Citation Nr: 1322946 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 13-08 659 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Whether new and material evidence has been received to reopen a claim for service connection for bilateral hearing loss, and if so, whether service connection is warranted. 2. Whether new and material evidence has been received to reopen a claim for service connection for posttraumatic stress disorder (PTSD), and if so, whether service connection is warranted. 3. Entitlement to service connection for tinnitus. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD T. M. Gillett, Counsel INTRODUCTION The Veteran served on active duty from May 1951 to November 1953. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran did not request a hearing before the Board. In June 2013, the Veteran's representative submitted additional evidence without a waiver of agency of original jurisdiction (AOJ) jurisdiction. Yet, as the Board will reopen and grant service connection for PTSD, reopen and remand the issue of service connection for bilateral hearing loss, and remand the issue of service connection for tinnitus, the Board need not discuss whether a remand to the AOJ would be necessary for review of the newly submitted evidence. 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 issues of service connection for bilateral hearing loss and tinnitus 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. In a January 2002 decision, the Board denied service connection for bilateral hearing loss, because evidence did not indicate that the Veteran developed bilateral hearing loss as a result of exposure to noise during service. 2. The evidence associated with the claims file subsequent to the January 2002 Board decision relates to the unestablished fact of in-service noise exposure resulting in bilateral hearing loss; the newly submitted evidence is neither cumulative nor redundant of evidence previously of record; and raises a reasonable possibility of substantiating the claim of service connection for bilateral hearing loss. 3. In a January 2002 decision, the Board denied service connection for PTSD, because a PTSD diagnosis was not supported by credible evidence of a corroborated in-service stressor. 4. The evidence associated with the claims file subsequent to the January 2002 Board decision relates to the unestablished fact of a PTSD diagnosis based on an in-service stressor related to fear of hostile military activity; the newly submitted evidence is neither cumulative nor redundant of evidence previously of record; and raises a reasonable possibility of substantiating the claim of service connection for PTSD. 5. The Veteran has diagnosed PTSD. 6. The Veteran's claimed stressors are related to fear of hostile military activity and are consistent with the places, types, and circumstances of service. 7. The evidence is in equipoise as to whether the PTSD stressors are adequate to support a diagnosis of PTSD, and the PTSD symptoms are related to the claimed stressors. CONCLUSIONS OF LAW 1. The January 2002 Board decision, which denied entitlement to service connection for bilateral hearing loss, was final when issued. 38 U.S.C.A. § 7104(b) (West 2002 & Supp. 2012); 38 C.F.R. § 20.1100 (2012). 2. New and material evidence has been received to reopen service connection for bilateral hearing loss. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156(a) (2012). 3. The January 2002 Board decision, which denied entitlement to service connection for PTSD, was final when issued. 38 U.S.C.A. § 7104(b) (West 2002 & Supp. 2012); 38 C.F.R. § 20.1100 (2012). 4. New and material evidence has been received to reopen service connection for PTSD. 38 U.S.C.A. § 5108 (West 2002 & Supp. 2012); 38 C.F.R. § 3.156(a) (2012). 5. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection PTSD have been met. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Because the determination below reopens the Veteran's claims for service connection for PTSD and bilateral hearing loss, there is no reason to discuss how VA has satisfied the VCAA duties to notify and assist. New and Material Evidence A Board decision denying service connection is final when issued. See 38 U.S.C.A. § 7104. However, if new and material evidence is presented or secured with respect to a claim that has been disallowed, VA must reopen the claim and review its former disposition. 