Citation Nr: 1015488 Decision Date: 04/28/10 Archive Date: 05/06/10 DOCKET NO. 08-13 403 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for left ankle arthritis. 2. Entitlement to service connection for musculoligamentous strains of the bilateral knees. 3. Entitlement to service connection for bilateral knee arthritis. 4. Entitlement to service connection for right hip condition, to include arthritis. 5. Entitlement to service connection for dizziness. 6. Entitlement to service connection for right ankle condition, to include arthritis. 7. Entitlement to service connection for left ankle strain. 8. Entitlement to service connection for bursitis, left hip. 9. Entitlement to service connection for left hip arthritis. 10. Entitlement to service connection for bilateral hearing loss. REPRESENTATION Appellant represented by: Nebraska Department of Veterans' Affairs ATTORNEY FOR THE BOARD L. Barstow, Associate Counsel INTRODUCTION The Veteran had active military service from January 1964 to January 1968, and from November 1981 to April 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. The issue of service connection for dizziness being remanded is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran has not been diagnosed with left ankle arthritis. 2. The Veteran's musculoligamentous strains of the bilateral knees are not causally or etiologically related to his military service. 3. The Veteran does not have a current diagnosis of bilateral knee arthritis. 4. The Veteran has not been diagnosed with any right hip conditions. 5. The Veteran has not been diagnosed with any right ankle conditions, to include arthritis. 6. The Veteran's left ankle strain is not causally or etiologically related to his military service. 7. The Veteran's left hip bursitis is not causally or etiologically related to his military service. 8. The Veteran does not have a current diagnosis of left hip arthritis. 9. The Veteran's bilateral hearing loss is as likely as not related to his military service. CONCLUSIONS OF LAW 1. The Veteran does not have left ankle arthritis that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2009). 2. The Veteran does not have musculoligamentous strains of the bilateral knees that are the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2009). 3. The Veteran does not have bilateral knee arthritis that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 11375107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2009). 4. The Veteran does not have a right hip condition, to include arthritis, that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2009). 5. The Veteran does not have a right ankle condition, to include arthritis, that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2009). 6. The Veteran does not have a left ankle strain that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2009). 7. The Veteran does not have left hip bursitis that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2009). 8. The Veteran does not have left hip arthritis that is the result of disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2009). 9. Resolving reasonable doubt in favor of the Veteran, the Veteran's bilateral hearing loss was incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board notes that the Veteran was apprised of VA's duties to both notify and assist in correspondence dated in July 2007, well before the AOJ's initial adjudication of the claims. Specifically regarding VA's duty to notify, the notification to the Veteran apprised him of what the evidence must show to establish entitlement to the benefits sought, what evidence and/or information was already in the RO's possession, what additional evidence and/or information was needed from the Veteran, what evidence VA was responsible for getting, and what information VA would assist in obtaining on the Veteran's behalf. The notification included the criteria for assigning disability ratings and for award of an effective date, see Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The RO also provided a statement of the case (SOC) and a supplemental statement of the case (SSOC) reporting the results of its reviews of the issues on appeal and the text of the relevant portions of the VA regulations. Regarding VA's duty to assist, the RO obtained the Veteran's service treatment records (STRs), post-service medical records, and secured examinations in furtherance of his claims. VA has no duty to inform or assist that was unmet. VA opinions with respect to the issues on appeal were obtained in August 2007. 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As noted below, the Board finds that the August 2007 VA opinions obtained in this case were sufficient, as they were predicated on a full reading of the VA medical records in the Veteran's claims file. They consider all of the pertinent evidence of record, the statements of the appellant, and provide explanations for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c)(4). II. Merits of the Claims Law Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in- service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Caluza v. Brown, 7 Vet. App. 498 (1995). Certain chronic diseases, including sensorineural hearing loss and arthritis, may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307(a)(3); 3.309(a) (2009). Moreover, the absence of evidence of hearing loss in service is not a bar to service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993). Analysis Left ankle arthritis and strain The Veteran's STRs show that he was diagnosed with a left Achilles tendon strain and tendonitis in December 1981, and complained of ankle pain in April 1982. His discharge examination in March 1988 showed no diagnosis of any left ankle disability. The Veteran was afforded a VA examination in August 2007. His claims file was reviewed. Following an exhaustive examination, which included x-rays, the Veteran was diagnosed with a left ankle strain. The examiner opined that it was less likely as not caused by or a result of military service. The rationale was that x-rays showed no evidence of arthritis and the Veteran had not sought any treatment in the past two years for that condition. There was no clinical evidence to support any chronic condition; single treatment for a contusion or Achilles tendonitis did not establish chronicity of disease during service. Here, although the Veteran did injury his left ankle in service, there is no evidence that he has been diagnosed with arthritis post service. X-rays in August 2007 showed no arthritis. None of the Veteran's voluminous post-service treatment records show any diagnosis of left ankle arthritis. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In other words, the evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, there is no competent medical evidence that shows left ankle arthritis. Therefore, service connection for left ankle arthritis is not warranted. With regards to a left ankle strain, although the VA examiner diagnosed him with that disability, the examiner opined that it was not related to military service. Although the Veteran had Achilles tendonitis in service, as noted by the examiner, chronicity of disease during service was not established. The Veteran's discharge examination in March 1988 showed no left ankle disability. The VA examiner's opinion is supported by the absence of any documented left ankle complaints for many years after service. Here, the Veteran's discharge examination showed no left ankle disability and no left ankle strain is documented until August 2007. There is no indication that the Veteran sought treatment for his left ankle prior to his claim. The Court has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (A prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). Thus, the lack of any objective evidence of continuing left ankle complaints, symptoms, or findings for more than 15 years between the period of service and his claim for service connection is itself evidence which tends to show that this disability did not have its onset in service or for many years thereafter. The Board acknowledges the Veteran's belief that he has left ankle arthritis and a strain related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to diagnosis and etiology of a disability. Espiritu v. Derwinski, 2 Vet. App. 492 (1992); 38 C.F.R. § 3.159(a) (1) (2009). Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Musculoligamentous strains and arthritis of bilateral knees The Veteran's STRs show that he had a swollen left knee in December 1967; he was diagnosed with traumatic joint effusion. He was diagnosed with chondromalacia patella of the left knee in December 1983. X-rays of the Veteran's right knee in August 1985 were normal. The Veteran was diagnosed with degenerative arthritis of the right knee in September 1987; the Veteran reported that he injured his right knee in December 1967. His discharge examination in March 1988 did not show musculoligamentous strains or arthritis of either knee. The Veteran's accompanying report of medical history shows that he reported being diagnosed with arthritis of the knees. Post-service treatment records are silent for any complaints related to his left knee. VA treatment records dated in August 2002 show that the Veteran recently broke his right leg. VA treatment records dated in October 2005 indicate that the Veteran reported that he fractured his lower right leg as a child. The August 2007 examiner did an exhaustive examination, including x-rays, of the Veteran's knees. The Veteran was diagnosed with musculoligamentous strain, bilateral knees. X-rays showed no evidence of arthritis. The examiner opined that the Veteran's bilateral knee conditions were less likely as not caused by or a result of military service. The examiner noted that the Veteran's post-service private treatment records showed no care related to any joint conditions. With regards to the Veteran being diagnosed with right knee arthritis in September 1987, the examiner noted that that was incorrect, as the injury was to the Veteran's left knee in December 1967. There was no evidence of any right knee injury in service and the Veteran confirmed that he only had one traumatic knee injury and that was to the left knee. Here, although the Veteran did have knee complaints in service, including being diagnosed with degenerative arthritis and chondromalacia patella of the left knee, and the VA examiner diagnosed him with bilateral musculoligamentous strains, the evidence does not show that the bilateral knee disabilities are related to his military service. The only medical opinion of record, that of the VA examiner, shows that the Veteran's condition is not related to his military service. There is no medical opinion to the contrary. Additionally, there is no post-service medical evidence that shows any diagnosis of chondromalacia patella or degenerative arthritis. No chronic disability that had its onset in service has been shown, and there is no medical evidence to support a continuity of symptomatology. The VA examiner's opinion is supported by the absence of any documented bilateral knee complaints for many years after service. Here, although the Veteran's reported medical history at his discharge examination included a notation that he had arthritis, the objective findings of the discharge examination showed no bilateral knee disability, and no bilateral musculoligamentous strain is documented until August 2007. There is no indication that the Veteran sought treatment for his knees prior to his claim. The Court has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense, supra; see also Maxson, supra. Thus, the lack of any objective evidence of continuing bilateral knee complaints, symptoms, or findings for more than 15 years between the period of service and his claim for service connection is itself evidence which tends to show that this disability did not have its onset in service or for many years thereafter. The Board acknowledges that the Veteran was diagnosed with arthritis while in service. However, x-rays at the VA examination failed to show arthritis. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich, supra. In other words, the evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, there is no competent medical evidence that shows bilateral knee arthritis. There is no evidence of chronicity since service. As noted above, the Veteran's post-service medical records fail to show treatment for his bilateral knees. Therefore, service connection for bilateral knee arthritis is not warranted. The Board acknowledges the Veteran's belief that he has bilateral musculoligamentous strain and bilateral knee arthritis related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to diagnosis and etiology of a disability. Espiritu, supra. Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Right hip condition The Veteran's STRs show no diagnosis of, or treatment for, any right hip condition. Voluminous post-service medical records fail to show any complaints related to the Veteran's right hip. There is no medical evidence showing the diagnosis of any right hip condition, including arthritis. At the Veteran's August 2007 examination, he made no complaints related to his right hip. Here, there is no medical evidence of record showing any right hip injury in service or any post-service right hip disability. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich, supra. In other words, the evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, there is no competent medical evidence that shows any right hip disability, including arthritis. As noted above, the Veteran's post-service medical records fail to show treatment for his right hip. Therefore, service connection for a right hip condition, including arthritis, is not warranted. The Board acknowledges the Veteran's belief that he has a right hip condition, including arthritis, related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to diagnosis of a disability. Espiritu, supra. Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Right ankle condition As noted above, the Veteran's STRs show a complaint of ankle pain in April 1982; the record does not indicate which ankle the Veteran had pain in. Post-service medical records fail to show any complaints of, or treatment for, his right ankle. The Board notes that VA treatment records show that the Veteran broke his right leg in 2002, and that in 2005 he reported fracturing his right leg as a child. However, those treatment records do not show any complaints regarding his right ankle. At the August 2007 examination, the Veteran did not make any complaints related to his right ankle. Here, although there was a complaint of ankle pain in service, the STR does not indicate which ankle the Veteran complained of. Additionally, there is no medical evidence showing any post-service right ankle condition, including arthritis. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C.A. § 1110, 1131; see Degmetich, supra. In other words, the evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, there is no competent medical evidence that shows any right ankle disability, including arthritis. As noted above, the Veteran's post-service medical records fail to show treatment for his right ankle, or any diagnosis of a right ankle disability Therefore, service connection for a right ankle condition, including arthritis, is not warranted. The Board acknowledges the Veteran's belief that he has a right ankle condition, including arthritis, related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to diagnosis of a disability. Espiritu, supra. Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Left hip bursitis and arthritis The Veteran's STRs showed that he had a left hip sprain in May 1966, and was diagnosed with probable osteoarthritis of the left hip in December 1983. His discharge examination showed no left hip disability. Post-service treatment records show no complaints of, or treatment for, his left hip. At the August 2007 VA examination, the Veteran reported that he had not seen a doctor specifically for his left hip since exiting service. Following examination, including x-rays, the Veteran was diagnosed with bursitis of the left hip. The examiner opined that it was less likely as not caused by or a result of his military service. The examiner noted that the Veteran had not sought any treatment in the past two years for his left hip and opined that there was no clinical evidence to support any chronic condition. Here, although the Veteran had a left hip sprain and was diagnosed with probable osteoarthritis of the left hip in service, his discharge examination showed no left hip disability. Post-service medical records fail to show any complaints of, or treatment for, the Veteran's left hip. There is no medical evidence of any continuity of symptomatology or of chronicity since service. X-rays in August 2007 showed no arthritis. Although the examiner diagnosed the Veteran with left hip bursitis, he opined that it was not related to the Veteran's service and provided a thorough rationale for that opinion. There is no medical opinion to the contrary. The VA examiner's opinion is supported by the absence of any documented left hip complaints for many years after service. Here, although the Veteran was diagnosed with probable osteoarthritis in service, his discharge examination showed no left hip disability, and no bursitis is documented until August 2007. There is no indication that the Veteran sought treatment for his left hip prior to his claim; indeed, the Veteran himself reported to the VA examiner that he had not seen any doctors specifically for his left hip since his release from service. The Court has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense, supra; see also Maxson, supra. Thus, the lack of any objective evidence of continuing left hip complaints, symptoms, or findings for more than 15 years between the period of service and his claim for service connection is itself evidence which tends to show that this disability did not have its onset in service or for many years thereafter. The Board acknowledges the Veteran's belief that he has left hip bursitis and arthritis, related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to diagnosis and etiology of a disability. Espiritu, supra. Consequently, the Veteran's own assertions as to diagnosis and etiology of a disability have no probative value. Bilateral hearing loss For the purposes of applying the laws administered by VA, impaired hearing is considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of those frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2009). The Veteran has been service connected for tinnitus; accordingly, in-service acoustic trauma is conceded. The Veteran had an audiometric test in June 1981. The Veteran had puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 0 0 15 30 LEFT 5 5 0 15 20 The Veteran had a second audiometric test in November 1986. The Veteran had puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 0 20 30 LEFT 5 5 0 15 25 The Veteran underwent a March 1988 discharge examination. The Veteran had puretone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 5 0 20 25 LEFT 5 5 0 15 15 The Veteran was afforded a VA audiological examination in August 2007. The Veteran's claims file was reviewed. The Veteran's puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 25 35 50 LEFT 10 10 15 40 45 Speech audiometry (in accordance with the Maryland CNC test) revealed speech recognition ability of 96 percent in the right ear and 92 percent in the left ear. The Veteran was diagnosed with bilateral normal to moderate sensorineural hearing loss. The examiner opined that the Veteran's bilateral hearing loss was not due to his military service. The rationale was that the Veteran had no rateable hearing loss at the time of separation from service. The examiner noted that the Veteran's military service showed no ear or hearing problem, which would have required medical follow-up or, if treated, would result in a change in auditory thresholds. The examiner explained that exposure to either impulse sounds or continuous exposure can cause a temporary threshold shift, which disappears in 16 to 48 hours after exposure to loud noise. Impulse sounds can also damage the structure of the inner ear resulting in an immediate hearing loss. Continuous exposure to loud noise can also damage the structure of the hair cells resulting in hearing loss. If the hearing did not recover completely from a temporary threshold shift, a permanent hearing loss existed. A normal audiogram subsequent to the noise exposure would verify that the hearing had recovered without permanent loss. Here, since the Veteran is service connected for tinnitus, acoustic trauma in service is conceded. Additionally, the August 2007 examination reveals that the Veteran has current bilateral hearing loss as defined by VA. A nexus between the Veteran's current disability and acoustic trauma is still needed. The Board notes that medical treatises indicate that the cause of hearing loss is often the same as the cause of coexisting tinnitus. See, e.g., Harrison's Principles of Internal Medicine 182 (Dennis L. Kasper et al. eds., 16th ed. 2005). However, as noted, the VA examiner in August 2007 opined that the Veteran's hearing loss is not related to his service, based on the normal audiological evaluation in March 1988. The Board will explore that question with a bit more detail. With regard to the Veteran's right ear, the Veteran showed elevated thresholds, of 30 at 4000 Hertz, on his examinations in June 1981 and November 1986, and of 25 at 4000 Hertz on his discharge examination in March 1988. With regard to his left ear, the Veteran showed an elevated threshold of 25 at 4000 Hertz on his examination in November 1986. The Board notes that the thresholds for normal hearing are 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. See Hensley, supra at 157 (citing Schroeder et al. eds., Current Medical Diagnosis & Treatment, 1988, pages 110-111). Therefore, the Veteran's audiological examinations show some degree of hearing loss in both ears, although not constituting a disability for VA purposes. Because the Veteran had noise exposure during service, is service- connected for tinnitus, had a degree of hearing loss for both ears shown during service, the August 2007 examination shows hearing loss constituting a current disability for VA purposes, and according the Veteran the benefit of the doubt, the Board finds that the Veteran's bilateral hearing loss is as likely as not related to his military service. The Board acknowledges the August 2007 VA audiologist's opinion to the contrary, but is more persuaded by the audiological evidence. Giving the Veteran the benefit of the doubt, the Board finds that the increased thresholds for his ears in service were indicative of the current hearing loss. The Board therefore finds that there is support for the conclusion that the Veteran's hearing loss is attributed to his military service. Consequently, on the basis of the above analysis, and after consideration of all of the evidence, the Board finds it is at least as likely as not that the Veteran's bilateral hearing loss is attributable to his active military service. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for left ankle arthritis is denied. Entitlement to service connection for musculoligamentous strains of the bilateral knees is denied. Entitlement to service connection for bilateral knee arthritis is denied. Entitlement to service connection for right hip condition, to include arthritis, is denied. Entitlement to service connection for right ankle condition, to include arthritis, is denied. Entitlement to service connection for left ankle strain is denied. Entitlement to service connection for bursitis, left hip is denied. Entitlement to service connection for left hip arthritis is denied. Entitlement to service connection for bilateral hearing loss is granted. REMAND The Veteran's STRs reveal that he complained of dizziness in December 1987, and post-service medical records show that he complained of dizziness in January 1993. The Veteran has not been afforded a VA examination to determine the etiology of his dizziness. In light of the Veteran having dizziness in service and post-service, the Board finds that a VA examination is necessary. See 38 U.S.C.A. § 5103A(d) (West 2002); Barr v. Nicholson, 21 Vet App 303 (2007); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to assess whether his dizziness is related to his military service. The examiner is requested to, among other things, obtain a detailed history of the Veteran's symptoms as observed by him and others since service, review the record, and offer an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of approximately 50 percent), or less likely than not (i.e., probability less than 50 percent) that the Veteran's dizziness is related to his military service. The claims folder and a copy of this decision must be reviewed by the examiner and the examiner should provide a complete rationale for any opinion given. The examiner should specifically identify that they have reviewed the claims file and medical records. All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail. The Veteran should be advised that failure to appear for an examination as requested, and without good cause, shall result in a denial of his claim. See 38 C.F.R. § 3.655 (2009). 2. The RO should then readjudicate the Veteran's claim for service connection for dizziness. If the claim remains denied, issue a supplemental statement of the case (SSOC) to the Veteran and his representative, and provide an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ L. M. BARNARD Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs