Citation Nr: 18142148 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 16-28 428 DATE: October 12, 2018 ORDER As new and material evidence has been received, the previously denied claim of service connection for bilateral hearing loss is reopened. As new and material evidence has been received, the previously denied claim of service connection for a cardiovascular disability is reopened. As new and material evidence has been received, the previously denied claim of service connection for a lung disability, including as due to in-service asbestos exposure, is reopened. As new and material evidence has not been received, the previously denied claim of service connection for left shoulder and neck arthritis, including as due to service-connected left thumb injury residuals, is not reopened. As new and material evidence has not been received, the previously denied claim of service connection for tinnitus is not reopened. As new and material evidence has not been received, the previously denied claim of service connection for residuals of a left arm injury is not reopened. Entitlement to service connection for a lung disability, including as due to in-service asbestos exposure, is denied. Entitlement to service connection for a left hip disability is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a cardiovascular disability is remanded. Entitlement to a disability rating greater than 10 percent for left thumb injury residuals is remanded. FINDINGS OF FACT 1. In a decision dated on September 3, 2009, the Board denied, in pertinent part, the Veteran’s claim of service connection for residuals of a left arm injury; this decision was not appealed and became final. 2. The evidence received since the September 2009 Board decision is either cumulative or redundant of evidence previously submitted in support of the Veteran’s claim of service connection for residuals of a left arm injury and does not relate to an unestablished fact necessary to substantiate this claim. 3. In a rating decision dated on September 7, 2013, the Agency of Original Jurisdiction (AOJ) denied, in pertinent part, the Veteran’s claims of service connection for bilateral hearing loss, a cardiovascular disability (which was characterized as ischemic heart disease), and for tinnitus and also denied a request to reopen a previously denied claim of service connection for left shoulder and neck arthritis; this decision was not appealed and became final. 4. The evidence received since the September 2013 AOJ decision relates to unestablished facts necessary to substantiate the claims of service connection for bilateral hearing loss and for a cardiovascular disability because it shows that the Veteran’s bilateral hearing loss and cardiovascular disability may be related to active service. 5. The evidence received since the September 2013 AOJ decision is either cumulative or redundant of evidence previously submitted in support of the Veteran’s claim of service connection for tinnitus and his request to reopen a previously denied claim of service connection for left shoulder and neck arthritis does not relate to unestablished facts necessary to substantiate either of these claims. 6. In a rating decision dated on March 20, 2014, the AOJ denied the Veteran’s claim of service connection for a lung disability; this decision was not appealed and became final. 7. The evidence received since the March 2014 AOJ decision relates to an unestablished fact necessary to substantiate the claim of service connection for a lung disability because it shows that the Veteran’s current lung disability may be related to active service. 8. The record evidence does not show that the Veteran was exposed to asbestos during active service. 9. The record evidence shows that the Veteran’s current lung disability is not related to active service or any incident of service, including as due to his claimed in-service asbestos exposure. 10. The record evidence shows that the Veteran does not experience any current left hip disability which is attributable to active service. CONCLUSIONS OF LAW 1. The September 2009 Board decision, which denied a claim of service connection for residuals of a left arm injury, is final. 38 U.S.C. §§ 7104, 7266 (West 2012); 38 C.F.R. § 20.1100 (2017). 2. Evidence received since the September 2009 rating decision in support of the claim of service connection for residuals of a left arm injury is not new and material; thus, this claim is not reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156 (2017). 3. The September 2013 AOJ decision, which denied claims of service connection for bilateral hearing loss, a cardiovascular disability, and for tinnitus and also denied a request to reopen a previously denied claim of service connection for left shoulder and neck arthritis, is final. 38 U.S.C. § 7105 (West 2012); 38 C.F.R. § 20.302 (2017). 4. Evidence received since the September 2013 AOJ decision in support of the claims of service connection for bilateral hearing loss and for a cardiovascular disability is new and material; thus, these claims are reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156 (2017). 5. Evidence received since the September 2013 rating decision in support of the claim of service connection for tinnitus and the request to reopen a previously denied claim of service connection for left shoulder and neck arthritis is not new and material; thus, these claims are not reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156 (2017). 6. The March 2014 AOJ decision, which denied a claim of service connection for a lung disability, including as due to in-service asbestos exposure, is final. 38 U.S.C. § 7105 (West 2012); 38 C.F.R. § 20.302 (2017). 7. Evidence received since the March 2014 AOJ decision in support of the claim of service connection for a lung disability, including as due to in-service asbestos exposure, is new and material; thus, this claim is reopened. 38 U.S.C. § 5108 (West 2012); 38 C.F.R. § 3.156 (2017). 8. The criteria for service connection for a lung disability, including as due to in-service asbestos exposure, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.303, 3.304 (2017). 9. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1966 to May 1968. The Veteran appointed his current representative to represent him by filing a completed VA Form 21-22a with the AOJ in September 2014. The Board observes that, in September 2009, it denied, in pertinent part, the Veteran’s claim of service connection for residuals of a left arm injury (which was characterized as residuals of a left arm injury (a “left arm disability”), claimed as secondary to residuals of a left thumb injury). The Veteran did not appeal this decision, and it became final. The Board also observes that, in September 2013, the AOJ denied, in pertinent part, the Veteran’s claims of service connection for bilateral hearing loss, a cardiovascular disability (which was characterized as ischemic heart disease), and for tinnitus and also denied a request to reopen a previously denied claim of service connection for left shoulder and neck arthritis. This decision was not appealed and became final. The Board finally observes that, in March 2014, the AOJ denied the Veteran’s claim of service connection for a lung disability. This decision was not appealed and became final. See 38 U.S.C. §§ 7104, 7105, 7266 (West 2012). The Veteran also did not submit any relevant evidence or argument within 1 year of the September 2013 or March 2014 rating decisions which would render either of these rating decisions non-final for VA adjudication purposes. See Buie v Shinseki, 24 Vet. App. 242, 251-52 (2011) (explaining that, when statements are received within one year of a rating decision, the Board's inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156 (b)). The Board does not have jurisdiction to consider a claim that has been adjudicated previously unless new and material evidence is presented. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). Therefore, the issues of whether new and material evidence has been received to reopen claims of service connection for bilateral hearing loss, a cardiovascular disability, a lung disability, left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury are as stated above. Regardless of the RO’s actions, the Board must make its own determination as to whether new and material evidence has been received to reopen these claims. That is, the Board has a jurisdictional responsibility to consider whether a claim should be reopened. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Service Connection The Veteran essentially contends that new and material evidence has been received sufficient to reopen his previously denied claims of service connection for bilateral hearing loss, a cardiovascular disability, a lung disability, left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury. He also contends that he incurred a left hip disability during active service. Neither the Veteran nor his representative has raised any other issues nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that Board not required to address issues unless specifically raised by claimant or reasonably raised by record evidence). 1. Whether new and material evidence has been received to reopen claims of service connection for bilateral hearing loss, a cardiovascular disability, and for a lung disability The Board finds that the evidence supports reopening the Veteran’s previously denied claims of service connection for bilateral hearing loss, a cardiovascular disability, and for a lung disability, including as due to in-service asbestos exposure. The Board agrees with the Veteran’s argument that new and material evidence has been received since the prior final rating decisions in September 2013 and in March 2014, respectively, sufficient to reopen each of these previously denied claims. The Board notes initially that claims of service connection may be reopened if new and material evidence is received. Manio v. Derwinski, 1 Vet. App. 140 (1991). The Veteran requested that his previously denied service connection claim for bilateral hearing loss be reopened when he submitted a VA Form 21-256b which was dated on May 16, 2014, and date-stamped as received by the AOJ on May 19, 2014. He subsequently requested that his previously denied service connection claims for a cardiovascular disability and for a lung disability be reopened when he submitted a VA Form 21-256b which was dated on September 30, 2014, and date-stamped as electronically received by the AOJ that same day. New and material evidence is defined by regulation. See 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). With respect to the Veteran’s application to reopen the previously denied service connection claims for bilateral hearing loss and for a cardiovascular disability, the evidence before VA at the time of the prior final AOJ decision in September 2013 consisted of the Veteran’s service treatment records, VA and private outpatient treatment records, and lay statements. The AOJ found that neither of these claimed disabilities had been diagnosed. Thus, the claims were denied. The newly received evidence shows that the Veteran currently experiences bilateral hearing loss and a cardiovascular disability which could be attributed to active service. For example, the Veteran’s recent VA outpatient treatment records show ongoing complaints of and treatment for bilateral hearing loss and for multiple cardiovascular disabilities. The Veteran also wears bilateral hearing aids. With respect to the Veteran’s requests to reopen previously denied service connection claims for bilateral hearing loss and for a cardiovascular disability, the Board notes that the evidence which was of record at the time of the prior final AOJ decision in September 2013 did not indicate that the Veteran experienced any current bilateral hearing loss or cardiovascular disability which could be attributed to active service. The newly received evidence suggests that the Veteran currently experiences both of these claimed disabilities which may be related to active service. With respect to the Veteran’s request to reopen his previously denied claim of service connection for a lung disability, including as due to in-service asbestos exposure, the Board notes that the evidence which was of record at the time of the prior prior final AOJ decision in September 2013 consisted of the Veteran’s service treatment records, VA and private outpatient treatment records, and lay statements. The AOJ found that, although a private clinician stated that the Veteran had bilateral pulmonary asbestosis, VA chest x-ray showed no active lung disease. Thus, the claim was denied. The newly received evidence shows that the Veteran currently experiences a lung disability which may be related to active service. For example, on VA respiratory conditions Disability Benefits Questionnaire (DBQ) in February 2017, the Veteran’s complaints included shortness of breath “while walking short distances [and] climbing stairs” since 1996. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. A history of chronic obstructive pulmonary disease (COPD) and tobacco use was noted. The Veteran’s respiratory condition required the use of oral or parenteral corticosteroid medications (4 or more intermittent courses) and systemic high dose corticosteroids for control, daily inhalational bronchodilator therapy, daily oral bronchodilators, and continuous outpatient oxygen therapy. A chest x-ray was normal. The diagnosis was COPD. The Board next notes that the United States Court of Appeals for Veterans Claims (Court) held in Shade v. Shinseki, 24 Vet. App 110 (2010), that the phrase “raises a reasonable possibility of substantiating the claim” found in the post-VCAA version of 38 C.F.R. § 3.156(a) must be viewed as “enabling” reopening of a previously denied claim rather than “precluding” it. All of the newly received evidence is presumed credible solely for the limited purpose of reopening the previously denied claim. See Justus, 3 Vet. App. at 513. Thus, the Board finds that the evidence submitted since September 2013 and March 2014 is new, in that it has not been submitted previously to agency adjudicators, and is material, in that it relates to unestablished facts necessary to substantiate the claims of service connection for bilateral hearing loss, a cardiovascular disability, and for a lung disability, respectively, and raises a reasonable possibility of substantiating each of these claims. Because new and material evidence has been received, the Board finds that the previously denied claims of service connection for bilateral hearing loss, a cardiovascular disability, and for a lung disability are reopened. 2. Whether new and material evidence has been received to reopen claims of service connection for left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury The Board next finds that the preponderance of the evidence is against granting the Veteran’s requests to reopen his previously denied claims of service connection for left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury. Despite the Veteran’s assertions to the contrary, the newly received evidence does not support reopening any of these previously denied claims. The Board again notes initially that claims of service connection may be reopened if new and material evidence is received. See Manio, 1 Vet. App. at 140. The Veteran requested that these previously denied service connection claims be reopened when he submitted a VA Form 21-256b which was dated on May 16, 2014, and date-stamped as received by the AOJ on May 19, 2014. New and material evidence is defined by regulation. See 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. See Justus, 3 Vet. App. at 513. With respect to the Veteran’s application to reopen his previously denied service connection claim for residuals of a left arm injury, the evidence which was before the Board at the time of the prior final decision in September 2009 consisted of his service treatment records, his post-service VA and private outpatient treatment records, and his Board hearing testimony and lay statements. The Board found that the medical evidence did not support finding an etiological link between any residuals of a left arm injury and active service or any incident of service. Thus, the claim was denied. With respect to the Veteran’s application to reopen his previously denied service connection claims for left shoulder and neck arthritis and for tinnitus, the evidence which was before the AOJ at the time of the prior final rating decision in September 2013 consisted of his service treatment records, his post-service VA and private outpatient treatment records, and lay statements. The AOJ found that there was no medical evidence of a diagnosis of tinnitus. The AOJ also found that the newly received evidence still did not establish an etiological link between the Veteran’s claimed left shoulder and neck arthritis and active service. Thus, both of these claims were denied. The newly received evidence still does not indicate that the Veteran experiences any current disability due to his claimed left shoulder and neck arthritis, tinnitus, or residuals of a left arm injury which could be attributed to active service. The evidence received since September 2009 (for residuals of a left arm injury) and since September 2013 (for left shoulder and neck arthritis and tinnitus) consists of additional VA and private outpatient treatment records and lay statements. Although this evidence shows ongoing complaints of and treatment for left shoulder and neck pain, this pain does not result in any functional impairment in the Veteran’s left shoulder or neck such that his complaints of pain alone can be considered a disability for VA adjudication purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (finding that pain alone may constitute a disability for VA disability compensation purposes if it results in functional impairment). This evidence also does not show that the Veteran experiences any current disability due to either his claimed tinnitus or residuals of a left arm injury which could be attributed to active service. The Veteran himself denied experiencing tinnitus on VA outpatient treatment in June 2017. This persuasively suggests that the Veteran himself does not believe that he experiences tinnitus which is attributable to active service or any incident of service. In other words, the Board finds that the evidence received since September 2009 