Citation Nr: 18147433 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 14-20 360 DATE: November 6, 2018 REMANDED Entitlement to service connection for a perforated right eardrum is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to November 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a July 2013 rating decision of a Regional Office of the Department of Veterans Affairs (VA). Entitlement to service connection for a perforated right eardrum is remanded. 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). The Veteran reports he assisted in firing large shipboard guns during his naval service and was exposed to loud noise related to this duty. He claims the noise made him feel that his eardrums had burst. The Veteran is service connected for bilateral hearing loss and tinnitus. A July 2013 VA hearing loss and tinnitus examiner opined that the Veteran’s hearing loss and tinnitus were more likely than not related to his service and explained that “high levels of noise can damage the outer hair cells of cochlea resulting in hearing loss.” This examiner also noted the Veteran had a perforated right eardrum. The duty to assist requires that VA provide an examination to assist the Veteran in substantiating his claim. Id. The Board notes that the Veteran’s February 1969 Report of Medical History contains a notation of “perforated TMs,” possibly indicating a perforated tympanic membranes or eardrums. However, the Report of Medical Examination indicates that the ears were normal. Accordingly, on remand the examiner should review the service treatment records and determine whether the notations on the entrance history indicate the Veteran entered service with a perforated right eardrum. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2014 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for any medical provider or treatment facility who may have records relevant to his claim for service connection for a perforated right eardrum. Make two requests for the authorized records from any provider or facility identified, unless it is clear after the first request that a second request would be futile. 3. Following completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any perforated right eardrum. Initially, the examiner must determine whether there is clear and unmistakable (obvious or manifest) evidence that a perforated right eardrum existed prior to service and was not aggravated (increased in severity beyond the natural progress of the disorder) by service. If an eardrum perforation is not shown to have clearly and unmistakably preexisted and not been aggravated by service, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the disorder is related to an in-service injury, event, or disease, including acoustic trauma from his proximity to large guns firing. The examiner must also opine whether any perforated eardrum is at least as likely as not (50 percent or greater probability) (1) proximately due to service-connected bilateral hearing loss or tinnitus, or (2) aggravated beyond its natural progression by service-connected bilateral hearing loss or tinnitus. The examiner is advised aggravation means the bilateral hearing loss and/or tinnitus caused an increase in the severity of the perforated eardrum beyond the natural progression of the disorder. If aggravation is found, the examiner must attempt to establish the baseline level of severity of the perforated eardrum prior to aggravation by (CONTINUED ON NEXT PAGE) the service-connected disability, or the medication taken to treat the service-connected disability. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jeanne Celtnieks, Associate Counsel