Citation Nr: 1319303 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 06-36 251 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD). 2. Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected bilateral knee and pes planus disabilities. 3. Whether the reduction of the evaluation for bilateral hearing loss disability from 50 percent to noncompensable effective from May 1, 2012 was proper. 4. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD T. Wishard, Counsel INTRODUCTION The Veteran had active military service from October 1972 to October 1976. These matters come before the Board of Veterans' Appeals (Board) from April 2006, July 2007, September 2008, and October 2011 rating decisions of the Department of Veterans Affairs (VA), Regional Office (RO) in Salt Lake City, Utah. These matters were previously before the Board in February 2010 and August 2012 and were remanded for further development. They have now returned to the Board for further appellate consideration. The issues of entitlement to an acquired psychiatric disability, to include PTSD, whether the reduction of the evaluation for bilateral hearing loss disability from 50 percent to noncompensable effective from May 1, 2012 was proper, and entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU), are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran is less than credible with regard to the onset of his current spine disability. 2. The earliest competent credible evidence of record of a spine disability is in 1987, more than ten years after separation from service. 3. The credible evidence of record reflects that the Veteran injured his spine post service in 1987 in a work incident. 4. The competent medical evidence of record is against a finding that the Veteran has a spine disability causally related to, or aggravated by active service. 5. The competent medical evidence of record is against a finding that the Veteran has a spine disability causally related to, or aggravated by, a service-connected disability. CONCLUSION OF LAW A lumbar spine disability (to include osteoarthritis, scoliosis, spondylolisthesis, foraminal stenosis, and disc degeneration) was not incurred in, or aggravated by, active service, and may not be presumed to have been so incurred or aggravated, nor is it proximately due to, the result of, or aggravated by, service-connected disability. 38 U.S.C.A. §§ 1110, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). See also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Notice was provided to the Veteran in November 2005 and April 2010 and the claim was subsequently readjudicated, most recent in a March 2013 supplemental statement of the case. Mayfield, 444 F.3d at 1333. VA has a duty to assist the Veteran in the development of the claims. The claims file includes service treatment records (STRs), VA and private medical records, and the statements of the Veteran in support of his claim. The Board has considered the statements and perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claim for which VA has a duty to obtain. An examination was obtained in March 2013. 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). In the present claim, the examiner found that the Veteran's claimed condition was less likely as not due to service because, in part, there was no evidence of the Veteran's claimed injury in the STRs. The examiner considered the statements of the Veteran but found no corroborating evidence. The Board acknowledges that corroborating evidence is not always necessary because a Veteran is competent to report jumping from a window and having resulting pain in the spine; however, upon careful review of the record and as discussed in further detail below, the Board finds that the Veteran is less than credible with regard to any such injury in service. As there is no competent credible evidence of any such injury in service, a further request for a medical opinion would serve no useful purposes. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (holding that VA was not required to provide a medical examination when the Board does not find the Veteran' statements credible.) See also Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the Veteran are to be avoided). The examiner also provided an opinion as to whether the Veteran's had a spine disability causally related to, or aggravated by, a service-connected disability. The Board finds that the examination/opinion is adequate, as it is predicated on an interview with the Veteran regarding his symptoms, a review of the claims file to include the Veteran's treatment records and x-rays, and includes a rationale for the opinion proffered. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issue on appeal has been met. 38 C.F.R. § 3.159(c) (4). Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the claim. Essentially, all available evidence that could substantiate the claim has been obtained. Legal Criteria Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet.App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). For some "chronic diseases," presumptive service connection is available. