Citation Nr: 1321952 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 09-23 112A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for left ear hearing loss. 2. Entitlement to service connection for bilateral carpal tunnel syndrome. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K.S. Hughes, Counsel INTRODUCTION The appellant is a Veteran who served on active duty for training (ACDUTRA) in the Illinois Army National Guard from January 1983 to April 1983 and on active (federalized service) duty from November 1998 to June 1999. These matters are before the Board of Veterans' Appeals (Board) on appeal from a July 2007 rating decision by the Chicago, Illinois Department of Veterans Affairs (VA) Regional Office (RO). In March 2013, a Travel Board hearing was held before the undersigned; a transcript of the hearing is associated with the claims file. 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 Veteran contends that he acquired left ear hearing loss and bilateral carpal tunnel syndrome driving a truck during his active duty service. He alleges exposure to further noise truama from firing howitzers, locomotive work, and guarding an airfield during deployment. See July 2009 VA Form 9 (substantive appeal) and March 2013 hearing transcript. Service personnel records reflect that his service occupational specialty was locomotive repairer and motor vehicle operator. The Veteran's service treatment records show the following puretone thresholds, in decibels, on September 1982 enlistment examination: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 10 10 5 LEFT 15 15 15 15 5 He underwent periodic audiometric evaluations in November 1986, March 1993, and August 1998 (about 3 months prior to his federalized (qualifying for VA compensation benefits) period of active service). The following puretone thresholds, in decibels, were noted on the August 1998 audiometry: HERTZ 500 1000 2000 3000 4000 RIGHT 30 30 20 20 LEFT 30 30 15 20 On December 2011 VA examination, the diagnoses included bilateral sensorineural hearing loss (SNHL). The examiner opined that the review of the STRs "revealed inconsistent test results from enlistment through the last test in 1993. This inconsistency was noted on responses to an evaluation at the Marion, Il VAMC [VA Medical Center] on 5-12-11." The examiner opined that, while audiometry test results on examination were reliable, he found "no evidence to tie them to military service." This examination report is inadequate for rating purposes as it is based on an incomplete/inaccurate factual record (as the last test in the STRs was not in 1993; but in August 1998). The Board observes that the absence of a hearing loss disability during service does not preclude service connection for such disability if the evidence of record shows that a hearing loss disability first noted after service is related to noise trauma therein (or is otherwise etiologically related to service). Hensley v. Brown, 5 Vet. App. 155, 159 (1993) The record also suggests that the medical evidence is incomplete. The most recent VA treatment records associated with the record (including in Virtual VA) are dated in May 2009. However, as noted in the December 2011 VA examination report, the Veteran had an audiology evaluation on May 12, 2011. Further, VA treatment records include a November 2002 notation of "last PE [physical examiantion] done after Bosnia tour in 1999," a September 2003 report of Occupational Therapy Consult Results note that the Veteran was "referred to OT secondary to diagnosis of bilateral CTS [carpal tunnel syndrome]," and a January 2009 notation that oustide medical reocrds were scanned consisting of "faxed orders from Dr. Rao office for ct chest/neck and fee base consult for ent Dr. Mann." These VA and private treatment records (including of a referral to OT for bilateral carpal tunnel syndrome) are not are not associated with the record, but may contain pertinent information. Further, although the RO made a formal finding of unavailability in August 2009 for treatment records from the Marion VAMC for the period of January 1, 1999 to November 7, 2002; the November 2002 notation suggests the existence of earlier treatment reports. Updated records of any VA and/or private treatment the Veteran may have received are also likely to contain pertinent information (and VA records are constructively of record) and must be secured. The Veteran is advised that when evidence (to include identifying information and releases for VA to secure private records) requested in connection with a claim for VA benefits is not received within a year of the request, the claim is to be considered abandoned. 38 C.F.R. § 3.158(a). Accordingly, the case is REMANDED for the following action: 1. The RO should ask the Veteran to identify the providers of all evaluations and/or treatment he has received for the disabilities at issue, and to provide the releases needed for VA to secure any private records of such evaluation/treatment. He must specifically provide releases for complete treatment records from Drs. Rao and Mann. The RO should obtain for the record complete clinical records (those not yet secured) from all sources identified (to specifically include updated VA treatment records). If any private provider does not respond to an RO request for records, the Veteran and his representative should be so advised, and reminded that ultimately it is his responsibility to ensure that private records are received. If he does not provide the information and releases sought within the one year period afforded by law, the claims must be further processed under 38 C.F.R. § 3.158(a). 2. After the development ordered in (1) is completed, the RO should forward the Veteran's claims file (to include this remand) to the December 2011 VA examiner for review and an addendum opinion that clarifies the opinion then offered. (i.e., a re-examination of the Veteran is not necessary unless the examiner so finds). [If the Decemer 2011 VA examiner is unavailable or unable to offer the opinion sought, the Veteran's claims file should be forwarded to another appropriate audiologist or otologist for an advisory medical opinion with the rationale sought.] Based on review of the record (and, if indicated, reexamination of the Veteran) the consulting audiologist/otologist should provide an opinion that responds to the following: Based on the factual evidence of record, what is the most likely etiology for the Veteran's left ear hearing loss? Specifically, is it at least as likely as not (a 50% or better probability) that it is related to the Veteran's exposure to noise trauma during either period of federalized military service or is otherwise related to such service? The consulting provider must explain the rationale for all opinions. 3. If, and only if following the development requested above , the record shows that the Veteran has carpal tunnel syndrome that may (recognizing this is a low threshold) be related to his federalized service, the RO should arrange for an examination of the Veteran by a neurologist to determine the likely etiology of the carpal tunnel syndrome. The Veteran's claims file (including this remand) must be reviewed by the examiner in conjunction with the examination. Based on examination of the Veteran and review of his claims file (and noting the Veteran's lay accounts), the examiner should opine whether carpal tunnel syndrome of either upper extremity is at least as likely as not (a 50 % or better probability) related to his federalized military service. The examiner must explain the rationale for all opinions, citing to any supporting factual data. 4. The RO should then review the record and readjudicate the claims. If either remains denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran and his representative the opportunity to respond. The case should then be returned to the Board, if in order, for further 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). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board 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). _________________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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).