Citation Nr: 18150064 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 08-10 359 DATE: November 14, 2018 ORDER Entitlement to service connection for intervertebral disc disease of the lumbar spine, including foraminal stenosis and disc bulges at L3-L4 and L4-L5, is granted. REMANDED Entitlement to an initial compensable disability evaluation for hearing loss in the left ear is remanded. FINDING OF FACT The most probative evidence of record indicates that the Veteran injured his low back during service, has experienced low back symptoms continuously since separation from service, and has been diagnosed with intervertebral disc disease of the lumbar spine, including foraminal stenosis and disc bulges at L3-L4 and L4-L5. CONCLUSION OF LAW The criteria for service connection for intervertebral disc disease of the lumbar spine, including foraminal stenosis and disc bulges at L3-L4 and L4-L5, have been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1981 to June 2005. 1. Entitlement to service connection for a lower back disability. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection can be demonstrated for a disease diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). As indicated in the March 2011 Board of Veterans’ Appeals decision remanding this issue to the Department of Veterans Affairs Regional Office (RO): Service treatment records reflect that the Veteran complained of low back pain in June 1986, May 1987, March 1988, April 1988, January 1990, October 1999, April 2002, July 2004, and August 2004. In May 1987 and April 2002, this pain was localized on his left side. In July 2004, he also complained of numbness and tingling in his back which comes and goes. Pain with forward flexion at 70 degrees was found at that time. Diagnoses of lumbosacral strain, probable left sacroiliac ligament strain, back strain, questionable low back pain with an etiology of strain, no diagnosis (no link between the Veteran’s complaint of pain and objective findings), low back pain, left sacroiliac dysfunction, low back pain, and lower back pain respectively were made. In March 2005, the Veteran underwent a VA general medical examination in preparation for his separation from service, which found his back to be normal, but did not include any radiologic examination of his back, despite his symptoms in service. Magnetic resonance imaging (MRI) in 2008 found abnormalities at L4-L5 and L5-S1, but neither a diagnostic interpretation of those abnormalities nor an opinion as to the etiology of those abnormalities was offered. The claim was remanded for development of a diagnosis and an opinion as to the etiology, but due to the Veteran’s living in Saudi Arabia, this development was delayed. In September 2018, the Veteran submitted records from February 2012, March 2012, and May 2016, in which he was diagnosed with lumbar intervertebral disc disorders (i.e., foraminal stenosis and disc bulges at L3-L4 and L4-L5), based upon MRI and his long history of lower back pain radiating to his right leg, dating back to at least 2005. As the Veteran has a current diagnosis of a lower back disability, in-service episodes of strain, and a record of continuous symptoms dating back to his service, service connection for intervertebral disc disease of the lumbar spine, including foraminal stenosis and disc bulges at L3-L4 and L4-L5, is granted. REASONS FOR REMAND 1. Entitlement to an initial compensable disability evaluation for hearing loss in the left ear. The March 2011 Board decision remanded this claim for the Veteran to undergo a hearing evaluation that included both tests required for evaluation of a hearing impairment under 38 C.F.R. § 4.85(a), a controlled speech discrimination test using the Maryland CNC list and a pure tone audiometry test at specified frequencies. This has not been accomplished, due in significant part to the fact that the Veteran has been living in Saudi Arabia. As correspondence from the Veteran in September 2018 indicates, he has now returned to the United States, which should facilitate the provision of the appropriate examination. Accordingly, though the Board regrets the further delay, this claim must be remanded to provide yet another opportunity to obtain the appropriate medical examination and opinions. The matter is REMANDED for the following action: Arrange for the Veteran to undergo a VA audiological examination to determine the current severity of his left ear hearing loss. The claims file shall be made available to and reviewed by the examiner, who shall note such review in an examination report. Then the examiner shall, to the extent possible, determine whether the Maryland CNC controlled speech discrimination test was conducted in March 2005 during service and January 2006 at Martin ACH, provide a percent interpretation of the speech discrimination test results obtained on each of these dates. Next, the examiner shall obtain from the Veteran a thorough description of his audiological symptoms, including the effects of such symptoms on his occupational functioning and daily activities. A Maryland CNC controlled speech discrimination test and a pure tone audiometry test, along with all other tests, studies, or evaluations deemed necessary, finally shall be performed. All findings shall be reported in detail. The rationale for any opinions expressed shall be provided in the examination report. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Haas, Associate Counsel