Citation Nr: 18145808 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-43 058 DATE: October 30, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for prostate cancer to include as due to herbicide exposure and/or asbestos is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1970 to November 1971. He served in the United States Army. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Also, VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2014); 38 C.F.R. § 3.159 (2018). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). 1. Entitlement to service connection for bilateral hearing loss is remanded. A June 2015 VA examination was conducted. The Veteran’s objective audiogram results showed the following: HERTZ 500 1000 2000 3000 4000 RIGHT 15 25 30 55 35 LEFT 10 15 35 50 50 Speech audiometry revealed speech recognition ability of 84 percent in the right ear and of 88 percent in the left ear. The Maryland CNC word list was used to test for the speech discrimination scores. The examiner determined that the Veteran had a diagnosis of bilateral sensorineural hearing loss in the frequency ranges of 500-4000 Hz and 6000 Hz and higher. The examiner opined that the Veteran’s bilateral hearing loss was less likely than not caused by or a result of an event in military service. The examiner reasoned that the Veteran’s enlistment examination showed normal hearing acuity in both ears at all test frequencies, and that the Veteran’s separation physical continued to show normal hearing acuity in both ears at all test frequencies with no significant shifts noted in either ear at any test frequency. However, the examiner did not explain why that indicates that the Veteran’s bilateral hearing loss is unrelated to service. Thus, a new VA examination is warranted. 2. Entitlement to service connection for tinnitus is remanded. A June 2015 VA examination was conducted. The Veteran reported that he had gradual onset of bilateral intermittent tinnitus a few years ago. The VA examiner opined that it was less likely than not that the Veteran’s tinnitus was caused by or a result of military noise exposure. The examiner reasoned that based on the reported time frame of onset, as well as hearing loss was not acquired while in service, it was less likely due to military noise exposure. However, the examination report did not explain why that indicates that the Veteran’s tinnitus is unrelated to service. Thus, a new VA examination is warranted. 3. Entitlement to service connection for prostate cancer to include as due to herbicide exposure and/or asbestos is remanded. A VA examination has not been provided for the Veteran’s claim of service connection for prostate cancer to include as due to herbicide exposure and/or asbestos. In a June 2015 Notice of Disagreement (NOD), the Veteran alleged that he served as a firefighter at Fort Rucker and was required to wear protective gear which caused exposure to asbestos. The Veteran’s DD-214 confirms that his MOS in service was 51M20 Firefighter. In a September 2014 private laboratory report, there was evidence of elevated prostate specific antigen (PSA), diffuse osseous metastatic disease, and hydronephrotic left kidney. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination is required. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, schedule a VA examination to assist in determining the etiology of the Veteran’s bilateral hearing loss and tinnitus. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must elicit a full history from the Veteran regarding his active service. (a.) The examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral hearing loss had onset in, or is otherwise related to, active service. (b.) The examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tinnitus had onset in, or is otherwise related to, active service. The examiner must consider an address the Veteran’s 1) lay statement regarding his active service, and 2) the June 2015 VA examination report. 4. After any additional records are associated with the claims file, schedule a VA examination to assist in determining the etiology of the Veteran’s prostate cancer to include as due to herbicide exposure and/or asbestos. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. The examiner must elicit a full history from the Veteran regarding his active service. (a.) The examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s prostate cancer to include as due to herbicide exposure and/or asbestos had onset in, or is otherwise related to, active service. The examiner must consider and address the Veteran’s lay statement regarding his duties as a firefighter in service and any statements regarding exposure to herbicides or asbestos. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 6. Ensure compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures. Stegall v. West, 11 Vet. App. 268, 271 (1998). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Nguyen, Associate Counsel