Citation Nr: 18153441 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-03 860 DATE: November 27, 2018 ORDER An increased rating of 10 percent for the Veteran’s service-connected left ear deep attic retraction pocket with minimal cholesteatoma (left ear disability) is granted. REMANDED Service connection for a right knee disability is remanded. Service connection for chronic sinusitis is remanded. An increased rating for bilateral hearing loss is remanded. A separate rating for possible complications of the Veteran’s left ear disability is remanded. An increased rating for irritable bowel syndrome (IBS) is remanded. FINDING OF FACT The medical evidence, including January 2016 private treatment records, shows ongoing symptoms including suppuration and treatment associated with the Veteran’s left ear deep attic retraction pocket with minimal cholesteatoma. CONCLUSION OF LAW The criteria for an increased rating of 10 percent (the maximum available) for the Veteran’s left ear deep attic retraction pocket with minimal cholesteatoma have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.87, Diagnostic Code 6200. 1. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1972 to December 1975 and December 1977 to February 1980. He has extensive additional service with the Reserves including deployments to Bahrain from February 1991 to March 1991 and in August 1992. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision. As discussed below, the Veteran did not waive Agency of Original Jurisdiction (AOJ/RO) review of newly submitted evidence. However, because the evidence supported a full grant (the highest available rating under the pertinent diagnostic code), the Veteran is not prejudiced by this grant of an increased rating for his left ear disability. Increased rating for the Veteran’s left ear disability. For the reasons outlined above, an increased rating is warranted. REASONS FOR REMAND 1. Service connection for a right knee disability is remanded. 2. Service connection for chronic sinusitis is remanded. 3. An increased rating for bilateral hearing loss is remanded. 4. A separate rating for possible complications of the Veteran’s service-connected left ear disability is remanded. 5. An increased rating for IBS is remanded. In an October 2018 letter to VA, the Veteran stated that he did not waive AOJ consideration of evidence associated with the claims file after the most recent statement of the case (SOC), and requested the Board return the case to the AOJ for initial review of this evidence and further adjudication. For this reason, the Board is required to remand the case to the AOJ. In the interest of judicial efficiency, the Board has also ordered the specific development described below so that the Veteran’s claims may be resolved more quickly. As noted below, the Board thanks the Veteran for submitting pertinent medical information. The Veteran has truly partnered with VA in developing his claims. However, the Board advises the Veteran that nexus (causal linkage) statements MUST be accompanied by a detailed explanation (rationale) for VA to grant service connection. In other words, a check box form with an attached report of medical history is not typically sufficient because the clinician did not explain or provide support for the conclusion linking the Veteran’s disability to service. What might be sufficient is a check box form as well as a detailed explanation describing WHY the clinician checked the box next to the positive statement. Similarly, for increased ratings claims, the Board suggests that the clinician describe the Veteran’s symptoms and treatment rather than just checking a box next to the desired rating criteria. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records for association with the claims file. 2. Send the Veteran a letter asking him to identify all treatment providers for the issues on appeal, and to authorize VA to obtain available records for association with the claims file. In the letter, please inform the Veteran that VA very much appreciates his submitting pertinent medical evidence BUT any opinion regarding service connection or increased rating criteria MUST be associated with a DETAILED explanation (rationale) that explains WHY this history caused the current disability (for service connection claims) OR describes the Veteran’s current symptoms in detail (for increased ratings claims). Otherwise, VA cannot legally rely on these opinions to grant benefits. 3. Review newly obtained evidence (to include the March 2018 VA audiological examination report), undertake any needed additional development, and issue an SSOC for any claims that are not granted in full. This development should include, but is not limited to, the following: 4. Schedule the Veteran for VA examinations with appropriate examiners to evaluate the nature and cause of the Veteran’s right knee and sinusitis disabilities, the current severity of service-connected IBS, and to evaluate the Veteran’s service-connected left ear disability for additional possibly compensable complications. A detailed explanation (rationale) is requested for all opinions provided and is very much appreciated. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation.) IRRITABLE BOWEL SYNDROME A new examination is required so that a VA examiner may review recent VA and private treatment records and the Veteran may describe his current IBS symptoms. The Board notes that the most recent VA examination is from February 2013, and that the record reflects ongoing treatment. Based on an examination, review of the record (including relevant private treatment records uploaded to the claims file on March 2, 2016), and any tests or studies deemed necessary, the examiner should describe all symptoms, pathology, and functional impairment associated with the Veteran’s IBS in sufficient detail to allow for application of the relevant rating criteria. The examiner should specifically consider whether the Veteran’s medications have any ameliorating effects on his symptoms or presentation and, if so, indicate or estimate the severity of his irritable bowel syndrome IGNORING such effects. RIGHT KNEE A new examination is required so that the VA examiner may review January 2016 private treatment records that contain a new diagnosis (traumatic osteoarthritis) and raise the possibility that this is related to the Veteran’s service, especially from parachute jumping. The Board also notes the February 2013 negative nexus opinion concluding that the Veteran’s then-current knee disability is related to a September 2006 (post-service) ACL tear. The examiner should answer the following questions based on (1) a review of the claims file and (2) interview and examination of the Veteran. a) Identify any right knee disabilities to include traumatic osteoarthritis. Any needed diagnostic testing should be performed. b) Is it at least as likely as not (a 50 percent or better probability) that any diagnosed right knee disability began during or is otherwise related to the Veteran’s service, especially to multiple high impact repetitive traumas associated with parachute jumps. SINUSITIS A new examination is required for the examiner to review new, pertinent evidence including the April 2016 private medical record raising the possibility of a link between the Veteran’s diagnosed chronic sinusitis and the Veteran’s hearing loss. Based on a review of the record and interview and examination of the Veteran, the examiner should provide opinions responding to the following: a) Is it at least as likely as not (a 50 percent or better probability) that the Veteran’s chronic sinusitis began during or otherwise related to the Veteran’s service? b) Is it at least as likely as not (a 50 percent or better probability) that the Veteran’s sinusitis was CAUSED by his service-connected hearing loss or left and/or right ear disabilities? c) Is it at least as likely as not (a 50 percent or better probability) that the Veteran’s sinusitis was AGGRAVATED by the Veteran’s service-connected hearing loss or left and/or right ear disabilities? Aggravation in this context means any worsening beyond natural progression. LEFT EAR: SEPARATE RATING As noted above, the Board assigned a full grant of benefits under DC 6200 for the Veteran’s left ear disability. DC 6200 also provides that associated complications, including labyrinthitis, are to be rated separately. 38 C.F.R. § 4.87, DC 6200. The record includes the Veteran’s March 2016 report of dizziness/vertigo associated with his ear conditions. On remand, the examiner should review the record—especially the Veteran’s copious private ENT records—interview and examine the Veteran, and state whether any as-of-yet uncompensated complications are present. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Robinson, Associate Counsel