Citation Nr: 18144090 Decision Date: 10/23/18 Archive Date: 10/23/18 DOCKET NO. 14-39 273 DATE: October 23, 2018 REMANDED Entitlement to service connection for residuals of a right eye injury, to include headaches, is remanded. Entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder disability, is remanded. Entitlement to service connection for a back disability is remanded. Entitlement to service connection for bilateral upper extremity neurological disorder, to include as due to a neck disability, is remanded. Entitlement to service connection for bilateral lower extremity radiculopathy due to a back disability is remanded. Entitlement to an initial rating in excess of 20 percent for a left shoulder disability is remanded. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1964 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from January 2011 and March 2011 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran and his spouse testified during a Board hearing before the undersigned Veterans Law Judge. 1. Entitlement to service connection for residuals of a right eye injury, to include headaches, is remanded. The Veteran seeks service connection for residuals of a right eye injury he incurred during service, describing right eye pain, headaches and blurred vision. The Veteran was afforded a VA examination in July 2010. Although the examiner offered a positive nexus opinion, in his rationale he indicated there were no current residuals of a right eye injury present. However, more recently the Veteran has been diagnosed with blepharitis OU and mild cataracts OU, and he reports headaches resulting from his in-service injury. See May 2013 VA treatment record. Thus, a new VA examination and medical nexus opinions are warranted on remand. 2. Entitlement to service connection for a neck disability, to include as secondary to service-connected left shoulder disability, is remanded. 3. Entitlement to service connection for a back disability is remanded. The Veteran asserts that his current neck and back disabilities were incurred during service due to duties of his military occupational specialty (MOS) as a bulk fuel maintenance man and engineer during the Vietnam war. Specifically, he maintains that the cumulative impact of heavy lifting and leaping into trenches and twisting his body to avoid gunshots caused his neck and back disabilities. See November 2009 VA Form 21-4138 and June 2018 Board Hearing Transcript at 21. Alternatively, he asserts that his neck disability is due to his service-connected left shoulder disability. See June 2018 Board Hearing Transcript at 21. He has current diagnoses of degenerative joint disease/degenerative disc disease of the cervical and lumbar spines, facet joint disease of the lumbar spine, and lumbar spinal stenosis, which he indicates may be related to service, triggering VA’s duty to obtain an examination and medical nexus opinions on direct and secondary service connection. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). 4. Entitlement to service connection for bilateral upper extremity neurological disorder, to include as due to a neck disability, is remanded. 5. Entitlement to service connection for bilateral lower extremity radiculopathy due to a back disability is remanded. The Veteran asserts that his bilateral upper extremity neurological disorder is due to duties of his MOS including steel cranking by hand and repetitive heavy lifting of fuel bladders, drums, and pumps. He maintains that symptoms of his disability began in service and have been continuous ever since, or alternatively due to his neck disability. He has a current diagnosis of bilateral upper extremity peripheral neuropathy and carpal tunnel syndrome and relates this condition to service, triggering VA’s duty to obtain an examination and medical nexus opinion. See McLendon, 20 Vet. App. 79 (2006). Further, his bilateral lower extremity radiculopathy claim is inextricably intertwined with his back claim, thus action on this claim is deferred pending development of his back claim. 6. Entitlement to an initial rating in excess of 20 percent for a left shoulder disability is remanded. During his June 2018 Board hearing, the Veteran testified that his left shoulder disability has worsened since his last VA examination in 2011. Specifically, he testified that his left shoulder pain and ability to lift have worsened. See June 2018 Board Hearing Transcript at 3, 13. As such, an updated VA examination is needed, as the February 2011 VA examination may no longer be reflective of the Veteran’s current level or nature of his disability. See Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007); Snuffer v. Gober, 10 Vet. App. 400 (1997). 7. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. During his June 2018 Board hearing, the Veteran’s spouse testified that the Veteran’s bilateral hearing loss has worsened since his last VA examination in 2010 and that he was scheduled for an upcoming VA examination. In June 2018, the Veteran underwent a VA audiological examination, which employed the CIDW-2 speech discrimination test as opposed to the Maryland CNC test. Therefore, this examination is inadequate for VA rating purposes and cannot be utilized to evaluate the Veteran’s bilateral hearing loss. 38 C.F.R. § 4.85(a). Thus, on remand an updated VA examination that complies with 38 C.F.R. § 4.85(a) is warranted. Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for a VA examination to determine the nature and etiology of any current residuals of a right eye injury. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Diagnose any right eye disability since November 2009. (b) For each right eye disability diagnosed since November 2009, to include blepharitis OU and mild cataracts OU (see May 2013 VA treatment record), please opine as to whether it is at least as likely as not (50 percent or better probability) that such disability is a residual of the Veteran’s in-service right eye injury, had its onset during service, or is otherwise related to service. (c) Please opine as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s diagnosed headaches had their onset in service or are otherwise related to service, to specifically include the right eye injury therein. A complete rationale should be given for all opinions and conclusions expressed. 4. Then schedule the Veteran for a VA examination to determine the nature and etiology of any current neck and back disabilities. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Diagnose any neck and back disabilities present since November 2009. (b) For each neck and back disability diagnosed, to include degenerative joint disease/degenerative disc disease of the cervical and lumbar spines (see July 2010 VA treatment record), lumbar spinal stenosis (see January 2010 VA treatment record), and facet joint disease of the lumbar spine (see December 2015 VA treatment record) please opine as to whether it is at least as likely as not (50 percent or better probability) that such disability had its onset during service or is otherwise related to service, including due to the cumulative impact of heavy lifting and/or leaping into trenches and twisting of the Veteran’s body to avoid gunshots. If you find that any of the above diagnoses are not warranted, please reconcile your finding with diagnoses of the same in the above cited VA treatment records. (c) For each neck disability diagnosed, please also opine as to whether it is at least likely as not (50 percent or better probability) that such disability: (i) is proximately due his service-connected left shoulder disability; or (ii) has been aggravated (worsened beyond natural progression) by his service-connected left shoulder disability. The examiner shoulder note that inquires (i) and (ii) require two opinions: one on proximate causation and one on aggravation. A complete rationale should be given for all opinions and conclusions expressed. 5. Then schedule the Veteran for a VA examination to determine the nature and etiology of his bilateral upper extremity neurological disorder. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner is asked to address the following: (a) Please opine as to whether it is at least as likely as not (50 percent or better probability) that his bilateral upper extremity peripheral neuropathy and carpal tunnel syndrome (see March 2018 VA examination report) had their onset during service or are otherwise related to service, to include duties of his MOS including steel cranking by hand and repetitive heavy lifting of fuel bladders, drums, and pumps. (b) If and only if a neck disability is service-connected, please also opine as to whether the Veteran’s bilateral upper extremity peripheral neuropathy or carpal tunnel syndrome are (1) proximately due to or (2) aggravated (worsened beyond natural progression) by that disability. Please note this inquiry requires two opinions: one on proximate causation and one on aggravation. A complete rationale should be given for all opinions and conclusions expressed. 6. Then schedule the Veteran for a VA examination to determine the current severity of his left shoulder disability. The examiner should conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested in (1) active motion, (2) passive motion, (3) in weight-bearing, (4) in non-weight-bearing, and (5) with range of motion of the opposite undamaged joint. Please specify range of motion measurements in all areas outlined above. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. Considering the Veteran’s reported history, the examiner should also provide an opinion describing functional impairment of the Veteran’s left shoulder due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. If unable to provide such an opinion without resorting to speculation, please provide a rationale for this conclusion. 7. Then schedule the Veteran for a VA examination to determine the current severity of his bilateral hearing loss using the Maryland CNC speech discrimination test pursuant to 38 C.F.R. § 4.85(a). The examiner should identify functional impairments due to his bilateral hearing loss. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel