Citation Nr: 1329537 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 10-16 883 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for hearing loss. 2. Entitlement to service connection for a disorder of the upper extremities, originally claimed as bilateral elbow pain with paralysis of hands. 3. Entitlement to a urinary tract disorder. 4. Entitlement to a higher (compensable) rating for a right knee disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD T. M. Gillett, Counsel INTRODUCTION The Veteran served on active duty from August 1993 to May 1997, from September 1999 to September 2007, and from February 2010 to December 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In the May 2009 rating decision from which this appeal arises, the RO also denied service connection for hemorrhoids and a sinus disorder. The Veteran included those issues on his May 2009 Notice of Disagreement and the RO included those issues on its subsequent October 2009 Statement of the Case. However, in his April 2010 Substantive Appeal to the Board, the Veteran specifically indicated that he wished to appeal only those issues listed in "The Issues" section above. Therefore, as they were not appealed to the Board, the issues of service connection for hemorrhoids and a sinus disorder are not in appellate status and are not before the Board. In April 2012, the Veteran testified at a hearing before the undersigned Veterans Law Judge, seated at the RO (Travel Board hearing). A transcript has been procured for the record. In April 2012, the Veteran submitted additional evidence with a waiver of Agency of Original Jurisdiction (AOJ) review. 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 During the pendency of the appeal, the Veteran served a period of active duty, lasting from approximately February 2010 to December 2010. Although the Veteran has submitted some treatment records dating from this period, the complete service treatment records for that period of service still must be procured for the record. All currently outstanding VA and private records pertinent to the Veteran's claims should also be procured. In a June 2008 VA audiology examination report, a VA examiner reported that the Veteran did not experience hearing loss symptomatology meeting the criteria for a hearing loss disability under VA regulations. At the April 2012 Travel Board hearing, the Veteran testified that he experienced hearing loss symptomatology which he believed was related to his several periods of service. Considering the Veteran's reports of current hearing loss symptomatology and the Veteran's service subsequent to the provision of the June 2008 VA audiology examination, another VA audiology examination should be provided. The Veteran originally filed a claim for service connection for bilateral elbow pain with paralysis of hands. In written statements filed with VA and his April 2012 testimony before the Board, the Veteran indicated that he was actually seeking service connection for what he believed to be a neurological disorder of the upper extremities, manifested by occasional numbness in his fingers. Although VA provided the Veteran with a June 2008 VA medical examination to determine the nature and etiology of any musculoskeletal elbow or hand disorder, VA did not provide a neurological examination to determine the nature and etiology of any neurological disorder of the upper extremities. Such an examination should be provided. The Veteran claims that he has a urinary tract disorder related to service. In the June 2008 VA medical examination, a VA examiner found no evidence of a urinary tract disorder. However, in a subsequent October 2010 service treatment record, written during the Veteran's most recent period of service, a service examiner noted treating the Veteran for urinary frequency problems. Therefore, another VA examination to determine the nature and etiology of any current urinary tract disorder should be provided. The Veteran states that his right knee disability is manifested by symptomatology more nearly approximating that required for a higher (compensable) rating under VA criteria. The record indicates that the Veteran has undergone treatment for his service-connected right knee disability, to include a right knee surgery, since the most recent June 2008 VA medical examination report. As this indicates potential worsening of the condition since the most recent VA medical examination, an additional VA medical examination to determine the current severity of his right knee disability should be provided. Accordingly, the case is REMANDED for the following action: 1. Obtain and associate with the claims file the Veteran's service treatment records for his most recent period of service, lasting from approximately February 2010 to December 2010. In doing so, VA regulations regarding the procurement of Federal records must be followed. 2. Obtain and associate with the claims file all outstanding records of VA and private treatment for the claimed disorders. All records/responses received should be associated with the claims file. All efforts to obtain the records should be fully documented, and the facility must provide a negative response if records are not available. Insure that the Veteran is provided with the necessary authorization and release forms to procure any outstanding private treatment records. At a minimum, procure any VA treatment records dated since January 2012, the date of the last treatment record on file. 3. After obtaining all outstanding records, afford the Veteran an appropriate VA examination to determine the current nature and etiology of his claimed hearing loss disorder. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. After a thorough examination, if a hearing loss disability meeting VA regulations is diagnosed, the examiner should address the following: Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's current hearing loss disability had it clinical onset during active service or is related to any disease, event, or injury during service. The examiner should consider the Veteran's entire medical history concerning hearing loss symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 4. After obtaining all outstanding records, afford the Veteran a VA neurological examination to determine the current nature and etiology of his claimed disorder of the upper extremities, claimed as bilateral elbow pain with paralysis of hands. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. After a thorough neurological examination, the examiner should address the following: Whether it is at least as likely as not (50 percent probability or greater) that any neurological disorder of the upper extremities present had it clinical onset during active service or is related to any disease, event, or injury during service. The examiner should consider the Veteran's entire medical history concerning neurological symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 5. After obtaining all outstanding records, afford the Veteran an appropriate VA examination to determine the current nature and etiology of his claimed urinary tract disorder. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. After a thorough examination, the examiner should address the following: Whether it is at least as likely as not (50 percent probability or greater) that any diagnosed any urinary tract disorder present had it clinical onset during active service or are related to any disease, event, or injury during service. The examiner should consider the Veteran's entire medical history concerning urinary tract disorder symptomatology. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 6. After obtaining all outstanding records, afford the Veteran a VA joints examination to determine the severity of the service-connected right knee disability. The relevant documents in the claims folder should be made available to the VA examiner for review. The VA examiner should report the passive and active range of motion in the right knee in degrees and clearly indicate what each number represents. The VA examiner should determine whether the knee disability is manifested by painful motion, weakened movement, excess fatigability or incoordination. These determinations should be expressed in terms of the degree of additional range- of-motion loss due to any painful motion, weakened movement, excess fatigability, or incoordination. The VA examiner should report whether there is lateral subluxation or lateral instability of the right knee, and if present, express an opinion as to the severity of such subluxation or lateral instability (slight, moderate, or severe). The VA examiner should report whether the functional impairment due to the disability of the right knee is severe, moderate or slight. The VA examiner should report on whether there has been removal of the semilunar cartilage that is symptomatic or if there is semilunar cartilage dislocation with frequent episodes of "locking," pain, and effusion into the joint. The VA examiner should provide a rationale for all conclusions reached. 7. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claims should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ JOHN Z. JONES 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).