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With "chronic disease" shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of a 'chronic disease' in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. If not manifest during service, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the 'chronic disease' became manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307. The term "chronic disease," whether as shown during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. Feb. 21, 2013). Arthritis and organic diseases of the nervous system are included in 38 C.F.R. § 3.309(a). In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of such Veteran's service as shown by such Veteran's service record, the official history of each organization in which such Veteran served, such Veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a) (West 2002). Under 38 C.F.R. § 3.310, service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice-connected disability by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). 38 C.F.R. § 3.310 was amended during the course of this appeal. Effective October 10, 2006, VA amended 38 C.F.R. § 3.310 to implement the decision in Allen, which addressed the subject of the granting of service connection for the aggravation of a nonservice-connected condition by a service-connected condition. See 71 Fed. Reg. 52,744 -47 (Sept. 7, 2006). The existing provision at 38 C.F.R. § 3.310 (b) was moved to sub-section (c). The amended 38 C.F.R. § 3.310 (b) institutes additional evidentiary requirements and hurdles that must be satisfied before aggravation may be conceded and service connection granted. To whatever extent the revised regulation may be more restrictive than the previous one, the Board will afford the Veteran review under both the old and new versions. See VAOPGCPREC 7-2003 (Nov. 19, 2003) Analysis The Board has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the medical evidence pertinent to the claim on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the U.S. Court of Appeals for the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. An essential element of entitlement to service connection is evidence of a current disability. The clinical evidence of record reflects that the Veteran has been diagnosed with degeneration of the lumbar spinal discs, lumbar spine foraminal stenosis, scoliosis, spondylolisthesis, and osteoarthritis; thus, the Board finds that the Veteran has a current lumbar spine disability; however, for the reasons noted below the Board finds that service connection is not warranted on a direct basis or on a secondary basis. Initially, the Board will discuss whether service connection is warranted on a direct incurrence basis. An August 1973 STR reflects that the Veteran sought treatment for low back pain. Upon physical examination, he had pain at 30 degrees. His urinalysis revealed motile bacteria. The Veteran was prescribed tetracycline, an antibiotic. A follow up appointment for his urinary tract infection was negative for back complaints. The Veteran sought treatment on approximately six occasions between August 1973 and March 1974 for a variety of concerns including sinus congestion, gastroenteritis, skin peeling off the hands, flat feet, a possible sprained ankle, and a chest cold; however, there are no further concerns regarding his back during this time period. A March 1974 STR reflects that the Veteran reported that he had a life long history of flat feet. He reported that he had had aching in the heel and legs since boot camp. Upon examination, it was noted that he did not have flat feet. Another March 1974 STR reflects that the Veteran was sent to physical therapy for Williams exercises and heel cord stretching exercises. The provisional diagnosis was "tight heel cords and [low back pain]. There were no clinical findings with regard to the back. The Veteran was seen on approximately 23 occasions between March 1974 and his discharge in 1976 for a variety of concerns including a vasectomy, chest pain, thigh pain, ankle and knee pain, trauma to a finger on the left hand, an upset stomach, a swollen right thumb, coughing, gastric distress, and edema of the right foot; however, there are no further concerns regarding his back. The Veteran's September 1976 report of medical history for discharge purposes reflects that he denied recurrent back pain. Based on the foregoing, the Board finds that the Veteran's low back symptoms in 1973, for which he was treated with antibiotics, and his low back symptoms in 1974 were acute and transitory and had resolved by the time of his separation in 1976. The Board also notes that there is no competent credible evidence of record that the Veteran's current back disability is causally related to active service. In November 1976, the Veteran filed a claim for entitlement to service connection for a sinus disability, bilateral knee disability, bilateral feet and leg disability, bilateral hearing loss disability, an ulcer, headaches, a chest/respiratory disability, and arthritis of the right thumb. The Board finds that if the Veteran had back problems at that time, it would have been reasonable for him to have reported it when he filed his claims for other disabilities; he did not. A July 1993 private mental health record reflects that the Veteran reported that in 1987, he was working when he injured his back. He reported that he had ruptured a disc at that time and injured some nerves in his back. He further reported that he had eventually had surgery which had helped relieve some of the pain but made some areas worse. He reported that he had been