Citation Nr: 0004615 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 98-10 405 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for fainting episodes. ATTORNEY FOR THE BOARD T. Mainelli, Associate Counsel INTRODUCTION The appellant had active service from June 1973 to August 1980. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 1997 rating decision, in which the Montgomery, Alabama, Regional Office (RO) of the Department of Veterans Affairs (VA) denied the appellant's claim for service connection for fainting episodes. The Board remanded this claim in November 1998, and following completion of the requested development, the case has been returned for further appellate review. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the appellant's appeal has been obtained by the RO. 2. Syncopal episodes, recently diagnosed as complex partial seizures without secondary generalization, were first manifested in service. CONCLUSION OF LAW Complex partial seizures without secondary generalization were incurred during active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the appellant's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Furthermore, the evidence is sufficient to decide the case. The Board accordingly finds the duty to assist him, mandated by 38 U.S.C.A. § 5107, has been satisfied. The appellant contends, in essence, that his syncopal episodes were first manifested, or incurred, during active service. On his induction examination, dated in June 1973, he denied complaint of "dizziness or fainting spells" and, in pertinent part, he was given a "normal" clinical evaluation. He first experienced a fainting spell in November 1973. At that time, the diagnosis was of fainting of questionable etiology, although a probable early viral syndrome was suspected. In November 1974, he presented with complaint of intermittent dizzy spells and syncopal episodes. He also reported a history of dizziness since the 4th grade. No formal diagnosis was offered. Post- service, the appellant was first treated for a syncopal episode by VA in 1989. Private medical providers also treated him for syncopal episodes of unknown etiology in 1996 and 1998. At those times, possible underlying factors of heat exhaustion, urinary tract infection and/or febrile illness had been noted. In 1998, the appellant underwent an extensive neurological evaluation by Arturo J. Otero, M.D. The examination report noted that a magnetic resonance angiography (MRA) of cranium revealed three tiny scattered abnormalities in the white matter of uncertain etiology, but the remainder of examination was otherwise unremarkable. Dr. Otero was unable to determine an etiological basis for the syncopal episodes, but he noted that they seemed to resemble some form of dysautonomic event. It did not appear that they were associated with any type of paroxysmal neurological event. Impression was of atypical episodes of paroxysmal loss of consciousness heralded by nausea, flushing sensation and dizziness. At that time, the appellant was given a prescription of carbamazepine. In May and August 1999, the appellant was afforded VA epilepsy and narcolepsy examinations with benefit of review of his claims folder. At that time, he reported the cessation of syncopal episodes following his treatment with anti- convulsants. Upon reviewing the record, the examiner commented that the etiology of the episodes of loss of consciousness was unclear and, thus, an organic disorder could not be identified. However, it was noted that, based upon his response to anti- convulsants, the syncopal episodes might by a manifestation of complex partial seizures without secondary generalization. If so, the examiner was of the opinion that such disorder did manifest itself during active service. Nonetheless, there was no electrophysiological evidence to confirm such a disorder. In this case, the appellant's induction examination does not contain any findings relative to a pre- existing condition of syncopal episodes. As such, he is presumed to have entered service in sound condition. 38 C.F.R. § 3.304(b) (1999). In order to rebut the presumption of soundness, there must be clear and unmistakable (obvious or manifest) evidence that such disability existed prior to service. Id. His service medical records do note his report of dizziness since the 4th grade, but such a report, in and of itself, is insufficient to overcome the presumption of soundness. See Miller v. West, 11 Vet.App. 345, 348 (1998)(determination of the existence of a pre- existing condition must be supported by contemporaneous evidence, or recorded history in the record, which provides a sufficient factual predicate to support a medical opinion). There is no medical evidence of record to support a finding that syncopal episodes existed prior to service and, therefore, the Board must conclude that a syncopal disorder did not pre- exist service. By his statements of record, the appellant has alleged to continuity of symptomatology following service. See Savage v. Gober, 10 Vet.App. 488 (1997); 38 C.F.R. § 3.303(b) (1999). Although medical examinations have failed to identify an underlying organic disorder for the appellant's syncopal episodes, he nonetheless holds current diagnoses of atypical episodes of paroxysmal loss of consciousness and complex partial seizures without secondary generalization. In August 1999, a VA examiner opined that the appellant's current complex partial seizures without secondary generalization were first manifested during service. This opinion is unrebutted by any medical evidence of record. See Hanson v. Derwinski, 1 Vet.App. 512 (1991) (an appellant is entitled to service connection where he submits supportable medical opinion of an etiological relationship that is unrebutted by other medical opinion of record). Accordingly, the Board concludes that service connection for complex partial seizures without secondary generalization is warranted. ORDER Service connection for complex partial seizures without secondary generalization is granted. NANCY I. PHILLIPS Member, Board of Veterans' Appeals