Citation Nr: 18149785 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-14 677 DATE: November 13, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a speech disability, to include as secondary to service-connected benign familial tremor, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include a thought and perception disorder, to include as secondary to service-connected benign familial tremor, is remanded. Entitlement to a disability rating in excess of 30 percent for a benign familial tremor is remanded. REASONS FOR REMAND The Veteran had active duty service with the United States Air Force from June 1976 to June 1980. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Veteran’s claim for thought and perception disorder has been expanded as reflected on the title page. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Entitlement to service connection for a bilateral hearing loss disability is remanded. The Veteran received a VA audiological examination in February 2016. The examiner reported that the Veteran had no hearing loss and, as such, no opinion was needed. 38 C.F.R. § 3.385 (2018). Nevertheless, the Board finds that this examination is not adequate as the examiner did not acknowledge or address private audiological evaluation from April 2013, revealing a left ear hearing loss disability for VA purposes. Id. While the Board notes that the Veteran’s right ear did not demonstrate measures consistent with hearing loss during the period on appeal, the Board finds that it is appropriate to conduct an assessment of the Veteran’s current hearing of the right ear, in light of his continued complaints of hearing loss. See Informal Hearing Presentation, dated October 2018. In light of the above, a remand is required to provide the Veteran a VA examination to determine the nature of any right or left hearing loss disability and determine whether any such disability is related to service. 2. Entitlement to service connection for a speech disability is remanded. An April 2013 private evaluation report from Dr. P. Y. indicates that the Veteran is diagnosed with a neurogenic speech disorder. Dr. P. Y. also opined that it was more likely than not that the Veteran’s speech disorder was a manifestation of the underlying progressive neurological disease and benign familial tremor. The Veteran received a VA examination to determine the severity of his benign familial tremor in February 2016. The examination report notes that the Veteran reported difficulty drinking and spilling vessels. The examiner noted that the Veteran did not have any pharynx or larynx concerns, that his speech was normal, and that he did not have any swallowing conditions. The examiner did not clarify whether the Veteran had difficulty spilling due to his upper extremities or due to spillage from his mouth. Additionally, in finding that the Veteran did not have any speech abnormalities, the examiner did not acknowledge or otherwise address the April 2013 diagnosis and opinion from Dr. P. Y. The Board acknowledges that Dr. P. Y. also opined that the Veteran’s speech disorder is more likely than not a manifestation of the underlying neurological disease and familial benign tumor. See Private Treatment Records, dated April 2013. However, the private provider offered a conclusory statement, which is inadequate for the purposes of adjudicating a claim. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Accordingly, a remand for a VA examination is warranted to clarify whether the Veteran has a speech disorder caused or aggravated by his service-connected benign familial tremor. 3. Entitlement to service connection for an acquired psychiatric disorder is remanded. An April 2013 private evaluation report from Dr. P. Y. indicates that the Veteran is diagnosed with a thought and perception disorder. The private examiner also opined that it was more likely than not that the Veteran’s thought and perception disorder was a manifestation of the underlying progressive neurological disease related to the Veteran’s benign familial tremor. However, as Dr. P. Y. offered only conclusory statement, it is inadequate for the purposes of adjudicating a claim. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Accordingly, a remand for a VA examination is warranted to clarify whether the Veteran has an acquired psychiatric disorder caused or aggravated by his service-connected benign familial tremor. 4. Entitlement to a disability rating in excess of 30 percent for a benign familial tremor is remanded. The Board notes that the Veteran was last afforded a VA examination to assess the severity of his benign familial tremor in February 2016. Since that examination, the record reflects that the Veteran’s benign familial tremor may have increased in severity. Specifically, in the October 2018 Informal Hearing Presentation, the Veteran’s representative asserted that the Veteran’s actual tremor was worse and that he now demonstrated additional residuals that were not considered in the February 2016 VA examination. The Board notes that a new examination is appropriate when there is an assertion of an increase in severity since the last examination. Therefore, the Veteran should be afforded another examination on remand. See 38 C.F.R. § 3.159 (2018); see also Barr, 21 Vet. App. at 312; Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Schedule the Veteran for an examination to determine the nature of any right or left hearing loss disability and to obtain an opinion as to whether such is related to the Veteran’s military service or his service-connected benign familial tremor. The claims folder must be thoroughly reviewed by the examiner in connection with the examination, and such review must be reflected on the examination report. A complete history should be elicited directly from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. An explanation for each opinion shall be provided. The examiner must provide an opinion as to: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any current hearing loss was incurred or is otherwise related to the Veteran’s military service, including his asserted noise exposure therein. (b.) Whether it is at least as likely as not (a 50 percent probability or more) that any current bilateral hearing loss is either caused by or aggravated by the Veteran’s service-connected benign familial tremor. A complete rationale should be provided for all opinions and conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. The examiner’s attention is invited to the Veteran’s statements concerning the onset of his claimed disabilities. The examiner is reminded that a medical opinion based solely on the absence of documentation in the record or that does not take into account the Veteran’s reports of symptoms and history is inadequate. 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 is advised that the absence of in-service evidence of a hearing disability during service is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a 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). Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. Schedule the Veteran for an examination to determine the nature of any current speech disability and to obtain an opinion as to whether any such disability is related to the Veteran’s military service or his service-connected benign familial tremor. The claims folder must be thoroughly reviewed by the examiner in connection with the examination, and such review must be reflected on the examination report. A complete history should be elicited directly from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. An explanation for each opinion shall be provided. The examiner must provide an opinion as to: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any current speech disability was incurred during or is otherwise related to the Veteran’s military service. (b.) Whether it is at least as likely as not (a 50 percent probability or more) that any current speech disability is either caused by or aggravated by the Veteran’s service-connected benign familial tremor. A complete rationale should be provided for all opinions and conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. The examiner’s attention is invited to the Veteran’s statements concerning the onset of his claimed disabilities. The examiner is reminded that a medical opinion based solely on the absence of documentation in the record or that does not take into account the Veteran’s reports of symptoms and history is inadequate. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a 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). Jones, 23 Vet. App. at 382. 4. Schedule the Veteran for an examination to determine the nature of any current psychiatric disability and obtain an opinion addressing whether any such disability is related to the Veteran’s military service or his service-connected benign familial tremor. The claims folder must be thoroughly reviewed by the examiner in connection with the examination, and such review must be reflected on the examination report. A complete history should be elicited directly from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. An explanation for each opinion shall be provided. (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any psychiatric disability was incurred during or is otherwise related to the Veteran’s military service. (b.) The examiner should also specifically opine as to whether it is at least as likely as not (a 50 percent probability or more) that any current psychiatric disability is either caused by or aggravated by the Veteran’s service-connected benign familial tremor. A complete rationale should be provided for all opinions and conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. The examiner’s attention is invited to the Veteran’s statements concerning the onset of his claimed disabilities. The examiner is reminded that a medical opinion based solely on the absence of documentation in the record or that does not take into account the Veteran’s reports of symptoms and history is inadequate. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a 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). Jones, 23 Vet. App. at 382. 5. Schedule the Veteran for an examination to determine the nature and severity of his benign familial tremor. The claims folder must be thoroughly reviewed by the examiner in connection with the examination, and such review must be reflected on the examination report. A complete history should be elicited directly from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. An explanation of the severity of the Veteran’s benign familial tremor, to include functional limitations and associated motor and cognitive deficits, should be included in the opinion. A complete rationale should be provided for all opinions and conclusions expressed. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Trotter, Associate Counsel