Citation Nr: 22018064 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-41 526 DATE: March 28, 2022 ORDER Entitlement to service connection for a seizure disorder is denied. FINDING OF FACT The persuasive weight of the evidence is against finding that the Veteran's seizure disorder is causally or etiologically related to her active service. CONCLUSION OF LAW The criteria for service connection for a seizure disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1978 to March 1979 and April 1989 to June 1989. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019 and October 2021, this matter was remanded for further evidentiary development. Prior to certification of the present claim to the Board, the Veteran's representative submitted correspondence withdrawing his representation and informed the Veteran of his withdrawal. See March 2020 Correspondence. The October 2021 Board remand found the withdrawal to be valid, and the Board continues to consider the Veteran to be unrepresented. The Veteran has not raised any issues in the current appeal that are not discussed herein, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Service connection for a seizure disorder Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for chronic disabilities if such is shown to have been manifested to a compensable degree within one year after the Veteran was separated from service. 38 U.S.C. §§ 1101, 1113; 38 C.F.R. §§ 3.307, 3.309. VA administers the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. The Veteran contends that she has a seizure disorder related to her military service. Confusingly, she has reported differing dates and circumstances relating to when her seizure disorder began. She has stated that her seizures developed secondary to her service-connected degenerative disc disease of the lumbar spine (hereinafter, back disability) or that she experienced a seizure which led to her injuring her back because she slammed into a wallor that the seizures developed after receiving anesthesia for either a rotator cuff surgery, a knee surgery at age 25, or following a hysterectomy. See September 2013 Statement in Support of Claim and September 1999, December 2003, August 2008, and January 2009 VA Treatment Records. She also reported that her seizures began at age 22 or age 25 and described a 25-year history of seizures in 2008, 2009, 2011, 2012, and 2013, and that her seizures began in November 2002. See, e.g., November 2007, January 2008, July 2008, August 2008, July 2011, September 2012, and January 2013 VA Treatment Records and January 2009 Social Security Administration (SSA) Records. Her service treatment records (STRs) do not reflect any complaints of, or treatment for, a seizure disorder. The Veteran's claims file includes multiple diagnoses: a seizure disorder; a seizure disorder thought to likely be primary generalized epilepsy; and generalized idiopathic epilepsy and epileptic syndromes. See November 2002, March 2008, and June 2020 VA Treatment Record and September 2020 VA Examination. The question is whether the Veteran's seizure disability is related to her active duty. Unfortunately, after a thorough review of the claims folder, the Board concludes that the weight of the evidence is against finding that the Veteran's seizure disorder is causally or etiologically related to her military service. The Veteran's VA treatment records reflect a diagnosis of, and treatment for, a seizure disorder dating back to 1999, with reports that her seizures may have begun even before that date. Following the March 2019 Board remand, the Veteran was accorded a VA examination in September 2020. The examiner included a diagnosis of generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus. The examiner recorded the Veteran's report of her history of seizures and that a diagnosis of seizures was given in 2008 based on a review of the records. The examiner opined that the Veteran's seizure disorder was not caused by her service or a service-connected condition. The examiner indicated that there was no objective evidence to support that the condition began in service, was caused by service or is otherwise etiologically related to service. The examiner suggested that, based on the Veteran's own statements provided in 2008, her condition pre-existed her service and there was no objective evidence to support that the condition was clearly and unmistakably aggravated beyond its natural progression by her military service. As support for this opinion, the examiner conducted an extensive review of the Veteran's claims file and referenced medical literature describing the causes of epilepsy and noted that a significant portion of cases are of unknown etiology. The October 2021 Board remand found the September 2020 VA examination to be adequate with the exception of the portion of the opinion addressing secondary service connection, as the examiner did not address whether the Veteran's seizure disorder was aggravated by her service-connected back disability. The Board noted that the Veteran contends her seizures began following her separation from service after a back injury and that the record reflects a back injury in 1989 and the Veteran is presently service connected for a back disability. A VA opinion was obtained in November 2021, which the Board finds to be adequate for adjudication purposes and complete in its rendering. As such, the Board finds substantial compliance with the October 2021 Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). The November 2021 VA medical examiner opined it was less likely than not that the Veteran's seizure disorder was caused by her service-connected back disability. The examiner referenced the September 2020 VA examination and reiterated that the Veteran reported, in 2008, that her seizures started when she was 25 years old in 1984. As noted above, it is unclear when the Veteran's seizures began as she provided differing reported onset dates and she has been inconsistent throughout the appeal period. The examiner stated that the Veteran's seizures would have reportedly pre-existed her injury that caused her back condition in 1989, if they did begin in 1984, and stated that a condition that already existed cannot be caused by a later incident. The examiner further opined that, even if this was not the case, a review of the medical literature does not demonstrate an etiological nexus between a back condition and seizure disorders. In support of this opinion, the examiner included a citation to medical literature addressing the causes of epilepsy and reiterated that a causative nexus could not be supported or established by peer reviewed medical literature. In addressing the question of aggravation, the examiner opined that it was less likely than not that the Veteran's service-connected back disability aggravated her seizure disorder. The examiner explained that this was so because there was no objective evidence to support the notion that the Veteran's service-connected back condition caused any measurable aggravation of her seizure condition beyond its natural progression. The most competent evidence of record does not demonstrate a causal or etiological link between the Veteran's seizure disorder and her military service. The Board assigns significant weight to the September 2020 and November 2021 VA opinions, as the examiners fully addressed the Veteran's claim. The examiners fully considered the Veteran's contentions and medical literature in providing rationale for the provided opinions. While the Veteran is competent to report her symptoms and to express her belief that her current disability is related to her service, she is not competent to provide a nexus opinion in this case. The record does not reflect that she has the requisite training or expertise to offer a medical opinion linking her current disability to her service, and as such she is not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). The Board finds the medical evidence of record to be more probative in finding that the Veteran's current seizure disorder is not related to her active service, as such was based on statements from and an interview with the Veteran and a review of the claims file by examiners with the requisite expertise for making such a determination. The September 2020 and November 2021 VA opinions are not contradicted by other competent, credible evidence of record, and the opinions provided therein do not support the Veteran's service connection claim. The record does not support the claim for service connection for a seizure disorder. In reaching this determination, the Board is mindful that all reasonable doubt is to be resolved in the Veteran's favor. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). However, because the evidence persuasively weighs against the claim, it must be denied. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Goreham 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.