Citation Nr: 18151156 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 13-03 564 DATE: November 16, 2018 REMANDED Entitlement to service connection for arthritis or residuals of fractured shoulder is remanded. Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for residuals of a concussion or fracture of the skull causing mental instability with memory loss or bipolar disorder and resulting in an aneurysm is remanded. Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for an acquired psychiatric condition, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1973 to March 1979. This matter was previously before the Board in July 2017, at which time the claims were remanded, in part, to obtain relevant service treatment records not yet associated with the claims file. In August 2017, newly obtained and relevant service treatment records were associated with the Veteran’s claims file. As such, the Veteran’s service connection claims for residuals of a concussion or fracture of the skull, shoulder disability and hearing loss will be reconsidered on the merits pursuant to 38 C.F.R. § 3.156 (c). REASONS FOR REMAND 1. Entitlement to service connection for arthritis or residuals of fractured shoulder is remanded. The Veteran contends that he suffers from a bilateral shoulder disability that resulted from a July 1974 in-service altercation and subsequent hospitalization. In March 2004, he underwent a VA examination in which he was diagnosed with traumatic arthritis of the left shoulder and glenohumeral joint with tendinosis and partial tear of the supraspinatus tendon with adhesive capsulitis. The examiner concluded that this injury “is likely resulting from the service-connected trauma in 1975.” However, the examiner – in addition to incorrectly stating the date of the Veteran’s in-service incident – provided no rationale to explain how he arrived at his conclusion and provided no medical findings concerning the Veteran’s right shoulder. As such, remand is needed for a new VA examination with opinion on the etiology of any diagnosed shoulder disability. 2. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran testified at his Board hearing that his hearing loss was the result of injuries he sustained during his July 1974 altercation and subsequent hospitalization. A review of his VA treatment records show that he has been diagnosed with sensorineural hearing loss and was issued hearing aids. In light of the Veteran’s credibly reported testimony attesting to symptoms of hearing loss since active duty service, as well as service treatment records documenting an in-service altercation and subsequent hospitalization, remand is needed for a VA examination with opinion on this issue. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 3. Entitlement to service connection for residuals of a concussion or fracture of the skull causing mental instability with memory loss or bipolar disorder and resulting in an aneurysm is remanded. 4. Entitlement to service connection for headaches is remanded. The Veteran contends that he suffers from residuals of a traumatic brain injury (TBI) as a result of his July 1974 in-service altercation and subsequent hospitalization. The Veteran stated that he suffered a concussion from his injuries. See February 2009 Statement in Support of Claim. A May 2010 VA examination noted that the Veteran had a possible TBI, but he would need a neuropsychological examination to determine whether his symptoms stem from a possible brain injury during his in-service attack. A November 2010 VA neuropsychological evaluation references the Veteran’s reports of suffering a severe TBI during active service, but it does not appear that the Veteran ever underwent a formal evaluation to confirm a diagnosis of TBI or any residual condition. Considering the Veteran’s assertions and the medical evidence of record, a new VA examination with opinion is needed on this issue. The claim of entitlement to service connection for headaches is intertwined with the service connection claim for residuals of a concussion or fracture of the skull and will be remanded as well. 5. Entitlement to service connection for hepatitis C is remanded. The Veteran contends that he contracted hepatitis C from air gun injections he received during active duty service. He also stated that he shared razors during service with other service members, which is another risk factor for the contraction of hepatitis C. In November 2017, a VA examiner concluded the Veteran’s hepatitis C was less likely than not incurred in or caused by his claimed in-service events. The opinion, however, is inadequate to adjudicate the Veteran’s claim, as the examiner relies exclusively on the absence of medical records documenting a diagnosis of hepatitis C until many years following discharge from active duty service to conclude that the Veteran’s history of post-service drug use was the likely cause of his contraction. On remand, an addendum opinion is needed for the VA examiner to more fully address the Veteran’s in-service risk factors and whether they may have resulted in his contraction of hepatitis C. 6. Entitlement to service connection for an acquired psychiatric condition, to include PTSD, is remanded. The Veteran has testified that he experiences a psychiatric disorder as a result of the July 1974 in-service assault. In May 2010, he was afforded a VA examination on this issue. In July 2017, the Board remanded this claim to afford the Veteran a VA examination to clarify whether his symptoms were related to a possible brain injury stemming from his in-service attack. In November 2017, a VA examiner diagnosed the Veteran with unspecified depressive disorder and mild neurocognitive disorder. He also stated that a review of the records did not show the Veteran was diagnosed with a TBI. However, no formal assessment was conducted to confirm whether the Veteran ever suffered a TBI. As this issue is intertwined with the service connection claim for residuals of a concussion or fracture of the skull, it will be remanded as well. Since the claim is being remanded, any outstanding VA treatment records should be obtained and associated with the Veteran’s claims file. See 38 C.F.R. § 3.159 (c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding VA treatment records regarding the Veteran dated from June 2018 to the present. 2. After completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed bilateral shoulder disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the July 1974 in-service altercation and subsequent hospitalization. The examiner should also consider and discuss the findings of a March 2004 VA examination report which noted a diagnosis of traumatic arthritis of the left shoulder and glenohumeral joint with tendinosis and partial tear of the supraspinatus tendon with adhesive capsulitis. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his diagnosed hearing loss. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the July 1974 in-service altercation and subsequent hospitalization. The examiner should also address statements the Veteran made in his January 2013 VA Form 9 attesting to in-service noise exposure to live-fire training exercises. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnoses related to his claimed residuals of a concussion or fracture of the skull. The examiner is asked to confirm whether the Veteran is currently diagnosed with a TBI or any residuals thereof. The examiner must opine whether any diagnosed condition is at least as likely as not related to an in-service injury, event, or disease, including the July 1974 in-service altercation and subsequent hospitalization. 5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hepatitis C is at least as likely as not related to risk factors for contraction of the disease during active duty service. The examiner is asked to specifically consider and comment on the significance of the Veteran’s reports of being injected with an air gun during service, as well as sharing razors with other service members. 6. Conduct any other development deemed necessary, to include obtaining addendum VA opinions concerning the nature and etiology of the Veteran’s claimed headache disorder and diagnosed psychological conditions. M. E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jack S. Komperda, Counsel