Citation Nr: 18147675 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 15-02 006 DATE: November 5, 2018 REMANDED Entitlement to service connection for low back disability is remanded. Entitlement to service connection for acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to a compensable disability rating for service-connected left ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 2000 to February 2001 and July 2009 to July 2010 in the United States Army. The Veteran also had service in the United States Army National Guard. 1. Entitlement to service connection for low back disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a low back disorder because no VA examiner has opined whether the Veteran’s low back pain is etiologicaly related to the in-serivce slip and fall. At the April 2013 VA spine examination, the Veteran stated he experienced constant moderate aching in his back as a result of that incident. The examiner stated that the Veteran did not have any lumbar spine disability, and commented that the Veteran’s subjective complaints appeared to be out of proportion to the objective findings. The Veteran reported “moderate” aching and the examination must address whether that pain reaches the level of functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). An addendum opinion is necessary. 2. Entitlement to service connection for acquired psychiatric disorder is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for acquired pyschiatric disorder because no VA examiner has adeqautely opined whether whether the Veteran reported psychiatric symptoms are attributable to a diagnoseable disorder etiologically related to service. VA examinations to date have indicated that the Veteran does not have symptoms that meet the criteria for a diagnosis of PTSD and that the Veteran’s only condition was “sleep disturbance directly related to his shift (work).” The examiner cited the Veteran’s erractic, and often overnight, work schdule as the source of the Veteran’s sleep difficulties and falling asleep during the day. However, the Veteran’s medical treatment records indicate that he has exerpeinced symptoms such as nightmares, hypervigilance, avoidance, disturbing thoughts, emotional numbness, irritability/anger, and exaggerated startle response. The Veteran also competently endorsed these symptoms on his VA For 9. An addendum opinion is required to address these symptoms and determine whether they are attributable to an acquired pyschiatric disorder that is etiologically related to active duty service. 3. Entitlement to a compensable disability rating for service-connected left ear hearing loss is remanded. In January 2015 statement, the Veteran asserted that the left ear hearing loss disability has increased in severity since the Veteran was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of left ear hearing loss disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability, to include whether the Veteran’s low back pain manifests as a disability for VA purposes. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the documented in-service slip and fall. If a back disability is not diagnosed, is it at least as likely as not that there is objective evidence of back pain? If so, does the objectively confirmed pain reach the level of functional impairment of earning capacity? In answering this question, the above opinion the examiner should ask the Veteran to explain the effect of pain. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran has an acquired psychiatric disorder is at least as likely as not related to active duty service. The VA examiner must address the evidence and competent reports of symptoms of sleep disturbance, nightmares, hypervigilance, avoidance, disturbing thoughts, emotional numbness, irritability/anger, and exaggerated startle response. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left ear hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to left ear hearing loss alone and discuss the effect of the Veteran’s left ear hearing loss on any occupational functioning and activities of daily living. If it is not possible to provide an opinion regarding symptoms or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. McLeod