38 U.S.C.A. § 5108; see Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Regardless of the RO's determination as to whether new and material evidence has been submitted, the Board has a jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. See Jackson v. Principi, 265 F.2d 1366 (Fed. Cir. 2001) (citing 38 U.S.C.A. §§ 5108, 7105(c) (West 2002 & Supp. 2012)). Accordingly, the Board must initially determine whether there is new and material evidence to reopen a previously denied claim. In order to prevail on the issue of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). Reopening Service Connection for Bilateral Hearing Loss The Veteran essentially contends that he developed bilateral hearing loss, secondary to noise exposure during service. The Veteran specifically claims that he experienced hearing loss due to exposure to the sounds of aircraft taking off and landing during service during the Korean War. The Veteran also contends that he experienced exposure to loud noises while performing his in-service duties as a cook during service. Reviewing the evidence of record prior to the January 2002 Board decision, the Veteran's service treatment records do not contain any notations indicating treatment or diagnosis for bilateral hearing loss. In a September 1951 service treatment record, the Veteran reported experiencing bilateral ear tenderness with external otitis. The service examiner reported cleaning the Veteran's ears and prescribing ear drops. Neither the Veteran nor the service examiner reported any hearing loss symptomatology. In a November 1953 service separation discharge examination report, a service examiner noted that clinical evaluation of the ears was normal. The service examiner reported that the Veteran's hearing, as tested using a whispered voice, was 15/15 in both ears. The first evidence of hearing loss symptomatology of record is a November 1993 VA audiogram report. In this record, a VA examiner noted that the audiogram revealed the presence of hearing loss. In an April 2001 VA audiology examination report, the Veteran indicated that he experienced hearing loss symptomatology, much worse in the left ear than the right ear. He gave a history of having served in Korea where he was exposed to considerable noise. Following examination, the VA examiner diagnosed asymmetric sensory hearing loss, left ear, with tinnitus and vertigo. The VA examiner commented that these symptoms were highly suggestive of an acoustic neuroma. The VA examiner did not provide an opinion as to whether the Veteran's hearing loss symptomatology was related to service. In the January 2002 decision, the Board denied service connection for bilateral hearing loss, because evidence did not indicate that the Veteran developed bilateral hearing loss as a result of exposure to noise during service. Reviewing the evidence submitted after the January 2002 Board decision, in a September 2009 VA treatment record, a VA examiner noted that the Veteran had diagnosed hearing loss. In an October 2009 claim to reopen the previously denied claim for service connection, the Veteran reported being constantly exposed to noise from enemy aircraft during service. In a January 2010 statement, a fellow service member who served with the Veteran wrote that, in a recent telephone conversation with the Veteran, he told the Veteran that he forgot to mention that both he and the Veteran experienced both aircraft and artillery noise during service. In a June 2013 brief in support of the Veteran's claim, the Veteran's representative wrote that the Veteran would have been exposed to loud noises while working in a kitchen during his term in service. With his brief, the Veteran's representative attached documents printed from the internet regarding the severity of noise in kitchens. In determining the issue of whether newly received evidence is new and material, the credibility of the evidence is to be presumed. Justus, 3 Vet. App. at 513. When credibility is presumed, as is required when determining solely whether to reopen a previously denied claim, the evidence submitted since the January 2002 Board decision indicates that the Veteran has a current hearing loss diagnosis and that the diagnosis might be related to incidents in service, to include jet noise and the noise the Veteran experienced working in a kitchen. The Board notes that the evidence in favor of the Veteran's claim, when taken at face value, is neither cumulative nor redundant of evidence previously of record, and raises a reasonable possibility of substantiating the Veteran's claim. Accordingly, the Board finds that the additional evidence is new and material to reopen service connection for bilateral hearing loss. Reopening Service Connection for PTSD The Veteran essentially contends that he developed PTSD due to incidents he experienced while serving in a war zone during the Korean War. The Board must analyze a claim for service connection for PTSD according to a specific set of regulations. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of a veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C.A. § 1154(b) (West 2002 & Supp. 2011); 38 C.F.R. § 3.304(f). Participation in combat, a determination that is to be made on a case-by-case basis, requires that a Veteran personally participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. See VAOPGCPREC 12-99; Moran v. Principi, 17 Vet. App. 149 (2003); see also Sizemore v. Principi, 18 Vet. App. 264, 273-74 (2004). Since the issuance of the January 2002 Board decision, denying service connection for PTSD, new regulations regarding evaluation for PTSD were created. Under the new regulations, if a stressor claimed by a veteran is related to a veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran's symptoms are related to the claimed stressor, provided that the claimed stressor is consistent with the places, types, and circumstances of a veteran's service, then the requirement for corroborating the stressor is eliminated. "Fear of hostile military or terrorist activity" means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. 