Citation Nr: 18146420 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 15-38 871A DATE: October 31, 2018 REMANDED Entitlement to service connection for glaucoma, including as secondary to diabetes mellitus type II (DM), is remanded. Entitlement to service connection for bilateral hearing loss (BHL) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1968 to June 1970. His awards include the Vietnam Service Medal, and the Combat Infantryman Badge. This matter is before the Board of Veterans’ Appeals (Board) on appeal of June 2012 and November 2012 rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA). On the Veteran’s request, a videoconference hearing was scheduled for August 2018. The Veteran was notified by letters of June 2018 and July 2018 of the date, time, and location of the hearing. He did not attend the scheduled hearing, nor did he ask for the hearing to be rescheduled. His hearing request is considered withdrawn. In October 2018, the Veteran’s representative submitted a written brief for the Board’s consideration. The duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 1. Entitlement to service connection for glaucoma, including as secondary to diabetes mellitus, type II (DM) is remanded. The Veteran is diagnosed with glaucoma. He claims this condition is directly related to his active service or is causally related to his service connected DM. A November 2012 VA eye conditions examination was provided. The examiner was asked only to provide an opinion as to whether glaucoma was related to the Veteran’s service connected DM. No opinion was requested or provided addressing direct service connection. The Veteran’s service treatment records include a March 1970 entry showing he sought treatment for “distance vision not sharp.” As there is evidence of in-service treatment for an eye condition, and a current eye disability, the VA duty to provide a medical examination addressing direct service connection for glaucoma is triggered. A new examination, fully addressing the Veteran’s claim, must be provided. See McLendon, supra. 2. Entitlement to service connection for bilateral hearing loss (BHL) is remanded. The Veteran claims his bilateral hearing loss is causally related to his active service. He asserts, in a June 2014 supplemental claim for hearing loss, that “I was Inf + Motors”. The Veteran’s DD214 documents his assignment as an infantryman and his receipt of awards for combat service in Vietnam. Accordingly, in-service acoustic trauma is conceded. A June 2012 VA hearing loss examination was provided and the examiner opined that the current hearing loss is less likely than not causally related to the Veteran's service. The examiner’s opinion was based on the absence of complaints of hearing loss during active service or soon after, the absence of treatment for hearing loss during active service or soon after, no documented hearing loss at the June 1970 separation examination, the absence of audiologic testing from June 1970 up to the June 2012 examination, prostate cancer in 2009, the Veteran’s age (63 at the time of the exam), and post service occupational noise exposure. However, the examiner did not discuss in-service acoustic trauma. The opinion provided is not based on full consideration of the Veteran’s medical history. The rationale provided is incomplete and the medical opinion is inadequate to determine the claim. See Stefl, supra. An additional VA hearing loss examination was provided in June 2014. The June 2014 examiner opined that hearing loss was less likely than not related to service. The only rational offered was that audiometric testing from the June 1970 separation examination showed normal hearing in both ears. The Board notes that normal hearing at separation is not fatal to a claim of service connection for hearing loss. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The June 2014 VA examiner did not base his opinion on a sufficient rationale. It is inadequate to make an informed decision on the Veteran’s claim. See Barr, supra; see also Stefl, supra. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from June 2018 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his glaucoma. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including a March 1970 service treatment record noting “distance vision not sharp.” The examiner must also opine whether the glaucoma is at least as likely as not (1) proximately due to service-connected DM, or (2) aggravated beyond its natural progression by service-connected DM. The term “aggravation” means a worsening of the underlying condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. If aggravation is found, please attempt to establish a baseline level of severity of any glaucoma prior to aggravation by the service-connected DM. (Continued on the next page)   3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his bilateral hearing loss. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including acoustic trauma related to the Veteran’s service as a combat infantryman in Vietnam. ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jeanne Celtnieks, Associate Counsel