Citation Nr: 22017604 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 20-25 996 DATE: March 25, 2022 REMANDED Entitlement to compensation for residuals of a fall under 38 U.S.C. § 1151 is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1980 to April 1987 and from January 1991 to June 1991. The Veteran passed away in October 2018. The appellant is his surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). This case was previously before the Board in April 2021 and December 2021, on which occasions the claim was remanded. Entitlement to compensation for residuals of a fall under 38 U.S.C. § 1151 is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the Veteran's claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the December 2021 Board decision the claim was remanded for further medical development. Specifically, the Board requested an addendum opinion considering whether the Veteran suffered an additional disability from a December 2017 fall during a syncopal episode that occurred as a side-effect of his prescribed Xarelto, Warfarin, and/or Pradaxa. In December 2021 VA addendum opinions were proffered by a dentist and a neurologist. In the dental opinion, the VA examiner opined that the Veteran did not have an additional disability. (12/20/2021, C&P Exam, p. 5). However, examinations conducted prior to the Veteran's death note that he was missing teeth 6 and 12, which the Appellant asserts were knocked out as a result of the December 2017 fall. Dental records from October 2017, prior to the fall, specifically note that tooth 6 was radiographed, but dental records from after the fall note that both teeth 6 and 12 were missing. The December 2021 dental examiner attributed the loss of these teeth to chronic adult periodontitis, but cited to no evidence confirming that these teeth were missing prior to the December 2017 fall. As such, the Board finds that there is sufficient evidence to find that an additional dental disability, namely the loss of teeth 6 and 12, occurred. Similarly, the December 2021 neurology opinion found that there was no evidence of an additional disability as a result of the December 2017 fall. (12/30/2021, C&P Exam, p. 4). However, a July 2018 VA examination did note a scar on the Veteran's forehead, which the examiner attributed to the December 2017 fall. (7/24/2018, C&P Exam, p. 13). As such, the Board finds that there is sufficient evidence to find that an additional disability, namely a forehead scar, occurred. As both December 2021 VA addendum opinions found that the Veteran suffered no additional disabilities, despite the aforementioned evidence documenting new disabilities after the December 2017 fall, the Board finds that the opinions are inadequate for evaluation purposes. As such, the Board must remand the claims for new addendum opinions. Additionally, while the appellant has not asserted that the Veteran's fall was caused by his service-connected disabilities, evidence in the Veteran's medical records raises the possibility that the December 2017 fall may have been related to his service-connected chronic obstructive pulmonary disease (COPD). In this regard, a January 2018 discharge summary notes that the Veteran was recovering from an upper respiratory infection. (6/26/2018, CAPRI, p. 2). Based on this notation, the Board finds that a medical opinion is needed regarding whether the Veteran's syncope was at least as likely as not proximately due to, or worsened beyond its natural progression, by his service-connected COPD. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the following: (a.) Was the loss of teeth 6 and 12, and the Veteran's forehead scar proximately caused by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the therapy, namely prescribing the Veteran Xarelto, Warfarin, and/or Pradaxa. When making this determination, please discuss if VA failed to exercise the degree of care that would be expected of a reasonable health care provider. (b.) If it is found that an additional disability was caused by the fall that occurred in December 2017 and/or the Veteran's prescribed Xarelto, Warfarin, and/or Pradaxa, the examiner should also provide an opinion as to whether any identified additional disability was an event that was reasonably foreseeable or an event not reasonably foreseeable. That is, was the event the type of risk that a reasonable health care provider would have disclosed in connection with informed consent procedures? (c.) Were the Veteran's episodes of syncope at least as likely as not proximately due to COPD? (d.) Were the Veteran's episodes of syncope at least as likely as not aggravated, i.e., worsened beyond its natural progression, by COPD? If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time. Following the above, issue a supplemental statement of the case, including adjudication on a secondary service connection basis. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Glenn, 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.