Citation Nr: 18149840 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-12 519A DATE: November 13, 2018 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to service connection for hyperlipidemia is denied. REMANDED The issue of entitlement to service connection for bilateral hearing loss is remanded. The issue of entitlement to service connection for erectile dysfunction is remanded. The issue of entitlement to service connection for a sleep disability, to include obstructive sleep apnea, is remanded. The issue of entitlement to service connection for hypertension is remanded. The issue of entitlement to service connection for a sinus disability to include sinusitis is remanded. The issue of entitlement to service connection for a pulmonary disability, to include pulmonary fibrosis, is remanded. FINDINGS OF FACT 1. Tinnitus originated during active service. 2. Hyperlipidemia is a laboratory finding and is not a disability for which service connection may be established. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 2. The criteria for service connection for hyperlipidemia have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1966 to November 1969. The Veteran served in the Republic of Vietnam. Service Connection Service connection may be granted for a recurrent disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 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). Tinnitus The Veteran asserts that service connection for tinnitus is warranted. The service medical records indicate that the Veteran presented a history of a pre service right tympanic membrane perforation and subsequent “chronic ear problems.” Clinical documentation dated in March 1969 states that the Veteran was found to exhibit a scarred and retracted right tympanic membrane. The records do not refer to tinnitus or ringing of the ears. The service personnel records state that the Veteran served in the Republic of Vietnam. The report of an April 2014 audiology examination conducted for the Department of Veterans Affairs (VA) states that the Veteran presented a history of in service noise exposure when “he was exposed to gunfire and rockets while stationed in a combat zone during the Vietnam War” and the onset of tinnitus “many years ago.” The Veteran was diagnosed with recurrent tinnitus. The examined concluded that it was “less likely than not (less than 50% probability) [that the tinnitus was] caused by or a result of military noise exposure.” The audiologist commented that “the exit audiogram indicated that the Veteran had normal hearing levels during military service” and “therefore, it is less as likely as not that the Veteran’s current tinnitus is related to military noise exposure.” The audiologist did not discuss or otherwise address the Veteran’s documented in service history of “chronic ear problems.” Because of that deficiency, the Board of Veterans' Appeals (Board) finds the April 2014 audiological report to be of limited probative value. The Board finds that the evidence is in at least equipoise as to whether the diagnosed recurrent tinnitus arose during active service. The Veteran served in the Republic of Vietnam and was exposed to gunfire and other combat related noise. The service medical records show that the Veteran complained of ear problems during active service. The Veteran has been diagnosed with recurrent tinnitus. 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). Resolving all reasonable doubt in the Veteran’s favor, the Board concludes that service connection is warranted for tinnitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Hyperlipidemia The Veteran contends that service connection for hyperlipidemia is warranted. He advances no specific argument as to why service connection for hyperlipidemia should be established. Hyperlipidemia is “a general term for elevated concentrations of any or all of the lipids in the plasma, including hypertriglyceridemia, hypercholesterolemia, etc.” Dorland’s Illustrated Medical Dictionary 891 (32nd ed. 2012). Hyperlipidemia or elevated cholesterol is a laboratory finding and does not constitute a recurrent disability for which VA compensation benefits may be granted. 61 Fed. Reg. 20,440 (May 7, 1996) (diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities.) VA clinical documentation shows that the Veteran has been found to exhibit hyperlipidemia on diagnostic studies. Those laboratory findings alone do not constitute a disability for which service connection may be granted. The laboratory findings have not been associated with a recurrent disability. Therefore, the Board concludes that service connection for hyperlipidemia is not warranted. REASONS FOR REMAND 1. The issue of entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that service connection for bilateral hearing loss is warranted. The service medical records show that the Veteran was seen for recurrent ear complaints. The report of the November 1966 physical examination for service entrance states that the Veteran was found to exhibit normal ears. On contemporaneous audiometric evaluation, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 0 (15) 0 (10) 0 (10) - 20 (25) LEFT 0 (15) 0 (10) 5 (15) - 5 (10) The numbers in the brackets reflect a converted score based upon the change in testing methods that occurred in 1966 and 1967. Clinical documentation dated in March 1969 states that the Veteran complained of right ear popping and recurrent discomfort. He presented a history of “chronic ear problems since perforation of tympanic membrane with a bobby pin” approximately eight years before the visit. Treating medical personnel observed that the right tympanic