Citation Nr: 18143384 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 16-42 230 DATE: October 19, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMANDS The Veteran had active duty service in the United States Army from October 1982 to September 1992. He also served as a member of the United States Army Reserve. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. Also on appeal was the issue of service connection for allergies; however, in a November 2016 rating decision, service connection for allergic rhinitis was granted; as that is considered a full grant of the benefit sought as to that issue, it is no longer on appeal. Bilateral Hearing Loss The Veteran contends that exposure to high levels of noise during his active duty service damaged his hearing. The Veteran was granted service connection for tinnitus during the pendency of his hearing loss claim. Therefore, the Board concedes that the Veteran sustained acoustic trauma during service. The report of the Veteran’s enlistment examination in September 1982 does not note impaired hearing. However, reports of audiometric evaluations the Veteran had during his active duty service show that there were shifts in his hearing thresholds between enlistment and separation. The report of his service separation (ETS) examination in September 1992 attributes “Hearing Loss” to the Veteran and shows that he was placed on an H2 profile for the period immediately preceding his discharge later that month. Post-service VA medical records show that assessments of the Veteran’s hearing were performed in February and June 2013. Each assessment identified “mild” sensorineural hearing in most Hertz frequencies, although the frequencies differed somewhat for the left and right ears, and “good” speech recognition. The Veteran has not reported exposure to high levels of noise occurring after service. A February 2014 VA hearing examination report reflects that the Veteran has hearing loss in the left ear for VA purposes. The VA examiner opined that “it is NOT at least as likely as not (50/50 probability) that the Veteran’s current hearing loss is related to his military service.” The basis was that the Veteran’s hearing was within normal limits at induction and at separation, and that comparison of the two revealed no significant change. However, the examiner failed to address the notation of “Hearing Loss” in the Veteran’s September 1992 service separation (ETS) examination report and the H2 profile. Further, the examiner failed to acknowledge the documentation in the service medical records of shifts in the Veteran’s hearing in the time between the service entrance and separation (ETS) examinations. In light of the above, the Board finds that a new VA examination and opinion is warranted to determine the nature and etiology of any hearing loss disability, with consideration of the Veteran’s complete service medical records. Bilateral Knee Trauma, to Include Osteoarthritis The Veteran contends that he developed knee pain during service because of repeated injuries. He points out that he was treated for knee injuries and pain during service and avers that he has experienced ongoing problems with his knees ever since. The Veteran is competent to describe his knee injuries and symptoms as he has experienced them. See 38 C.F.R. ¶ 3.159(a)(2); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Service treatment records show that the Veteran was seen for knee problems that were assessed as soft-tissue injuries and placed on temporary profiles. He was seen in March 1983 for pain in both knees, including the kneecaps; the assessment was pain in knee caps. He was seen in July 1983 with complaints of pain in both his knees; no swelling or discoloration was found and the assessment was “etiology unknown.” A temporary problem consisting of left-knee pain was noted in December 1986. A 1987 record from a military family practice clinic indicates that he injured his left knee playing basketball and was assessed with an MCL (medial collateral ligament) strain but with full range of motion. In August 1990, he was seen for pain in his lower left leg arising after jogging, was assessed with a sprain but with good range of motion and no edema, and was placed on an L3 profile for 10 days. He was seen in March 1992 after in injuring his right knee playing basketball, assessed with a soft-tissue injury, and placed on an L2 profile (“no running, jumping, sports”) for 10 days. The report of his September 1992 separation (ETS) medical examination cites no disorder of the knees, though, and all x-ray findings developed at that time were within normal limits. Post-service VA medical records reflect that more than once in 2013, the Veteran was seen for problems with his knees. A private medical record dated in December 2014 shows that osteoarthritis of both knees was disclosed by x-rays. The recorded assessment was osteoarthritis for the right and left knees and left-knee internal derangement. A VA knee and lower leg examination was performed in February 2014. The VA examination report notes that post-service imaging studies of “the knee” revealing “degenerative or traumatic arthritis” and “[q]uestionable left medial collateral avulsion” had been performed but the date of the studies is not specified. The VA examiner’s opinion was that “it is less as likely as not that the veteran’s bilateral knee c[ ]ondition was incurred in or caused by the right knee injury…or the bilateral knee complaints….” The examiner’s rationale was that the “knee injuries reported during service appear acute, self-limiting involving soft tissues. [The Veteran] was placed on profile only 30 days after each incident and was able to resume full activities after these.” However, the examiner failed to consider the Veteran's assertions that he has had knee symptoms since service. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Accordingly, the Board finds that a new VA examination and opinion is warranted to determine the nature and etiology of any diagnosed bilateral knee disability. Lastly, because the Veteran had active duty for training (ACDUTRA) in the Army Reserve from January 2001 to May 2001, the personnel and medical records from this period of service should be obtained and associated with the file. The matter is REMANDED for the following actions: 1. Obtain all the service medical and personnel records for the Veteran that may be outstanding, to include the records from his period of active duty training (ACDUTRA) from January 2001 to May 2001 and associate them with the claims file. 2. Schedule the Veteran for a new VA examination, with a medical professional who has not previously examined him, if possible, to ascertain whether he has a bilateral hearing loss for VA purposes. (a.) Request the examiner to obtain a detailed medical history. (b.) If a hearing loss disability is shown for VA purposes, request the examiner to opine on whether it is at least as likely as not (50 percent or greater probability) that any hearing loss disability first manifested in service, within a year after discharge, or is otherwise related to active service. In providing the above opinion, the examiner should (1) except that the Veteran had acoustic trauma during his active duty service, as VA has already awarded him service connection for tinnitus related to acoustic trauma and (2) address the changes in the Veteran’s puretone hearing thresholds from active duty entrance examination to separation examination as well as the notations of “Hearing Loss” and the H2 profile in the separation examination report. The examiner must consider the Veteran’s statement regarding the onset and the continuity of hearing loss symptomatology. Dalton v. Nicholson, 21 Vet. App. 23 (2007). A complete rationale for any opinion expressed must be clearly set forth in the report. The examiner must not rely solely on the possibility that the Veteran’s hearing was within normal limits for VA purposes at the time of separation from service, as the basis for any opinion provided. The reasons for accepting or rejecting any of the Veteran’s statements should be set forth in detail. 3. Schedule the Veteran for a new VA examination, with a medical professional who has not previously examined him, to determine the nature and etiology of any diagnosed bilateral knee disability. (a.) Request the examiner to obtain a detailed medical history. (b.) The examiner should provide an opinion as to whether is it at least as likely as not (50 percent probability or greater) that any diagnosed knee disability, to include arthritis, first manifested in service, within a year after discharge, or is otherwise related to active service. In providing this opinion the examiner is to address the Veteran’s service treatments records, to include the L3 profile of August 1990 and the L2 profile of March 1992. The examiner should consider statements from the Veteran regarding the onset and continuity of knee symptomatology since service. Dalton v. Nicholson, 21 Vet. App. 23 (2007). If it is determined that there is another likely etiology for any diagnosed knee disability, that should be stated. (Continued on the next page)   A complete rationale for any opinion expressed must be clearly set forth in the report. The reasons for accepting or rejecting any of the Veteran’s statements should be set forth in detail. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Pitts, Associate Counsel