or September 2013, respectively, is duplicative of evidence previously considered by the AOJ in adjudicating the Veteran’s claims. The Board again notes that the Court held in Shade, 24 Vet. App 110 (2010), that the phrase “raises a reasonable possibility of substantiating the claim” found in the post-VCAA version of 38 C.F.R. § 3.156(a) must be viewed as “enabling” reopening of a previously denied claim rather than “precluding” it. All of the newly received evidence is presumed credible solely for the limited purpose of reopening the previously denied claim. See Justus, 3 Vet. App. at 513. With respect to the Veteran’s requests to reopen his previously denied service connection claims for left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury, the Board finds that there is no reasonable possibility that the newly received evidence would enable rather than preclude reopening any of these claims. Unlike in Shade, there is no evidence in this case – either previously considered in the September 2009 Board decision, which denied service connection for residuals of a left arm injury, the September 2013 AOJ decision, which denied service connection for tinnitus and declined to reopen the previously denied service connection claim for left shoulder and neck arthritis, or received since each of these decisions became final – which demonstrates that any of these disabilities is related to active service or any incident of service. Thus, the analysis of new and material evidence claims that the Court discussed in Shade is not applicable to the Veteran’s requests to reopen his previously denied service connection claims for left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury. In summary, as new and material evidence has not been received, the previously denied claims of service connection for left shoulder and neck arthritis, tinnitus, and for residuals of a left arm injury are not reopened. 3. Entitlement to service connection for a lung disability The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for a lung disability, including as due to in-service asbestos exposure. The Veteran essentially contends that he incurred a lung disability during active service or, alternatively, he was exposed to asbestos during active service which caused or contributed to his current lung disability decades after his service separation. The record evidence does not support his assertions regarding an etiological link between the Veteran’s current lung disability (diagnosed as COPD) and active service or any incident of service, including as due to in-service asbestos exposure. It shows instead that his current COPD is not related to active service. For example, the Veteran’s available service treatment records show no complaints of or treatment for a lung disability. Nor does a review of these records show any documentation of in-service asbestos exposure. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). The post-service evidence also does not support granting the Veteran’s claim of service connection for a lung disability. It shows instead that his current lung disability (diagnosed as COPD) is not related to active service. For example, following VA respiratory conditions DBQ in February 2017 (discussed above), the VA examiner opined that it was less likely than not that the Veteran’s COPD was related to active service, including as due to in-service asbestos exposure. The rationale for this opinion was based on a review of the Veteran’s claims file. The rationale also was that there was no x-ray or computerized tomography (CT) scan showing that the Veteran had been exposed to asbestos. The rationale also was that the Veteran’s COPD “is more likely than not a complication of his history of tobacco use disorder.” The Board acknowledges that, in a July 2018 letter, a VA clinician stated that the Veteran had “a history of moderate to severe COPD. He has a history of asbestosis.” The Court has held that the Board is free to assess medical evidence and is not compelled to accept a physician's opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). A medical opinion based upon an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A bare conclusion, even one reached by a medical professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). A bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a medical professional. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). The Court also has held that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). A review of the July 2018 VA clinician’s letter shows that this clinician relied on the Veteran’s inaccurately reported history of asbestosis which is not supported by a review of the record evidence. This clinician also did not identify any “clinical data” on which his conclusions regarding the Veteran’s medical history were based. Thus, the Board finds that the July 2018 letter from a VA clinician is not probative on the issue of whether the Veteran’s current lung disability (diagnosed as COPD) is related to active service or any incident of service, including as due to in-service asbestos exposure. Despite the Veteran’s assertions to the contrary, the record evidence does not support granting his claim of service connection for a lung disability, including as due to in-service asbestos exposure. The record evidence does not show that the Veteran was exposed to asbestos at any time during active service. More importantly, it shows that his current lung disability (diagnosed as COPD) is not related to active service or any incident of service. The February 2017 VA examiner specifically opined that it was less likely than not that the Veteran’s current COPD was related to active service. This opinion was fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to service connection for a lung disability, including as due to in-service asbestos exposure. In summary, the Board finds that service connection for a lung disability, including as due to in-service asbestos exposure, is not warranted. 4. Entitlement to service connection for a left hip disability The Board finally finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for a left hip disability. The Veteran essentially contends that he incurred a left hip disability during active service. Contrary to these assertions, the record evidence shows instead that the Veteran does not experience any current left hip disability which is attributable to active service or any incident of service. For example, the Veteran’s available service treatment records show no complaints of or treatment for a left hip disability during active service. The Board again notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan, 451 F.3d at 1337, and Barr, 21 Vet. App. at 303. The post-service evidence also does not support granting the Veteran’s service connection claim for a left hip disability. It shows that he does not experience any current left hip disability which could be attributed to active service or any incident of service. The Board notes in this regard that a service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced a left hip disability at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). There is no evidence – other than the Veteran’s lay assertions – demonstrating that he experiences any current left hip disability which could be attributed to active service. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to service connection for a left hip disability. In summary, the Board finds that service connection for a left hip disability is denied. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss and for a cardiovascular disability is remanded. As noted above, the Board has reopened the Veteran’s previously denied claims of service connection for bilateral hearing loss and for a cardiovascular disability. A review of the record evidence shows that additional development is necessary before either of these underlying claims can be adjudicated on the merits. With respect to the Veteran’s service connection claim for bilateral hearing loss, the Board notes that a review of the record evidence shows ongoing complaints of and treatment for bilateral hearing loss. The Veteran also wears hearing aids. To date, however, he has not been provided with an appropriate VA examination. The Board observes in this regard that VA’s duty to assist includes providing an examination where necessary. Thus, the Board finds that, on remand, the Veteran should be scheduled for appropriate examination to determine the nature and etiology of his current bilateral hearing loss. With respect to the Veteran’s service connection claim for a cardiovascular disability, the Board acknowledges that he was examined for VA adjudication purposes in February 2017. Unfortunately, a review of the Veteran’s February 2017 VA heart conditions DBQ shows that the VA examiner who completed this DBQ was not asked to provide and did not provide an opinion as to whether the Veteran’s current cardiovascular disability was related directly to active service. See 38 C.F.R. §§ 3.303, 3.304 (2017). Thus, the Board finds that, on remand, the February 2017 VA heart conditions DBQ should be returned to the VA examiner who completed it or another appropriate clinician for an addendum opinion which addresses whether the Veteran’s current cardiovascular disability is related directly to active service. Id. 2. Entitlement to a disability rating greater than 10 percent for left thumb injury residuals is remanded. The Veteran contends that his service-connected left thumb injury residuals are more disabling than currently evaluated. A review of the record evidence shows that the Veteran’s most recent VA hand and finger conditions DBQ occurred in August 2014. The Court has held that when a Veteran alleges that his service-connected disability has worsened since he was examined previously, a new examination may be required to evaluate the current degree of impairment. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); but see Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007) (finding "mere passage of time" does not render old examination inadequate). Given the Veteran's contentions, and given the length of time which has elapsed since his most recent VA examination in August 2014, the Board finds that, on remand, he should be scheduled for an updated VA examination to determine the current nature and severity of his service-connected left thumb injury residuals. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of any bilateral hearing loss. The claims file should be provided for review. The examiner is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that bilateral hearing loss, if diagnosed, is related to active service or any incident of service. A rationale also should be provided for any opinions expressed. If any requested opinion cannot be provided without resorting to mere speculation, then the examiner should explain why. The examiner is advised that the absence of contemporaneous records showing complaints of or treatment for bilateral hearing loss, alone, is insufficient rationale for a medical nexus opinion. 2. Send the February 2017 VA heart conditions DBQ to the VA examiner who completed it or another appropriate clinician for an addendum opinion. In the addendum opinion, the February 2017 VA examiner or another appropriate clinician should opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s cardiovascular disability is related directly to active service or any incident of service. The examiner should provide a separate opinion and rationale for each cardiovascular disability currently experienced by the Veteran, if possible. A rationale also should be provided for any opinions expressed. If any requested opinion cannot be provided without resorting to mere speculation, then the February 2017 VA examiner or another appropriate clinician should explain why. The February 2017 VA examiner or another appropriate clinician is advised that the absence of contemporaneous records showing complaints of or treatment for a cardiovascular disability, alone, is insufficient rationale for a medical nexus opinion. 3. Schedule the Veteran for updated examination to determine the current nature and severity of his service-connected left thumb injury residuals. 4. Readjudicate the appeal. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel