Citation Nr: 18147356 Decision Date: 11/06/18 Archive Date: 11/02/18 DOCKET NO. 15-42 668 DATE: November 6, 2018 ORDER Service connection for tinnitus is granted. REMANDED The issue of service connection for bilateral hearing loss is remanded. The issue of an initial rating in excess of 10 percent for the Veteran’s left Achilles tendinitis is remanded. The issue of an initial compensable rating for the Veteran’s chronic obstructive pulmonary disease (COPD) is remanded. FINDING OF FACT Tinnitus originated during active service. CONCLUSION OF LAW The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1981 to September 1989 and from July 21, 1991 to July 26, 1991. He had additional duty with the Alabama Army National Guard. Service Connection for Tinnitus The Veteran asserts that service connection for tinnitus is warranted as the claimed disorder was manifested as the result of his in service noise exposure. Service connection may be granted for recurrent disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The Veteran is competent to report that tinnitus was present in service and that it has existed from service to the present. 38 C.F.R. § 3.159 (a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Charles v. Principi, 16 Vet. App 370, 374 (2002). The service treatment records do not refer to tinnitus or ringing of the ears. The report of an October 2013 Department of Veterans Affairs (VA) audiological examination states that the Veteran reported that he had initially experienced tinnitus “in the 1980s.” The Veteran was diagnosed with tinnitus. The examiner stated that the diagnosed tinnitus was “less likely than not (less than 50% probability) caused by or a result of military noise exposure.” A February 2015 written statement from A. Ali, M.D., indicates that the Veteran’s tinnitus was “secondary to his exposure to loud noise while in service.” In an undated written statement received in April 2015, the Veteran conveyed that he experienced recurrent ringing of the ears during active service which persisted to the present day. The Board finds that the evidence is in at least equipoise as to whether the Veteran’s tinnitus arose during active service. The Veteran has related the onset of tinnitus during active service which has persisted to the present day. The Veteran has been diagnosed with recurrent tinnitus on post service VA and private examinations. Dr. Ali has related the tinnitus to active service. Resolving all reasonable doubt in the Veteran’s favor, the Board of Veterans’ Appeals (Board) concludes that service connection is warranted for tinnitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. The issue of service connection for bilateral hearing loss is remanded. The Veteran asserts that service connection for bilateral hearing loss is warranted as the claimed disability was manifested during active service secondary to his in service noise exposure. Service connection for impaired hearing shall be established when the thresholds for any of the frequencies of 500, 1000, 2000, 3000 and 4000 Hertz are 40 decibels or more; or the thresholds for at least three of these frequencies are 26 decibels; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The service treatment records reflect that the Veteran was seen for auditory changes. An August 2011 Army audiological evaluation notes that a September 2008 reference audiogram revealed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 10 5 15 25 LEFT 35 35 25 35 40 On audiological evaluation, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 10 15 30 LEFT 35 50 40 50 60 The military examiner noted that the Veteran had “steady noise exposure.” An impression of asymmetrical hearing loss was advanced. The Board is unable to determine whether either the September 2008 audiological examination or the August 2011 audiological examination was conducted during or proximate to a period of active service, active duty, or active duty for training. Indeed, the Veteran’s complete periods of active duty, active duty for training, and inactive duty for training with the Alabama Army National Guard have not been verified. Clinical documentation dated after August 2017 is not of record. VA should obtain all relevant military, VA, and private treatment records which could potentially be helpful in resolving the Veteran’s claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. The issue of an initial rating in excess of 10 percent for the Veteran’s left Achilles tendinitis is remanded. The Veteran asserts that an initial rating in excess of 10 percent is warranted for his left Achilles tendonitis as the disability is productive of significant left lower extremity impairment. The Veteran was last afforded a VA examination which addressed the service connected left Achilles tendonitis in October 2013. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Given the passage of some five years since the October 2013 VA examination, the Board finds that further VA lower extremity examination is necessary to determine the current nature and severity of the service connected left Achilles tendonitis. 3. The issue of an initial compensable rating for COPD is remanded. The Veteran asserts that an initial compensable rating is warranted for his COPD as the disability is productive of significant physical impairment. An August 2018 written statement from C. Yongkuma, M.D., conveys that the Veteran was being treated for COPD and “experiences significant exacerbations” requiring prescribed “steroids to overcome the flare.” Clinical documentation of the cited private treatment is not of record. Given the apparent worsening of the service connected pulmonary disability, the Board finds that further VA pulmonary examination is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider, including C. Yongkuma, M.D., who has treated him for any hearing loss disability and the service connected left Achilles tendonitis and COPD. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Contact the National Personnel Records Center (NPRC) or the appropriate service entity and request verification of the Veteran’s complete periods of active duty, active duty for training, and inactive duty for training with the Alabama Army National Guard and forward all available service medical and personnel records associated with the Veteran’s service for incorporation into the record. 3. Obtain the Veteran’s VA treatment records dated after August 2017. 4. Schedule the Veteran for a VA joints examination to assist in determining the current nature and severity of service-connected left Achilles tendonitis. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Provide ranges of motion for weight-bearing and nonweight-bearing and passive and active motion of the left ankle. The examiner should state whether there is any additional loss of ankle function due to painful motion, weakened motion, excess motion, fatigability, incoordination, or on flare up. (b) Specifically address the impact of the left Achilles tendonitis disabilities on the Veteran’s vocational pursuits. 5. Schedule the Veteran for a VA pulmonary examination to assist in determining the nature and severity of the service-connected COPD. Both pre bronchodilator and post-bronchodilator pulmonary function testing must be conducted unless medically contraindicated. Values should be provided for FVC, FEV-1, FEV-1/FVC, and DLCO. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should opine as to whether the Veteran’s use of prescribed steroids constitutes systemic corticosteroid use. The examiner should also provide an opinion as to the occupational impairment caused by the respiratory disability. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Abdelbary, Associate Counsel