38 C.F.R. § 3.304(f)(3) (as amended 75 Fed. Reg. 39843 (effective July 12, 2010)). If a veteran did not engage in combat with the enemy, or the claimed stressors are not related to combat, and the stressor is not related to "fear of hostile military or terrorist activity," then the veteran's testimony alone is not sufficient to establish the occurrence of the claimed stressors and his testimony must be corroborated by credible supporting evidence. Cohen v. Brown, 10 Vet. App. 128 (1997); Moreau v. Brown, 9 Vet. App. 389 (1996); Dizoglio v. Brown, 9 Vet. App. 163 (1996). Furthermore, service department records must support, and not contradict, the claimant's testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994). The question of whether the Veteran was exposed to a stressor in service is a factual one, and VA adjudicators are not bound to accept uncorroborated accounts of stressors or medical opinions based upon such accounts. Wood v. Derwinski, 1 Vet. App. 190 (1991), aff'd on reconsideration, 1 Vet. App. 406 (1991). Hence, whether a stressor was of sufficient gravity to cause or support a diagnosis of PTSD is a question of fact for medical professionals and whether the evidence establishes the occurrence of stressors is a question of fact for adjudicators. Reviewing the evidence of record prior to the January 2002 Board decision, in a May 1951 service induction medical examination report, the service examiner noted that the Veteran did not have any psychiatric abnormalities. The Veteran's service treatment records contain no notation indicating treatment or diagnosis for a psychiatric disorder during service. In a November 1953 service discharge medical examination report, the service examiner noted that the Veteran did not have any psychiatric abnormalities. The Veteran's service personnel records indicate that his specialty during service was that of a cook, and that he served in Korea during the Korean War for the majority of 1952. For his service, the Veteran was awarded a Korean Service Medal and a United Nations Service Medal. The Veteran's service treatment and personnel records contain no notation suggesting that the Veteran received any awards or wounds indicating participation in combat during service. In a September 1993 lay statement, the Veteran stated that he was stationed in Korea when he was 18. The Veteran indicated that he experienced the effects of general warfare during that time, including the greater problem of guerilla warfare. The Veteran reported being told that CIA estimates indicated that there were more than 80,000 well-armed guerillas behind the frontlines in 1952. The Veteran wrote that, in 1952, it was not uncommon to "witness the Human Spoils of Combat ... anywhere South of the 38th Parallel." The Veteran reported discovering during that time that "when it comes to others' blood, I am a complete sissy." The Veteran wrote that the trauma of "living on the edge" for the 12 months of 1952 caused him to become "very keyed-up" and to develop "a hyper personality." The Veteran indicated that the trauma and stress of his service in Korea, for which he received "three battle stars," caused him to maintain a "keyed-up, hyper personality (something inside just short of rage)" for the rest of his life. In a February 1994 VA psychiatric examination report, the VA examiner noted that he had no records to review prior to writing the examination report. During an interview, the Veteran stated that he was one of the top trainees during basic training. The Veteran indicated that he was sent initially to serve in the Food Services department in Mississippi, but then was sent to Korea. The Veteran reported being stationed in Korea with the motor pool and food services. The Veteran indicated that, despite experiencing guerilla attacks during his service in Korea, they were able to defend themselves. The Veteran reported being exposed to war atrocities, killings, and "blood everywhere." The Veteran stated that he became quite hyperactive during that period and developed ulcers. The Veteran reported being unable to stand seeing faces cut, or women and children crying. The Veteran indicated that he saw himself as being physically disabled as he was unable to keep a job or do the things that he used to do. The Veteran reported being a loner, wanting to stay away from everybody. The Veteran stated that he wanted to live in a farm-like environment, maybe in South Alabama. The Veteran indicated that he currently lived in Birmingham, Alabama, but