Citation Nr: 18146007 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-40 005 DATE: October 30, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to a psychiatric disorder, to include bipolar disorder and mood disorder, is remanded. Entitlement to service connection for a heart disorder, to include coronary artery disease (CAD), is remanded. REASONS FOR REMAND The Veteran had active service from November 1977 to September 1980. The Veteran initially filed a claim of entitlement to service connection for a mental health condition, specifically bipolar disorder, which was denied. However, in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims clarified how the Board should analyze claims for posttraumatic stress disorder and other acquired psychiatric disabilities. As emphasized in Clemons, a veteran’s claim “cannot be limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed.” Id. As the evidence reflects that the Veteran has other psychiatric diagnoses, the issue has been recharacterized as a psychiatric disorder, to include bipolar disorder and mood disorder. 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran’s claim of service connection for bilateral hearing loss is remanded for a new VA examination. A May 2016 VA examiner opined that the Veteran’s bilateral hearing loss was less likely than not caused by or a result of service as the Veteran’s hearing was normal at separation. However, the VA examiner did not discuss the Veteran’s contention of in-service noise exposure from working in the engine room on board the USS Richmond K. Turner. Additionally, in December 2017, the Veteran noted recent research regarding the effects of prolonged loud noise exposure and the delay of any resulting hearing loss. A new VA examination should be provided in order to address the Veteran’s contentions. 2. Entitlement to a psychiatric disorder, to include bipolar disorder and mood disorder, is remanded. The Veteran’s claim of service connection for a psychiatric disorder is remanded for a VA examination. The evidence reflects that the Veteran has current diagnoses of stable bipolar disorder with depressive features, mood disorder, and depression not otherwise specified (NOS). In December 2017, the Veteran contended that his in-service alcohol abuse may have been “hiding a greater mental health condition,” as he was diagnosed with alcohol overuse/abuse and recommended for alcohol rehabilitation during service. Unfortunately, no VA examination has been provided in order to evaluate the nature and etiology of the Veteran’s psychiatric disorder. See 38 C.F.R. § 3.159(c)(4). This should be accomplished on remand. 3. Entitlement to service connection for a heart disorder, to include CAD, is remanded. The Veteran’s claim of service connection for a heart disorder is remanded for a VA examination. The Veteran contends that his heart disorder is secondary to the medication and stress resulting from his psychiatric disorder. Unfortunately, no VA examination has been provided in order to evaluate the nature and etiology of the Veteran’s heart disorder. See 38 C.F.R. § 3.159(c)(4). This should be accomplished on remand. The matters are REMANDED for the following action: 1. Provide the Veteran with a current VA audiological examination and opinion regarding the nature and etiology of his bilateral hearing loss. The claims file, and a copy of this remand, will be available to the examiner, who must acknowledge receipt and review of these materials in any report generated as a result of this remand. Although a complete review of the record is imperative, attention is called to the following: *Service treatment records (STRs) including audiological examination results from June 1977, February 1978, May 1978, December 1978, December 1979, and September 1980. *The Veteran’s April 2014 statement in which he reported that he worked in the engine room on board the USS Richmond K. Turner, where the noise was very intense. *A May 2016 VA examination report, including puretone testing results. *The Veteran’s December 2017 statement. THEN, after examining the Veteran and reviewing the claims file in its entirety, the examiner is asked to provide an opinion addressing the following: Whether the Veteran’s bilateral hearing loss at least as likely as not (50 percent probability or greater) had its onset during active service or is otherwise related to it, to include noise exposure. A complete rationale should be provided for any opinion provided. 2. Provide a comprehensive VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s claimed psychiatric disorder. The claims file, and a copy of this remand, will be available to the examiner, who must acknowledge receipt and review of these materials in any report generated as a result of this remand. Although a complete review of the record is imperative, attention is called to the following: *A November 1979 STR reflecting a provisional diagnosis of alcohol overuse/abuse and recommendation for alcohol rehabilitation. *A March 2013 private treatment record reflecting symptoms of a mood disorder, which the Veteran had had since he was a teenager. *A May 2013 private treatment record reflecting assessments of bipolar I disorder, depressed; rule out bipolar II; and alcohol dependence, in remission. *VA treatment records from October 2013 reflecting an assessment of reported bipolar disorder with depressive features, and from March 2014 reflecting a diagnosis of a mood disorder and the Veteran’s report of mental problems all his life. *A January 2015 VA treatment record reflecting treatment for depressed mood and anxiety; and diagnoses of mood disorder with a history of bipolar disorder, depression NOS, and rule out attentional problems. *The Veteran’s December 2017 statement in which he contended that his in-service alcohol use may have been “hiding a greater mental health condition.” After reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: a) Identify all currently diagnosed psychiatric disorders, to include mood disorder and bipolar disorder, and indicate the likely onset of such. b) For EACH diagnosis, provide an opinion as to whether it at least as likely as not had its onset during active service or is otherwise related to it. **In doing so, the VA examiner should consider all evidence, to include the Veteran’s contention that his current psychiatric disorder is related to his in-service alcohol abuse.** A complete rationale should be provided for any opinion provided. 3. Provide a comprehensive VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s claimed heart disorder. The claims file, and a copy of this remand, will be available to the examiner, who must acknowledge receipt and review of these materials in any report generated as a result of this remand. Although a complete review of the record is imperative, attention is called to the following: *An October 2013 VA treatment record reflecting an assessment of quiescent CAD and that the Veteran had a stent for typical anginal symptoms, such as jaw pain and chest pressure, in 2010 with no recurrence. *An April 2014 statement in which the Veteran contended that his heart disorder was secondary to the medication and stress resulting from the psychiatric disorder. *A March 2016 VA treatment record reflecting an assessment of CAD with rare, intermittent left-sided upper chest pain. After reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: a) Identify all currently diagnosed heart disorders, to include CAD, and indicate the likely onset of such. b) For EACH diagnosis, provide an opinion as to whether it at least as likely as not had its onset during active service or is otherwise related to it. c) For EACH diagnosis, provide an opinion as to whether it is at least as likely as not caused by, aggravated by, or related to medications, stress, and treatment of the Veteran’s psychiatric disorder or service-connected disability. A complete rationale should be provided for any opinion provided. 4. Thereafter, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jane R. Lee