Citation Nr: 1306846 Decision Date: 02/28/13 Archive Date: 03/01/13 DOCKET NO. 10-02 197 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to an initial compensable rating for left ear hearing loss. 2. Entitlement to service connection for right ear hearing loss. 3. Entitlement to service connection for Meniere's Disease. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Emily L. Tamlyn, Counsel INTRODUCTION The Veteran served on active military duty from January 1959 to November 1962. These issues come before the Board of Veterans' Appeals (Board) on appeal from a March 2008 RO rating of the Department of Veterans Affairs Regional Office (RO) in Winston-Salem, North Carolina. In that decision, the RO granted a claim for service connection for left ear hearing loss (assigning a noncompensable rating effective April 24, 2007) and denied claims for service connection for right ear hearing loss and vertigo or Meniere's Disease. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Board finds that further clarification is needed regarding whether the Veteran's currently diagnosed Meniere's Disease is related to service. During service, the Veteran had an injury while training, which resulted in a facial bone fracture (he is service-connected at 0 percent for a comminuted left malar fracture). The February 1960 narrative summary states that the exercising horse which he was using collapsed, he fell and the equipment struck him in the face. An October 1991 record from Dr. H.M. shows the Veteran had a deviated nasal septum to the left and apparently an old nasal fracture, but the Veteran did not recall the original injury. The January 2008 VA bone examination report states: "Veteran says he was on a mechanical bull doing a hand stand and he fell and fractured his left facial bone." Regardless of the lack of consistency regarding the in-service treatment reports and the Veteran's post-service recollections of his injury, the evidence does show in-service trauma to the face. At separation in October 1962, the Veteran denied dizziness or fainting spells on the report of medical history. The report of medical examination noted that he had been treated for nerve and artery involvement, though the February 1960 treatment records, while confirming infraorbital nerve involvement, specifically indicated that there was no artery involvement. Since head trauma is a known cause of Meniere's Disease, an opinion is required to determine whether the Veteran's incident in service could have caused the Meniere's Disease that was diagnosed years later. The March 2008 VA ear disease examination noted the Veteran's exposure to acoustic trauma in service and his onset of dizziness in 1991, but did not acknowledge the Veteran's in-service facial or head trauma. A June 2009 VA examination for traumatic brain injury (TBI) noted the Veteran did not have a TBI in service, but a definitive opinion in regard to the facial trauma and the Meniere's Disease is not in the file. Also, in August 2008, Dr. J.M. stated that the Veteran's exposure to loud noises in service may have caused his Meniere's Disease/vertigo. On remand, a comprehensive opinion is sought. Further, a July 2009 VA examination report indicates that the Veteran has been receiving VA treatment. Thus, additional outpatient records must be associated with the file on remand. As the right ear etiology has been linked to the Meniere's Disease (see March 2008 VA examination report), the claim for service connection for right ear hearing loss must also be remanded. The examiner should also consider the August 2008 opinion of Dr. J.M., who noted the Veteran's asymmetric hearing loss with a history of Meniere's Disease, as well as his exposure to loud jet engines in the military and then opined that the degree of hearing loss bilaterally is consistent with his exposure to loud noise. Also, the March 2008 VA audiology examination was incomplete. Pure tone and speech audiometrics were not considered reliable for reporting purposes. Initial testing indicated bilateral sensorineural hearing loss worse in the left ear. Repeat thresholds were not consistent enough to indicate good test reliability. As a result, a new examination is needed to determine current hearing acuity for the left ear. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. First, request all VA treatment records for the Veteran and associate them with the file. If they are unavailable, notify the Veteran and document this fact in the file. See 38 C.F.R. § 3.159(e) (2012). 2. After the above development has been completed, send the claims file to a VA examiner for: an opinion and examination as to whether the diagnosed Meniere's Disease is related to active service, to include facial and acoustic trauma; an opinion as to whether the right ear hearing loss is related to Meniere's Disease or service; and a hearing acuity test. The examination report should state that the claims file and a copy of this remand have been reviewed. The examiner should reference the relevant records cited above. The examiner should indicate: * whether it is at least as likely as not that the currently diagnosed Meniere's Disease is related to the Veteran's active service, to include the in-service facial trauma and/or acoustic trauma. * If Meniere's Disease is related to service, the examiner should state whether the right ear hearing loss was at least as likely as not caused by the Menierie's disease. If not, is it at least as likely as not that the right ear hearing loss was aggravated (made permanently worse beyond the natural progression of the disease) by the Meniere's Disease. o If Meniere's Disease aggravates right ear hearing loss, identify the baseline level of severity of the right ear hearing loss and the permanent, measurable increase in the disability's severity that is attributable to the Meniere's Disease. A rationale supported by accurate facts should be included in these opinions. The examiner shall also perform an evaluation for hearing impairment as required by 38 C.F.R. § 4.85, that shall include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test. The VA examiner should provide an explanation a description of any functional effects caused by service-connected hearing disability. All opinions and conclusions expressed must be supported by a complete rationale in a report. 3. Readjudicate the claims. If the determinations remain adverse to the Veteran, he and his representative should be furnished with a supplemental statement of the case and given an opportunity to respond. No action is required of the Veteran until he is notified by the agency of original jurisdiction; however, the Veteran is advised that failure to report for any scheduled examination may result in the denial of his claim. 38 C.F.R. § 3.655 (2012). The appellant has the right to submit additional evidence and argument on the 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 or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ ERIC S. LEBOFF Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the Court. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).