stated that he used to live in Florida. The Veteran reported that he experienced nightmares while he lived in Florida. The Veteran stated that he would find himself in the backyard at night on many occasions during his time of residence in Florida, believing he had a rifle in his hand, seeing guerillas coming over the fence. The Veteran indicated that he would find himself out of breath, sweating profusely, and wanting to run away from danger. The Veteran reported that he chose to live in Birmingham where he did not know anyone, even though he could live in Kentucky or Alabama where he knew people. The Veteran stated that he had been very irritable and restless all of his life. The Veteran indicated that he could not tolerate family gatherings, to include family dinners. The Veteran reported experiencing nightmares, and seeing flashbacks of atrocities against women and children. The Veteran indicated that he avoided war movies and that sudden noises would make him "jumpy." The Veteran stated that he had restricted his activities, and attempted to minimize his psychological trauma and its affects. The Veteran reported seeing his symptoms as being cowardly and ignored them. The VA examiner noted that, in attempting to ignore his symptoms, the Veteran isolated himself from other people. The Veteran indicated that he lived alone and avoided any kind of stimuli that would remind him of war. The February 1994 VA examiner noted that the Veteran did not volunteer any symptomatology and that the examiner detected the symptoms only through questioning. The VA examiner diagnosed chronic PTSD. In a June 1995 private psychiatric examination report, a private examiner noted that the Veteran was meeting with him to assist in a claim for Social Security Disability benefits. When asked how he was disabled, the Veteran indicated that he had a hernia which kept him from being able to sleep, a left leg disorder, hypertension, and "problems with my nerves." The Veteran reported that, during the "Korean police action," he served as a cook. The Veteran stated that he was in combat. The Veteran indicated that, for years following his discharge from service, he experienced dreams and flashbacks of "various atrocities which were frightening." The Veteran reported that his greatest difficulty was in getting along with people as he had an extremely high temper. The Veteran indicated that his temper caused him problems during his employment in the construction field and in his two marriages. The Veteran was reluctant to say what ended his first marriage, which lasted 15 years. Regarding his 20-year-long second marriage, the Veteran indicated that he ran off on several occasions before finally getting a divorce in 1986. The Veteran stated that he had lived alone since 1990 as he preferred to be alone due to his intolerance for other people. The Veteran reported having no friends and no hobbies since 1992. During the examination, the June 1995 private examiner noted that the Veteran was cooperative, but reluctant to give information of a personal nature. The private examiner wrote that the Veteran appeared to have an underlying anger which he seemed to have to keep under control during the initial part of the interview. The private examiner stated that the Veteran's history appeared to be credible. The private examiner indicated that the Veteran appeared to be a very stoic man with underlying anger and hostility issues which he attempted to control. The private examiner stated that, due to his anger and hostility, the Veteran tended to avoid people and dislike crowds. The private examiner reported that the Veteran appeared to be easily provoked. The private examiner noted that the Veteran had stated that his personality markedly changed after returning from combat duty in Korea. The private examiner wrote that the Veteran was totally and permanently disabled from any gainful employment, primarily due to his anti-social, hostile personality disorder. After the examination, the June 1995 private examiner diagnosed (Axis I) history of PTSD, (Axis II) anti-social personality disorder, (Axis III) history of hiatal hernia, history of left inguinal hernia treated surgically with residual pain, history of chronic low back pain, history of high blood pressure, (Axis IV) problems related to social environment, economic problems, and (Axis V) Global Assessment of Functioning (GAF) score of 51. In a November 1998 statement, the Veteran reported being assigned to protect a radar installation in Korea during service. The Veteran said that low flying aircraft attempted to unload explosives on the radar installation over and over again. The Veteran stated that sometimes the aircraft were close enough to fire at the base with rifles. The Veteran also reported that there were bands of guerillas who tried to destroy the radar site. He said that his unit lost two or three people during that year, while inflicting much heavier losses on opposing forces. He said that sometimes they would find the dead bodies of enemy soldiers, and once another man in his unit probed the mouth of a dead body using a bayonet. The Veteran did not provide any specific dates for these incidents or the names of the persons involved. In a March 2001 VA psychiatric examination report, the Veteran reported experiencing many traumatic and life-threatening situations while serving as a cook during the Korean War. The Veteran stated that, while in Korea, his base was attacked by the enemy on a daily basis, especially at night. The Veteran stated that he was awarded Korean Service Ribbons with three cups and battle stars. The Veteran reported that he was assigned during his tour as one of two men who had to protect a radar station. The Veteran indicated that he was under constant attack while performing this duty and had to be on constant guard. The Veteran reported seeing the dead bodies of women and children during his tour. The Veteran also indicated that he was involved in a guerilla war despite his specialty as a cook. The Veteran indicated that he had felt anxious and hyperactive since his service in Korea. The Veteran stated that he underwent a nervous breakdown in 1955 and was prescribed valium. The Veteran reported feeling uncomfortable talking about his problems as he did not believe that it was "manly." The Veteran indicated that he had difficulty controlling his temper, and that he was often mean and difficult with which to work. The Veteran stated that he experienced difficulty with feelings of nervousness and anxiety. The Veteran reported experiencing nightmares about being fired upon by the enemy. The Veteran stated that he experienced intrusive thoughts during the daytime about the war. He indicated that he had become increasingly isolated and withdrawn. The Veteran reported disliking the sound of loud noises. The Veteran stated that he was withdrawn from his family. The Veteran indicated that he had remarried about six weeks prior to the examination. Upon examination, the March 2001 VA examiner noted that the Veteran became quite emotional when describing the various traumatic events he experienced during the Korean War. After the examination, the VA examiner diagnosed (Axis I) chronic mild to moderate PTSD; depressive disorder, not otherwise specified (NOS), secondary to PTSD; (Axis IV) problems related to primary support group, unemployment, other social environment problems, health problems, and (Axis V) GAF score of 52 to 53. In a January 2002 decision, the Board denied service connection for PTSD. In the decision, the Board noted that the Veteran had been diagnosed as having PTSD. Yet, the Board denied the claim, finding that the Veteran was not a combat veteran and that the PTSD diagnosis was not supported by credible evidence of a corroborated in-service stressor. Reviewing the evidence submitted since the January 2002 Board decision, in a September 2009 VA treatment record, specifically a history and physical, a VA examiner diagnosed PTSD without further explanation. In an October 2009 statement, included with his application to reopen service connection for PTSD, the Veteran stated that his base underwent anti-aircraft fire while he was stationed in Korea as the enemy continually attempted to destroy their radar site. As noted above, in the January 2002 decision, the Board denied service connection for PTSD because the PTSD diagnosis was not supported by credible evidence of a corroborated in-service stressor. Yet, since the issuance of the January 2002 decision, VA amended its rules regarding the corroboration of stressors. Under the new regulations, if a stressor claimed by a veteran is related to a veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran's symptoms are related to the claimed stressor, provided that the claimed stressor is consistent with the places, types, and circumstances of a veteran's service, then the requirement for corroborating the stressor is eliminated." 38 C.F.R. § 3.304(f)(3). The record indicates that the Veteran was diagnosed as having PTSD by VA examiners prior to January 2002 due to incidents involving fear of hostile military activity during the Korean War. The Board finds that such incidents are consistent with those which would have been experienced by an individual serving in the Korean War on an airbase. The Board notes that the Veteran's accounts of his stressors, along with the September 2002 diagnosis of PTSD, when taken at face value, are neither cumulative nor redundant of evidence previously of record, relate to the unestablished fact of a corroborated stressor necessary to substantiate the Veteran's claim, and raise a reasonable possibility of substantiating the Veteran's claim. Accordingly, the Board finds that the additional evidence is new and material to reopen service connection for PTSD. Service Connection for PTSD As noted above, the Veteran seeks service connection for PTSD. For the sake of brevity, although the Board will consider the evidence already listed in the section regarding the reopening of the Veteran's claim for service connection, the Board will not reiterate that evidence in this section of the opinion. In an October 2009 VA treatment record, the Veteran reported working in food services during the Korean War. The Veteran stated that he experienced multiple incidents during which his life was endangered during that conflict and instances during which he was awakened by incoming fire. The Veteran indicated that he had now been divorced three times and that he only had a few friends. The Veteran reported experiencing problems with anger. The VA examiner diagnosed (Axis I) anxiety disorder NOS, consider PTSD, and (Axis V) GAF score of 58. In a December 2009 VA treatment record, the Veteran talked about how he had discussed his sleeping difficulties with VA examiners in the past and that they had told him that he should file a claim for service connection for PTSD. Upon examination, the VA examiner noted that the Veteran showed no acute emotional distress. The diagnoses were anxiety disorder NOS and rule-out PTSD. In a December 2009 VA treatment record, the Veteran told the VA examiner that he had a claim for service connection pending at VA and that all he really wanted to talk to the examiner about was a "decent sleeping pill." The Veteran reported undergoing enemy attacks while working in the mess hall in Korea. The Veteran indicated that he had difficulty sleeping, primarily due to primary initial insomnia, complicated by hiatal hernia and reflux pain. The Veteran stated that lightning would sometimes trigger a flashback. The Veteran reported feeling depressed occasionally, but stated that he would go out and do things to get over these feelings. The Veteran indicated that he went absent without leave (AWOL) during service because he wanted to get out of service. The Veteran reported that he was granted a general discharge. The Veteran stated that he had little contact with his family and lived on his own. The VA examiner diagnosed, in particular part, anxiety disorder NOS and a history of PTSD per the Veteran and notes submitted by the Veteran. In a February 2010 VA treatment record, the Veteran reported that the sleep medication that he had been provided was helpful. The Veteran indicated that he experienced difficulty sleeping and some anxiety. The Veteran indicated that he slept for seven hours per night and had only two nightmares per month. The Veteran also reported having an inadequate income, and the use of alcohol and drugs. The VA examiner noted that the Veteran appeared to be fairly euthymic with a congruent affect. After an examination, the Veteran diagnosed, amongst other things, anxiety disorder NOS, with PTSD symptoms, which was improving. In a March 2010 VA psychiatric examination report, the Veteran reported that the feelings of anger he experienced towards other people was related to his ability to see through situations and to call "b.s." on them as he got older. The Veteran stated that it bothered him that he did not feel successful, that he had undergone three divorces, and that he had isolated himself by choice. The Veteran indicated that he had experienced psychiatric disorder symptomatology daily to weekly in frequency since service, and that his symptoms currently were mild. The Veteran reported taking psychiatric medication, but stated that he was not sure how the drugs were working. The Veteran stated that he had two adult daughters and had an "okay" relationship with them, but acknowledged that he often would not talk to them for years because of differences of opinions. The Veteran reported not wanting to deal with others because he liked things to happen his way. When asked by the VA examiner to describe his service-related stressors, the Veteran directed the VA examiner to the information he had submitted to the RO previously in support of his claim. Upon examination, the March 2010 VA examiner noted that the Veteran was uncooperative, displayed a somewhat haughty demeanor, and attempted to control the examination at times. The VA examiner indicated that the Veteran's was mildly irritable, displayed a full and reactive affect, and frequently expressed suspicion. In reviewing the results of the best PTSD tests available, the VA examiner noted that the Veteran's objective assessed response style issues precluded a conclusive diagnosis of a mental disorder. The VA examiner reported that, despite the Veteran's response style, the Veteran's score on a validated PTSD scale was consistent with relatively mild PTSD. Based on the Veteran's refusal to cooperate fully with the interview, the VA examiner found that the Veteran's current mental condition was unclear. After an examination, the March 2010 VA examiner diagnosed "no diagnosis (provisional). The VA examiner wrote that he could not provide an opinion as to whether the Veteran's claimed PTSD was related to service without resorting to mere speculation. The VA examiner wrote that PTSD was not diagnosed in the current examination because the results of objective testing did not conform to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) guidelines for the diagnosis of PTSD. The VA examiner noted that the evidence was reviewed in the context of the Veteran's external incentive (i.e. disability benefits). The VA examiner noted that the Veteran's previous diagnoses of PTSD, found in the claims file, appeared to have been based predominantly on the Veteran's subjective reports of his symptomatology, with no objective assessment of response style conducted. Therefore, the VA examiner found that the responses were inapplicable to the current examination. