary to service-connected bilateral hearing loss, is remanded. REASONS FOR REMAND The Veteran had active military service from February 1957 to August 1961 and from August 1961 to August 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2021, at which time it was remanded for further development. The Veteran testified before the undersigned Veterans Law Judge during a November 2021 Board hearing. A copy of the transcript has been associated with the file. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900. Entitlement to service connection for benign paroxysmal positional vertigo (BPPV), to include as secondary to service-connected bilateral hearing loss Establishing service connection for purposes of entitlement to VA disability compensation generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the claimed in-service injury or disease and the current disability. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Secondary service connection may be granted for disabilities which were proximately due to, the result of, or aggravated beyond natural progression by a service-connected disability. 38 C.F.R. § 3.310(a). The Veteran contends that his currently diagnosed BPPV is related to service. In the alternative, he contends that his BPPV is secondary to his service-connected bilateral hearing loss. He contends that chronic infections of his right ear during service and a post-service surgery in 1968 to repair a ruptured eardrum have resulted in vertigo and dizziness, beginning in service with continuity of symptomatology. As an initial matter, the Board notes that the Veteran has a current diagnosis of BPPV and is service connected for bilateral hearing loss. In addition, service treatment records document treatment for chronic otitis media, perforation of tympanic membrane (right), mastoiditis, and chronic right ear infections. In November 2021, the Board remanded the case to the RO for additional development. Specifically, the Board requested a medical opinion on both direct and secondary service connection. The examiner was directed to consider the Veteran's contentions regarding the onset and continuity of his vertigo symptoms. Accordingly, addendum opinions were provided in December 2021. The VA examiner found it was less likely than not that the Veteran's BPPV was related to service, or to his service-connected bilateral hearing loss. Although the examiner noted medical evidence suggesting a diagnosis of BPPV in 2008 and 2010, she failed to address the Veteran's contentions of experiencing vertigo in-service, with continuity of symptoms since service, as requested by the Board remand. In addition, a treatment record from January 2007 noted vertigo since his 1968 surgery. As such, remand is required for addendum medical opinions. VA has a duty to ensure that medical examinations are adequate. For the reasons outlined above, the Board finds the examiner's opinions inadequate. Consequently, a remand for addendum opinions is necessary to correct such inadequacies and ensure the completeness of the medical evidence prior to the Board's adjudication of the Veteran's claim. Remand is further warranted as the Veteran testified during his November 2021 Board hearing that a private ENT specialist from Wheeling, WV had provided a positive nexus opinion regarding his vertigo. He testified he submitted this document to his VFW representative at the time to associate with the file. No such document is of record. Hearing Transcript, Page 7. On remand, efforts should be made to procure the private treatment records from Wheeling, WV, including the private positive nexus opinion that the Veteran contended he submitted to his VFW representative in July 2019 or in 2020. Furthermore, the Veteran testified that he continues to receive treatment for his vertigo through VA, at Watson's Clinic in Lakeland, Florida, but no records are associated with the file. Hearing Transcript, Page 11. Accordingly, on remand efforts should be made to obtain those records. VA must "make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant's claim for a benefit." 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(1). The matter is REMANDED for the following action: 1. Obtain and associate with the file any outstanding VA treatment records, including but not limited to, relevant treatment records from Watson's Clinic in Lakeland, Florida. 2. Ask the Veteran to provide appropriate releases for records of private treatment from providers in Wheeling, WV, and to identify and provide an appropriate release for relevant private treatment records for any other care providers who have treated him for the issue remaining on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new and additional evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact and the Veteran and his representative should be notified. 3. Encourage the Veteran and his representative to submit any evidence, to include any positive medical opinions relating the Veteran's BPPV to service and/or secondary to the Veteran's service-connected bilateral hearing loss. This includes a copy of the private nexus opinion from the Wheeling, WV ENT specialist the Veteran mentioned during his November 2021 Board hearing. 4. After the necessary records development has been completed, obtain addendum opinions regarding the nature and etiology of the Veteran's BPPV. The entire claims file, including a copy of this Remand, must be made available to, and reviewed by the examiner. The examiner is asked to opine: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's BPPV arose during his period of active service, or is otherwise related to an in-service injury, event, or disease during the Veteran's active service, to include his conceded in-service noise exposure. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's BPPV was (1) proximately due to the Veteran's service-connected hearing loss, or (2) aggravated beyond its natural progression by the Veteran's service-connected bilateral hearing loss. The examiner is asked to provide a specific opinion on both causation and aggravation. In providing an opinion, a full record review is necessary, specifically addressing: (1) the Veteran's contentions that his continual right ear infections in service caused dizziness and vertigo in service, with symptoms continuing to present; (2) the January 2007 treatment record noting vertigo since his 1968 eardrum surgery; (3) the Veteran's service treatment records documenting chronic ear infections, chronic otitis media, chronic mastoiditis, and a perforated tympanic membrane and post-service treatment noting surgery for a perforated eardrum. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. However, if there is medical reason to doubt its veracity, the examiner should explain why the Veteran's statements or recollections are inconsistent with the evidence in this case, medical principles relating to the onset and progress of the disease, the specific findings in the record, and/or your professional judgment. Failure to consider and comment on the Veteran's credible lay statements will result in an inadequate opinion. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Krista Johnson, Associate 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.