on worker's compensation since 1987. The Board notes that the 1987 injury was more than ten years after the Veteran's separation from service. In August 1993, the Veteran filed a claim for bilateral ankle disability. Again, the Board finds that if the Veteran had back problems since service, it would have been reasonable for him to have reported it when he filed his claim for another disability; he did not. A September 2004 private record from Nurse Practitioner D.S. reflects that the Veteran reported that he sustained a work-related injury in 1987 which resulted in a diskectomy in 1987. He reported that he has experienced continued low back and leg pain since that time. He reported some aching pain in his lower thoracic area, but the majority of his pain was described as radiating across the lower lumbar area and down the left leg. He was diagnosed with status post lumbar discketomy, left leg radiculopathy, lumbar facet syndrome, and sacroiliac joint dysfunction. The record is negative for any mention of an injury in service and/or pain since service. A December 2005 VA examination report reflects that the Veteran reported that he began having low back symptoms in 1987 when he twisted his back after helping a co-worker who was about to fall into a pit. It was noted that the Veteran had "experienced no other injuries" other than the 1987 injury. A March 2013 VA examination report reflects that the Veteran reported that his back pain began in 1974 when he jumped out of a second story window while on active duty. He reported that he had back problems from that time, that his back did not improve with his surgery in 1987, and that he continues to have back problems. The Board finds, based on the record as a whole, that the Veteran's statement as to injuring his back by jumping out a second story window in service is less than credible. The Veteran's STRs are negative for any mention of the Veteran injuring his back after jumping out of a window. As noted above, the STRs include numerous complaints, to include as to his knees, ankles, stomach, thigh, finger, thumb, foot, headaches and coughing. They note complaints due to reportedly falling on deck, trauma while working on a motorcycle, and hitting his hand on a wall. The Board finds that if the Veteran had injured his back after jumping out of a second story window, it would have been reasonable for him to have sought treatment, and for it to have been noted in his STRs; it is not. In addition, the Veteran denied recurrent back pain on separation, the Veteran failed to note back complaints or file a claim for service connection for a back disability when filing claims for other disabilities in1976, failed to note back complaints or file a claim for service connection for a back disability when filing claims for other disabilities in 1993, reported on numerous occasions that he injured his back in a post service 1987 injury, and initially contended that his back injury was secondary to his service-connected disabilities (See December 2006 statement). Moreover, the clinical records between 1976 and March 2013 are negative for an allegation of the Veteran having injured his back in active service. The earliest contention that the Veteran has a back disability due to an in-service injury is in 2013, while undergoing an examination for VA compensation purposes, and after many years of back treatment without any such prior allegation. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). See Cartright v. Derwinski, 2 Vet. App.24, 25 (1991) (finding that, while the Board may not ignore a Veteran's testimony simply because he or she is an interested party and stands to gain monetary benefits, personal interest may affect the credibility of the evidence); see also Caluza v. Brown, 7 Vet. App. 498, 510-511 (1995) (credibility can be generally evaluated by a showing of interest, bias, or inconsistent statements, and the demeanor of the witness, facial plausibility of the testimony, and the consistency of the testimony). Based on the foregoing, the Board finds that service-connection on a direct incurrence basis is not warranted. There has been no demonstration by competent medical, nor competent and credible lay, evidence of record, that the Veteran has a current back disability causally related to, or aggravated by active service. Next, the Board will discuss whether service connection or a back disability on a secondary basis is warranted. The Veteran is service connected for bilateral knee degenerative joint disease, bilateral pes planus, bilateral hearing loss, healing lesion of the lower lobe of the right lung, and a retention cyst of the left maxillary sinus. A December 2005 VA examination report reflects that the Veteran reported that his low back symptoms began in 1987 following a post service work injury. He also alleged that the current symptoms were due to his service-connected knee disability. Upon clinical examination, it was noted that the examiner felt that the Veteran was exaggerating his symptoms and was not cooperating fully. The examiner found that the Veteran had "very little objective evidence of pathology in the knees. Both knees are quite stable. They are not inflamed. There is some limitation of motion in the knees, but again, this examiner believes that the veteran is not giving full effort as far as range of motion in the knees is concerned." The examiner opined as follows: It is this examiner's opinion that the veteran's low back condition is directly secondary to the trauma he experienced in 1987 resulting in diskectomy at the L5/S1 level. It is further this examiner's opinion that the back condition is not caused by or a result of the veteran's service-connected knee condition. A July 2006 DRO informal conference report reflects that the Veteran reported that it was his belief that his back disability is secondary to his service-connected disabilities. A January 2006 private record from Dr. D. reflects that the Veteran wore knee braces which helped his low back pain. It was further noted that he had a history of walking with his feet everted [sic] and that this caused increased knee pain and back pain. It was noted that "with shoe inserts and with knee braces on, he has noticed improvement in his knee pain and more so with his back pain." Radiographic views of his spine showed degenerative disc disease involving the L5-S1 disc with moderate loss of disc height. No rationale was provided for the Veteran's inverted feet. Moreover, no mention was made of the Veteran's prior back injury. A September/October 2010 QTC examination report is of record. The report reflects that the Veteran had persistent pain since his disc surgery. Upon examination, the Veteran's posture and gait were normal and he did not use an assistive device for ambulation. The examiner opined that there was no association between the Veteran's knee condition and the pes planus as related to his back. An August 2011 VA examination report reflects a diagnosis of lumbar spine degenerative disc disease with intravertebral disk syndrome with no radiculopathy provided on examination. Upon clinical examination, the examiner stated as follows: His posture and gait are interesting in that he uses the cane periodically in the left hand but mostly in the right hand. He leans on it quite heavily which causes a moderate antalgic gait that is non specific given that he describes both knees hurting and his back hurting as well as his feet. He was able to walk the short 5 to 6 feet in the clinic and actually had a better gait without the cane. He is able to rock back on his heels and stand up on his toes. Romberg is negative. He has orthotics and he reports that they are helpful. In regard to assistive devices, in reviewing the medical record, it is difficult to understand the usage of his bilateral knee braces in the setting of no evidence of instability as these are actually ACL type braces which would not be useful for global pain which he describes. In regards to the orthotics, he states that they are helpful but the cane itself is inconsistent with his knee pain in that he leans quite heavily right-sided but walks fairly well without the cane in clinic. The August 2011 examiner also opined that there is no clear indication for the veteran to use canes or bracing at this point. The March 2013 VA examiner opined as follows with regard to the etiology of the Veteran's current back disabilities: The [Veteran] has severe osteoarthritis to his lumbar spine with scoliosis and multilevel spondylolisthesis in addition to his long standing history of lumbar radiculopathy with lower lumbar spinal stenosis (documented in 2010) and lumbar partial discectomy from 1987. While the Vet's altered gait and weight bearing due to his longstanding knee and foot pain may transiently aggravated his back pain, these conditions would not be expected to have caused degeneration of the lumbar spinal discs, lumbar spine foraminal stenosis, scoliosis, spondylolisthesis, and osteoarthritis. The examiner opined that it is less likely than not that the Veteran's current spinal disabilities are due to service. He also stated that it is not at least as likely as not that the Veteran's lumbar spine disability was aggravated beyond its natural progression by a service-connected disability. The examiner stated as follows: As opined above, the knee and foot problems would not be expected to have caused the disc problems, nor would they be expected to cause the Vet's lumbar radiculopathy. The Vet gave a history of jumping from a second story building, but the Service Treatment Record contains no mention of back injury or of any injury associated with the alleged jump. The back problems appear to have originated some time after the knee and foot problems. While the Vet's use of a cane and alteration of his biomechanics resulting from his foot and knee pain may transiently aggravate his back pain, it is unlikely that these would cause further damage to his degenerating discs, arthritis and radiculopathy. Use of a cane should reduce the weight on his lumbar spine. Pain from his knees and feet contributes to his avoidance of standing (an activity which causes him back pain.) It is doubtful that the foot and knee conditions aggravated the lumbar spine conditions. (As noted above, the Board finds that the Veteran is less than credible with regard to jumping out a window. Thus, the examiner need not have opined as to whether the Veteran's alleged back injury in service was causally related to his current back disabilities.) The Veteran is competent to attest to factual matters of which he has first-hand knowledge (e.g., pain). See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). To this extent, the Board finds that the Veteran is competent to report that he has a back pain. The Veteran, however, has not been shown to have the experience, training, or knowledge necessary to provide a competent etiology opinion as to his numerous back disabilities. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issue in this case, back disabilities, to include degeneration of the lumbar spinal discs, lumbar spine foraminal stenosis, scoliosis, spondylolisthesis, and osteoarthritis, with sufficient evidence of a post-service injury and surgery. The Board finds that such an etiology finding falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Although the Veteran has stated that he believes that his foot and knee problems are the cause of his back disabilities, he has not cited sufficient competent credible literature or evidence to support his assertion. In addition, the Board finds that the clinical opinion by a physician who has examined the Veteran and his clinical records is more probative than lay statements or clinical statements made without sufficient rationale. The probative value of medical opinions is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guarneri v. Brown, 4 Vet. App. 467, 470-71 (1993). There is no requirement that additional evidentiary weight be given to the opinion of a medical provider who treats a veteran; courts have repeatedly declined to adopt the "treating physician rule." See White v. Principe, 243 F.3d 1378, 1381 (Fed. Cir. 2001); Van Slack v. Brown, 5 Vet. App. 499, 502 (1993). The Board finds that the opinion by the March 2013 clinician is the most probative opinion of record as it provides a more than adequate rationale after review of the Veteran's clinical records and an examination of the Veteran. In sum, the competent credible evidence of record is against a finding that the Veteran has a back disability causally related to, or aggravated by, service or a service-connected disability. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected bilateral knee and pes planus disabilities is denied. REMAND Acquired Psychiatric The Veteran avers that he has an acquired psychiatric disability due to service. Specifically, he avers that while working at a correction facility, he witnessed attempted suicides and suicides, which he contends are the cause of his current mental disorder(s). The Veteran has been diagnosed with bipolar disorder. The Board acknowledges that numerous records reflect that the Veteran had been diagnosed with PTSD; however, the Veteran does not have any verified in-service stressors. In addition, a November 1993 VA psychology report of the Minnesota Multiphasic Personality Inventory (MMPI) reflects that the examination of the validity scale suggest that the Veteran did not have a valid profile and that the Veteran responded in a way to distort and exaggerate his functioning. It was noted that the Veteran's elevations on clinical scales is "often an artifact of an attempt to exaggerate symptoms." It was further noted the Veteran's profile was consistent with substance abuse, but that it was not clear if this was due to the Veteran faking a response. With regard to acquired psychiatric disorders other than PTSD, the Board finds that VA should attempt to obtain additional clinical records, if any, and a supplemental VA clinical opinion. The Veteran separated from service in October 1976. A December 1976 VA examination report reflects that the Veteran reported he has a "high temper" and gets irritated with people. The examiner stated that he could "not find evidence of any psychiatric disorder." The Veteran has contended that he was hospitalized in 1977, within approximately one year after separation from service. A 1993 medical discharge summary reflects that the Veteran reported that he had a past history of depression and that he was hospitalized in 1977. Subsequent statements by the Veteran reflect that the hospitalization may have been between 1977 and 1980. A July 1993 private medical record reflects that the Veteran reported that he was treated for depression at Wadley Regional Medical Center in 1986 for a three to four week period. VA should attempt to obtain records from any hospitalization in approximately 1977 to 1980, and from 1986. As noted above, the Veteran contends that his current mental disability is due to witnessing suicides and/or suicide attempts in service. There is no corroborating evidence that any such actions took place. The Board acknowledges that a September 2008 VA memorandum on formal finding of unavailability is associated with the claims file. It reflects that the Veteran had not provided detailed information to allow for a stressor verification. Despite a lack of specific names and dates, the Board finds that VA should attempt to obtain any statistical records from the Marine Barracks, Naval Base, Charleston, South Carolina from March 1973 to October 1976, if any such records were made and maintained, with regard to the number of suicides or suicide attempts at the confinement facility. Thereafter, a supplemental clinical opinion should be obtained. The March 2013 VA examiner found that there was no "clear evidence that [the Veteran's] disorder is related to military service. Moreover, [the Veteran] noted that he began to experience mood symptoms prior to his military service as well as during periods of heavy alcohol and drug use. As a