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. § 3.304(f). As noted above, under VA regulations, if a stressor claimed by a veteran is related to a veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran's symptoms are related to the claimed stressor, provided that the claimed stressor is consistent with the places, types, and circumstances of a veteran's service, then the requirement for corroborating the stressor is eliminated." 38 C.F.R. § 3.304(f)(3). The Board finds that the Veteran experienced incidents resulting in fear of hostile military activity that are consistent with those which would have been experienced by an individual serving in the Korean War on an airbase. Therefore, the requirement to corroborate the Veteran's in-service stressors involving fear of hostile military activity is eliminated and his in-service stressors are considered confirmed. The Board notes that the record indicates that the Veteran was diagnosed by a VA examiner as having PTSD related to such stressors in the past, most recently in a March 2001 VA psychiatric examination report. However, since the October 2009 filing of his claim to reopen service connection for PTSD, VA examiners have diagnosed the Veteran as having some PTSD symptomatology, but have not diagnosed PTSD itself. In fact, in the March 2010 VA psychiatric examination report, the VA examiner diagnosed the Veteran as having no disabilities. In reviewing the previous examination reports, diagnosing PTSD, the VA examiner wrote that the previous diagnoses appeared to have been based predominantly on the Veteran's subjective reports of his symptomatology, with no objective assessment of response style conducted. The VA examiner reported that his diagnosis was based on better testing criteria, but did not delineate clearly what specific testing he conducted. Service connection may be granted only if a disability existed at the time a claim for VA disability compensation was filed or at any time during the pendency of the claim, even if the disability resolves prior to the adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Although the Veteran was not diagnosed as having PTSD since the filing of his October 2009 claim for benefits, in a September 2009 VA treatment record, written one month prior to the filing of the application to reopen, a VA examiner diagnosed the Veteran as having PTSD. As this diagnosis is so close in time to the date of the filing of the claim, resolving doubt in the Veteran's favor, the Board finds that the record indicates that the Veteran was diagnosed as having PTSD at the time of the filing of his October 2009 application to reopen service connection for PTSD. As noted above, in the March 2010 VA psychiatric examination report, the March 2010 VA examiner wrote that the previous diagnoses of PTSD were based predominantly on the Veteran's subjective reports of his symptomatology, with no objective assessment of response style conducted. Yet, the Board notes, although the March 2010 VA examiner reported that his diagnosis was based on better testing criteria, he did not delineate clearly what specific testing he conducted. Moreover, the record contains multiple records from different examiners, to include VA examiners, diagnosing the Veteran as having PTSD related to in-service stressors related to hostile military activity. Therefore, the Board finds that the evidence is in relative equipoise as to whether the Veteran has a currently diagnosed PTSD disorder related to a stressor involving hostile enemy activity. Resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for PTSD is warranted. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER New and material evidence having been received, the appeal to reopen service connection for bilateral hearing loss is granted. Service connection for PTSD is granted. REMAND The Board finds that additional development is required before the issues of service connection for bilateral hearing loss and tinnitus may be adjudicated. 38 C.F.R. § 19.9 (2012). The Veteran claims that he developed bilateral hearing loss and tinnitus, secondary to noise exposure during service. The Veteran specifically claims that he experienced hearing loss due to the sounds of aircraft taking off and landing during service during the Korean War. The Veteran also contends that he was exposed to loud noises while performing his in-service duties as a cook during service. The Board finds that a VA audiology examination is necessary to assist in determining the nature and etiology of the Veteran's claimed bilateral hearing loss and tinnitus disorders. VA must afford a veteran a medical examination or obtain a medical opinion when necessary to make a decision on a claim. See 38 U.S.C.A. § 5103A(d) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(c)(4). The United States Court of Appeals for Veterans Claims (Court) in McLendon v. Nicholson, 20 Vet. App. 79 (2006), provided further guidance, outlining that VA must provide a medical examination when there is: (1) competent evidence of a current disability or persistent recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. With respect to the need for an indication that a veteran's current disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, the Court stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and a veteran's service. The types of evidence that "indicate" that a current disability "may be associated" with military service include, but are not limited to, medical evidence that suggests a nexus, but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology to include symptoms capable of lay observation. McLendon, 20 Vet. App. at 83. Previously, in an April 2001 VA audiology examination report, the Veteran indicated that he experienced hearing loss which was much worse in the left ear than the right ear. He gave a history of having been in Korea where he was exposed to considerable noise. Following examination, the VA examiner diagnosed asymmetric sensory hearing loss, left ear, with tinnitus and vertigo. The examiner commented that these symptoms were highly suggestive of an acoustic neuroma. However, the VA examiner did not provide an opinion as to whether the Veteran's hearing loss symptomatology was related to service. Recent VA treatment records include diagnoses for both bilateral hearing loss and tinnitus. Therefore, the record contains competent evidence of a current bilateral hearing loss and tinnitus disorders, and lay evidence suggesting an association between the Veteran's current hearing loss and tinnitus disorders and in-service exposure to loud noises. The Board finds that this evidence is sufficient to warrant a VA audiology examination to determine the nature and etiology of any existent bilateral hearing loss and tinnitus disorders under the low threshold of McLendon. On remand, the Veteran's records from the Social Security Administration (SSA) should be obtained, as well as any recent VA treatment records. 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. Make arrangements to obtain the Veteran's VA treatment records for hearing loss and tinnitus, dated since October 2012. 2. Request from the SSA complete copies of any disability determination(s) it has made concerning the Veteran (including in approximately 1993) and copies of the medical records that served as the basis for any such decision(s). If these records are not available, a negative reply is required. 3. Thereafter, schedule the Veteran for a VA audiology examination. All indicated tests and studies should be performed. Prior to the examination, the claims folder should be made available to and reviewed by the VA examiner. The VA examiner should offer the following opinions: a. Is it at least as likely as not (50 percent or greater likelihood) that any diagnosed bilateral hearing loss disorder had its clinical onset during active service or is related to any incident of service, to include in-service exposure to loud noises? b. Is it at least as likely as not (50 percent or greater likelihood) that any diagnosed tinnitus had its clinical onset during active service or is related to any incident of service, to include in-service exposure to loud noises? A rationale should be provided for any opinion or conclusion expressed. If the VA examiner is unable to provide the requested opinion with what is considered to be a generally accepted degree of medical certainty, i.e., without resorting to speculation, the reasons should be so stated. The VA examiner should in such case explain why it would be speculative to respond. 4. After completion of the foregoing and all other necessary development, re-adjudicate the claims for service connection for bilateral hearing loss and tinnitus. If any benefit sought remains denied, the Veteran and the representative should be furnished a supplemental statement of the case, and should be given an opportunity to submit written or other argument in response before the claims file is returned to the Board for further appellate consideration. The Veteran is advised to appear and participate in any scheduled VA examination, as failure to do so may result in denial of this claim. See 38 C.F.R. § 3.655 (2012). The Veteran 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). ______________________________________________ P.M. DILORENZO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs