Citation Nr: 18147422 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-21 091 DATE: November 5, 2018 REMANDED Entitlement to service connection for a right hand disability is remanded. Entitlement to service connection for a left hand disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicide agents is remanded. Entitlement to a compensable evaluation for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1970 to February 1972. This case comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. 1. The claims for entitlement to service connection for bilateral hand disabilities, bilateral knee disabilities, bilateral ankle disabilities, a left hip disability, and for diabetes mellitus, to include as secondary to exposure to herbicide agents, are remanded. Additional development is necessary before these claims can be finally adjudicated. The record reveals the Veteran has not yet been afforded VA examinations is explore the etiology of these disorders. With respect to the musculoskeletal disorders listed above, the Veteran has consistently averred that they resulted from injuries sustained in service during routine parachute jumps completed in training. The service personnel records support the Veteran’s contentions that he performed such jumps. However, no treating or examining provider has explicitly linked any current disability to any in-service injury, including as due to parachute jumps in service. On remand, VA examinations must be scheduled and etiological opinions obtained. With respect to diabetes, the Veteran has stated that he believes his diabetes to be etiologically related to in-service exposure to herbicide agents. A VA examination to explore the etiology of diabetes must be scheduled, and this theory of entitlement assessed by a VA examiner. 2. Entitlement to a compensable evaluation for bilateral hearing loss is remanded. The Veteran has not undergone a VA audiological examination since April 2014. Over four years having passed, the Board finds that a new examination must be conducted to explore the current severity of the Veteran’s service-connected hearing loss. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, the RO should obtain any outstanding VA and private treatment records. 2. Then, schedule the Veteran for a VA examination to explore the etiology of his bilateral hand disabilities. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should specifically state whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral hand disabilities are etiologically related to any aspect of the Veteran’s military service. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. Schedule the Veteran for a VA examination to explore the etiology of his bilateral knee disabilities. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should specifically state whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral knee disabilities are etiologically related to any aspect of the Veteran’s military service. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 4. Schedule the Veteran for a VA examination to explore the etiology of his bilateral ankle disabilities. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should specifically state whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral ankle disabilities are etiologically related to any aspect of the Veteran’s military service. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 5. Schedule the Veteran for a VA examination to explore the etiology of his left hip disability. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should specifically state whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left hip disability is etiologically related to any aspect of the Veteran’s military service. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 6. Schedule the Veteran for a VA examination to explore the etiology of his diabetes mellitus. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should specifically state whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s diabetes mellitus is etiologically related to any aspect of the Veteran’s military service, to include as secondary to exposure to an herbicide agent. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 7. Schedule the Veteran for a VA examination to evaluate the current severity of his service-connected bilateral hearing loss. The electronic claims folders should be made available to the examiner for review in conjunction with the examination. Any indicated studies should be performed. The examination should be conducted in accordance with the current disability benefits questionnaire or examination worksheet applicable to hearing loss. 8. After the above development is completed, readjudicate the claim on the merits. If any benefits sought are not granted, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and afford them a reasonable opportunity to respond. Then, return the claim to the Board. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Z. Sahraie, Associate Counsel