result, his Bipolar Disorder is less likely than not (less than 50 5) due to or a result of his military service." The Board is unclear as to what the examiner means by a lack of "clear evidence." STRs are not necessary to support a Veteran's claim. In addition, the Veteran is presumed to have been mentally sound when accepted into service. The clinician should provide a more thorough rationale which provides the reason(s) for the opinion that the Veteran's bipolar disorder is less likely than not related to service, to include a discussion of the Veteran's symptoms, the length of time since service, the Veteran's alcohol and drug use, the Veteran's documented proficiency and conduct ratings in service, and the biological and/or environmental reasons, if pertinent, for bipolar disorder, and the likelihood, if any, that stress in service would be the cause of the Veteran's current bipolar disorder. Reduction of Bilateral Hearing Loss disability rating and TDIU In his VA Form 9 received by VA in October 2011, the Veteran requested a Travel Board hearing on the issue of entitlement to TDIU. In his VA Form 9 received by VA in April 2012, the Veteran requested a Travel Board hearing on the issue of whether the reduction of the evaluation for bilateral hearing loss disability from 50 percent to noncompensable effective from May 1, 2012 was proper. Based on the foregoing, the Veteran should be scheduled for a Travel Board hearing on the above two issues. Accordingly, the case is REMANDED for the following action: 1. Request the appellant to identify all medical providers (VA and private) from whom he has received mental health/psychiatric treatment, and complete and return a provided VA Form 21-4142, Authorization and Consent to Release Information, for the identified mental health/psychiatric treatment records, to include hospitalization in approximately 1977, and/or from 1977 to 1980, and hospitalization at the Wadley Regional Medical Center in 1986. After obtaining a completed VA Form 21-4142, the AOJ should attempt to obtain all pertinent medical records, which are not already associated with the claims file. If any of the above searches for any such records yields negative results, this fact should be noted in the claims folder. Any documents received by VA should be associated with the claims folder. 2. Attempt to obtain statistical records from the Marine Barracks, Naval Base, Charleston, South Carolina from March 1973 to October 1976 with regard to the number of suicides or suicide attempts at the confinement facility. If a searches for any such records yields negative results, this fact should be noted in the claims folder. Any documents received by VA should be associated with the claims folder. 3. After completion of the foregoing, request the March 2013 VA examiner, or another clinician if he is unavailable, to provide a supplemental opinion. The clinician should provide a more thorough rationale which provides the reason(s) for the prior opinion, if still the same, that the Veteran's bipolar disorder is less likely than not related to service, to include, if pertinent, a discussion of the Veteran's symptoms, the length of time since service, the Veteran's alcohol and drug use, the Veteran's documented proficiency and conduct ratings in service, the biological and/or environmental reasons for bipolar disorder, and the likelihood, if any, that stress in service would be the cause of the Veteran's current bipolar disorder. If the examiner's opinion is not the same as previously noted in March 2013, the examiner should provide a complete rationale for the new opinion. 4. If the clinician cannot provide an adequate rationale without another examination, schedule the Veteran for a VA examination with the appropriate clinician. The examiner is requested to furnish an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran has a current acquired psychiatric disability causally related to, or aggravated by, his military service. The claims folder should be reviewed in conjunction with such examination and the examination report should indicate that such a review was performed. Any opinion expressed should be accompanied by a complete rationale. 5. After undertaking any other development deemed appropriate, the RO should readjudicate the issue of entitlement to service connection for an acquired psychiatric disability. If the benefit sought on appeal is not granted, the RO should issue a supplemental statement of the case and provide the Veteran and his representative with an appropriate opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. 6. If a hearing has not yet been scheduled on the issues of entitlement to TDIU, and whether the reduction of the evaluation for bilateral hearing loss disability was proper, schedule the Veteran for a Travel Board hearing at the Salt Lake City, Utah RO before a Veterans Law Judge of the Board, unless otherwise notified by the appellant or his representative. 7. After the hearing is conducted, or if the appellant withdraws his hearing request, or fails to report for the hearing, then in accordance with appellate procedures the claims file should be returned to the Board for appellate review. 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 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. 2012). ______________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs