Citation Nr: 18140801 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 14-41 668 DATE: REMANDED Service connection for a left ankle disability is remanded. Service connection for a right ankle disability is remanded. Service connection for a left knee disability is remanded. Service connection for a right knee disability is remanded. Service connection for bilateral hearing loss is remanded. Service connection for tinnitus is remanded. Service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1970 to May 1972, and July 1979 to June 1993 in the United States Army. He served in the Republic of Vietnam from October 1970 to April 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified before the undersigned during a hearing at the RO. A transcript of the hearing is included in the electronic claims file. Remand is needed for several reasons. Initially, the Veteran has indicated that he receives his medical care through VA. At present, the claims file does not contain any post-service treatment records. All VA treatment records must be requested and associated with the file. Additional medical opinions are also needed to resolve the claims on appeal. As for the claims involving the ankles, knees, and right shoulder, the Veteran testified that the physical rigors of his lengthy military service caused his current disabilities. Service treatment records (STRs) indeed show complaints and treatment pertaining to the bilateral knees and ankles in March 1993, April 1993, and on his Report of Medical History on separation. The Veteran testified that he also sustained injuries to these areas during a slip and fall accident in service which resulted in hernia surgery, although he did not make specific orthopedic complaints at the time. The slip and fall accident is corroborated in January 1988 STRs. While a VA examination was conducted in April 2016, the examiner did not address the right shoulder and did not address any of the pertinent STRs. Further, in requesting an opinion on etiology, the RO asked the examiner to opine on whether the conditions were caused by low back pain in the military, which is not applicable to the facts of this case and may have caused misunderstanding. As for bilateral hearing loss and tinnitus, VA has already acknowledged the Veteran’s high probability of hazardous noise exposure as an infantryman in the Army. Further, at the May 2018 hearing, the Veteran’s spouse testified regarding her personal observations of his difficulty hearing during and since military service. On VA examination in May 2016, the examiner opined that the hearing loss was less likely than not caused by noise exposure because the 15-20 decibel shift shown over a 23-year period, between 1970 and 1993, was consistent with a normal progression of hearing loss and not acoustic trauma. As for tinnitus, he similarly opined there was no objective evidence of acoustic trauma to support a nexus. However, a comparison of in-service audiograms shows that even between 1972 and 1980, an 8-year span, a 15-20 decibel shift occurred. It is thus not clear whether the examiner considered all of the in-service audiograms in rendering his opinions. The matters are REMANDED for the following action: 1. Contact the Veteran and ask him to identify the locations of all post-service VA medical treatment. Then, obtain the identified records and associate them with the claims file. 2. Schedule the Veteran for an examination to address the nature and etiology of his bilateral knee disabilities, bilateral ankle disabilities, and right shoulder disability. The examiner must opine whether it is at least as likely as not that any of these disabilities are related to an in-service injury, event, or disease.  In doing so, the examiner must consider the following: • lay testimony of the Veteran regarding the rigors of his lengthy military service, and symptoms during and since service • January 1988 in-service slip and fall accident • Service treatment records documenting complaints and treatment pertaining to the knees and ankles from March 1993, April 1993, and on separation from service • April 2016 VA examination report 3. Schedule the Veteran for an examination to address the nature and etiology of his bilateral hearing loss and tinnitus. The examiner must opine whether it is at least as likely as not that bilateral hearing loss and tinnitus are related to an in-service injury, event, or disease, including in-service hazardous noise exposure.  In doing so, the examiner must consider the following: • lay testimony of the Veteran and his wife regarding hearing difficulties and tinnitus in and since service • numerous in-service audiograms, including, those dated from 1970, 1972, 1980, 1986, 1988, 1989, and upon separation, as well as the threshold shifts illustrated by those audiograms, including between 1972 and 1980 • May 2016 VA examination report JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Smith, Counsel