membrane was scarred and retracted and the Veteran’s “hearing was OK.” The report of the October 1969 physical examination for service separation states that the Veteran was found to exhibit normal ears. On contemporaneous audiometric evaluation, the Veteran exhibited pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 5 10 0 - 5 LEFT 0 15 0 - 0 The report of the April 2014 audiology examination conducted for VA states that the Veteran had no history of either ear trauma or ear disease. On the audiological evaluation, the Veteran’s pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 65 70 70 80 LEFT 45 50 55 70 70 Speech audiometry found speech recognition ability of 67 percent in the right ear and of 88 percent in the left ear. The Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner concluded that “the Veteran’s hearing loss was not at least as likely as not (50% probability or greater caused by or a result of an event in military service.” The examiner commented that “the rationale is that the exit audiogram indicated that the Veteran had normal hearing levels during military service” and “therefore, it is less as likely as not that the Veteran’s current hearing loss is related to military noise exposure.” The audiologist did not note or otherwise address the documented in service recurrent ear complaints or history of a right tympanic membrane injury. Because of that deficiency, the Board finds that the examination report is of limited probative value. 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). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, the Board finds that further VA audiology evaluation is needed. Clinical documentation dated after February 2016 is not of record. VA should obtain all relevant 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 entitlement to service connection for erectile dysfunction is remanded. The Veteran asserts that service connection for erectile dysfunction is warranted as the disability initially manifested during active service secondary to an in service penile surgical procedure. The service medical records show that the Veteran was diagnosed with external urethral meatus condyloma acuminata. Clinical documentation dated in February 1968 indicates that the Veteran underwent a cystourethroscopy, a urethral meatotomy, and electrocoagulation of the urethral condyloma acuminata. A September 2005 VA treatment record shows that the Veteran presented a history of erectile dysfunction for the preceding 37 years. The Veteran stated that the erectile dysfunction began during active service. The report of a February 2016 VA urology examination states that the Veteran presented a history of erectile dysfunction since December 1968. The Veteran was diagnosed with erectile dysfunction. The examiner incorrectly indicated that the “duration of this problem has been 15 years” and concluded that “the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event, or illness.” The VA physician commented that the “Veteran did have a cystourethroscopy as treatment for his condyloma condition which is located on the urethra or tip of his genitalia;” “it has been shown that this type of procedure does have side effects and one of them is impairment of the sexual performance and libido;” and “this has been shown on a previous study, but did mention that the impairment was temporarily short-lived.” The Board finds the examination report makes contradictory findings that the erectile dysfunction both was manifested during active service secondary to the documented in service urological procedures and was initially manifested many years after service separation. Because of cited discrepancies, the Board finds that the February 2016 VA urological report to be of no probative value. Therefore, further VA urological evaluation is necessary to address the issues raised by the Veteran’s appeal. 3. The issue of entitlement to service connection for a sleep disorder, to include obstructive sleep apnea, is remanded. The Veteran contends that service connection for a sleep disability is warranted as obstructive sleep apnea was initially manifested during active service by excessively loud snoring. The report of a February 2016 VA sleep disability examination states that the Veteran “was noted to be snoring since being in the service” and initially diagnosed with sleep apnea in 2001. The Veteran was diagnosed with obstructive sleep apnea. The examiner concluded that “the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event, or illness.” The VA physician commented that “at a young age, sleep apnea is less likely to be prevalent as compared with the older age group.” The Board is unable to discern whether or not the VA examiner found that the Veteran’s in service snoring was an initial manifestation of the currently diagnosed sleep apnea or the basis for his determination that the sleep apnea was not “incurred in or caused by the claimed in-service injury, event, or illness.” Therefore, the Board finds that further VA sleep study is needed to determine the relationship, if any, between the diagnosed sleep apnea and active service. 4. The issue of entitlement to service connection for hypertension is remanded. The Veteran contends that service connection for hypertension is warranted. The service medical records do not refer to hypertension. In a June 2013 Application for Disability Compensation and Related Compensation Benefits (VA Form 21 526EZ), the Veteran stated that he was initially diagnosed with hypertension in 2000. Service connection may be established for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be established on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection is currently in effect for diabetes mellitus, right upper extremity median nerve peripheral neuropathy. left upper extremity peripheral neuropathy, right lower extremity peripheral neuropathy, and left lower extremity peripheral neuropathy. The Veteran has not been provided a VA hypertension examination. The Board finds that an evaluation is needed to determine the relationship between the diagnosed hypertension and active service or a service connected disability. 5. The issues of service connection for a sinus disability, to include sinusitis, and a recurrent pulmonary disability, to include pulmonary fibrosis, are remanded. The Veteran asserts that service connection for a sinus disability and a pulmonary disability are warranted as the disorders initially manifested during active service. The service medical records show that the Veteran was seen for respiratory complaints on several occasions. Clinical documentation dated in a December 1967 treatment entry shows that the Veteran complained of nasal congestion and a cough. Impressions of an acute upper respiratory infection and pharyngitis were made. In a June 2013 Application for Disability Compensation and Related Compensation Benefits, VA Form 21 526EZ, the Veteran stated that he was initially diagnosed with sinusitis and a pulmonary disability at the Las Vegas, Nevada, VA medical facility in 1969. Clinical documentation of the cited VA treatment is not of record. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for any hearing loss, erectile dysfunction, sleep, hypertensive, sinus, and pulmonary disabilities. 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. Obtain the Veteran’s VA clinical documentation not already of record, including any treatment provided at the Las Vegas, Nevada, VA medical facility in 1969 and pertaining to all treatment after February 2016. 3. Schedule the Veteran for a VA audiology examination to assist in determining the current nature of any identified hearing loss disabilities and their relationship, if any, to active service. 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) Diagnose all hearing loss disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hearing loss disability had its onset during active service or is related to any incident of service, including the documented in service ear complaints and the Veteran’s combat experiences while in the Republic of Vietnam. 4. Schedule the Veteran for a VA urology examination to assist in determining the current nature of the Veteran’s erectile dysfunction and its relationship, if any, to active service or a service connected disability. 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) Diagnose all erectile dysfunction disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified erectile dysfunction had its onset during active service or is related to any incident of service, including the documented in service February 1968 cystourethroscopy, urethral meatotomy, and electrocoagulation of the urethral condyloma acuminata and the Veteran’s subjective history of recurrent erectile dysfunction since active service. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified erectile dysfunction is due to diabetes mellitus and the other service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any erectile dysfunction disability has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by diabetes mellitus and the other service connected disabilities. 5. Schedule the Veteran for a VA examination with a medical doctor to assist in determining the nature and etiology of any identified sleep disability. 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) Diagnose all sleep disabilities found. (b) Opine as to whether it is at least as likely as not (50 percent probability or greater) that any identified sleep disability, to include sleep apnea, had its onset during active service or is related to any incident of service, including the Veteran’s subjective history of in service excessive snoring. 6. Schedule the Veteran for a VA hypertension examination to assist in determining the current nature of any identified hypertensive disability and its relationship, if any, to active service or a service connected disability. 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) Diagnose all hypertensive disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability had its onset during active service or is related to any incident of service, or manifested within one year following separation from service. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hypertensive disability is due to diabetes mellitus and the other service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any hypertensive disability has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by diabetes mellitus and the other service connected disabilities. 7. Schedule the Veteran for a VA examination with a medical doctor to assist in determining the nature and etiology of any identified sinus or pulmonary disability. 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) Diagnose all sinus and pulmonary disabilities found. (b) Opine as to whether it is at least as likely as not (50 percent probability or greater) that any identified sinus disability, to include sinusitis, had its onset during active service or is related to any incident of service. (c) Opine as to whether it is at least as likely as not (50 percent probability or greater) that any identified pulmonary disability, to include pulmonary fibrosis, had its onset during active service or is related to any incident of service. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel