Citation Nr: 18146902 Decision Date: 11/02/18 Archive Date: 11/01/18 DOCKET NO. 17-51 495 DATE: November 2, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to a rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity is remanded. Entitlement to a rating in excess of 10 percent for service-connected radiculopathy of the left lower extremity is remanded. REASONS FOR REMAND 1. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran claims that he is entitled to service connection for bilateral hearing loss, as he was exposed to acoustic trauma in association with his military occupational specialty (MOS) and the condition had its onset during active duty service. The record reflects that the Veteran routinely exposed to noise while operating heavy equipment throughout his active duty service. The Veteran was found to have normal hearing at his September 1996 entrance examination and no indication was made of hearing or ear problems. However, his separation examination shows that he indicated a history of hearing loss and the examiner noted a hearing loss diagnosis per audiogram. Further, audiograms conducted during his active service note his noise exposure and show some degree of change in his hearing levels. October 1999 July 2000 audiograms note, “I am aware of a change in my hearing…,” and an October 2000 private audiogram noted that the Veteran stated, “he is aware of some hearing deficit mostly with speech discrimination problems.” In a July 2015 VA examination, the examiner diagnosed the Veteran with sensorineural hearing loss in his right ear, but opined that his hearing loss was less likely than not related to his active duty service. The examiner noted his noise exposure as a heavy equipment operator during service, and indicated that after service he worked as an auto mechanic. The examiner stated that the Veteran’s hobbies include shooting on a gun range, but he claimed to use double hearing protection while shooting. The Veteran claimed that he had difficulty hearing in the presence of background noise or conversations, particularly with women or if he was not directly facing the speaker, and also had difficulty hearing his customers and colleagues with a moderate amount of noise in the back ground. Despite the conceded noise exposure during service, the examiner concluded that the Veteran’s hearing loss was not related to his service because his hearing was within normal ranges on his entrance and separation examinations, and a permanent threshold shift did not exist in the 1000-4000 Hz range. The Board finds that the July 2015 examination is not adequate for the purposes of deciding the Veteran’s claim, as the examiner failed to address all relevant evidence of record. The Veteran’s service treatment records specifically note hearing loss associated with his work as a heavy equipment operator, including on his separation examination. Additionally, the examiner noted that a permanent threshold shift did not exist in the 1000-4000 Hz range, but did not provide an explanation as to why it was therefore less likely than not that his hearing loss was related to his duties as a heavy equipment operator. Further, the examiner provided no discussion relating to the onset or progression of the Veteran’s hearing loss, which is highly relevant to an etiological analysis, or indicate that a request for such information was made. Accordingly, a new examination is necessary in order to obtain an adequate opinion concerning the nature and etiology of the Veteran’s claimed hearing loss. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). 2. Entitlement to a rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity and entitlement to a rating in excess of 10 percent for service-connected radiculopathy of the right lower extremity are remanded. The Veteran asserts that the symptoms related to his bilateral radiculopathy of the lower extremities is more severe than that reflected by the currently assigned 10 percent ratings. The record reflects that the Veteran was most recently afforded a VA examination addressing his bilateral radiculopathy in May 2016. In that examination, the examiner indicated that his symptoms due to radiculopathy were moderate intermittent pain in both lower extremities. The examiner further noted that the Veteran claimed the pain radiating from his back alternated from his right to left lower extremity, and was intermittent but could be intense. The Veteran also reported that he felt his knee buckled due to radiculopathy. The examiner indicated that the Veteran did not experience constant pain, paresthesias and/or dysesthesias, or numbness in connection with his radiculopathy. The examiner indicated that his radiculopathy of both the right and left lower extremities was mild. A September 2015 VA primary care record noted that the Veteran claimed he experienced numbness and tingling in his lower extremities, which increased with sitting. Additionally, the Veteran claimed to experience numbness and shooting pains in his legs which caused him to be unable to walk at times. In his August 2016 notice of disagreement, the Veteran stated that his bilateral radiculopathy was not re-evaluated at the time of his back conditions, calling into question the thoroughness of the examiner’s determination regarding the symptoms related to his radiculopathy. The Board finds that the examiner failed to address the Veteran’s claim of numbness and tingling documented prior to the May 2016 examination, and that additional symptoms related to his radiculopathy could affect the classification of the overall severity of the disability. Therefore, the May 2016 examination failed to address all relevant evidence of record and is inadequate for the purposes of deciding the instant claims. See Barr, supra. Accordingly, a new examination is necessary on remand. The AOJ should also obtain any relevant, outstanding VA treatment records and afford the Veteran the opportunity to submit or identify any relevant, outstanding private treatment records. The AOJ should attempt to obtain any such records for which proper approval has been provided. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records. Also, afford the Veteran the opportunity to submit or identify any relevant, outstanding private treatment records. The AOJ should attempt to obtain any such records identified for which the proper approval has been provided 2. Schedule the Veteran for an examination with an appropriate examiner to determine the nature and etiology of any current hearing loss disability. The examiner should be provided a copy of the entire claims file, including a copy of this remand, for review and should note that a review of the file was completed in the examination report. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s hearing loss is related to his active duty military service. The examiner should specifically discuss the onset of the Veteran’s hearing loss symptoms and his level of noise exposure during and since active duty service. The examiner should also discuss the instances where the Veteran was noted to have hearing loss related to his duties as a heavy equipment operator present in his service treatment records. The examiner must provide a rationale for all opinions rendered. If the requested opinions cannot be provided without resorting to speculation, the examiner should provide reasons why this is so, and discuss whether the inability to provide the necessary opinion is due to the absence of evidence or the limits of medical and scientific knowledge. 3. Schedule the Veteran for an examination with an appropriate examiner in order to determine the current severity of the Veteran’s bilateral radiculopathy of the lower extremities. The examiner should specifically discuss the Veteran’s claims regarding numbness and tingling in his lower extremities, and also opine as to whether the Veteran’s claim of his knee giving way is related to his radiculopathy disabilities. The examiner must provide a rationale for all opinions rendered. If the requested opinions cannot be provided without resorting to speculation, the examiner should provide reasons why this is so, and discuss whether the inability to provide the necessary opinion is due to the   absence of evidence or the limits of medical and scientific knowledge. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Ferguson, Associate Counsel