Citation Nr: 18153484 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 17-43 446 DATE: November 28, 2018 REMANDED Entitlement to service connection for a bilateral shoulder disability is remanded. Entitlement to service connection for a bilateral eye disability is remanded. Entitlement to service connection for left paracardiac fibrosis, to include subsegmental atelectasis, is remanded. Entitlement to a compensable evaluation for right ear hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1978 to March 1982 and in the United States Army from March 1991 to July 1991, September 2006 to February 2008, January 2012 to October 2012, and July 2013 to April 2014. 1. Service connection for a bilateral shoulder disability is remanded. The Veteran is seeking entitlement to service connection for a shoulder condition. While the Veteran does not clarify which shoulder, private records from Dr. C.M.Q. diagnose him with degenerative joint disease of both shoulders, as well as a right rotator cuff tear. An April 2016 MRI of the Veteran's left shoulder showed calcific tendinopathy. In a February 2016 medical report, Dr. C.M.Q. opined that it is more probable than not that the Veteran’s musculoskeletal disabilities were secondary to his military service, although no rationale was provided. In a February 2016 letter, the Veteran described the extreme physical demands of his service, including walking, running, crawling, and jumping with over a hundred pounds of body armor and gear. In May 2016, the Veteran was afforded a VA examination of his shoulders and arms, but the only disability noted by the examiner was the Veteran’s already service connected right bicep rupture. The Board finds that a remand is required to identify the nature and etiology of any shoulder disabilities shown during the appeal period and address the discrepancies between the findings on VA examination and private examination. In this regard, for any identified conditions of the left or right shoulder, the examiner must address whether they are at least as likely as not caused or aggravated by the Veteran's active military service, to include the demands of his physical service such as lifting and carrying heavy gear. 2. Service connection for a bilateral eye disability is remanded. The Veteran is also seeking entitlement to service connection for a bilateral eye disability. Service treatment records show that the Veteran was treated for refractive error in service. Generally, VA regulations specifically prohibit service connection for either a congenital defect or a refractive error of the eye, including astigmatism, myopia, hyperopia, and presbyopia, unless such a defect was subjected to a superimposed disease or injury that created additional disability. See VAOPGCPREC 82-90, 55 Fed. Reg. 45711 (July 18, 1990) (service connection may not be granted for defects of congenital, developmental or familial origin, unless the defect was subject to a superimposed disease or injury). In October 2016, the Veteran described his bilateral eye condition as due to “environmental hazard in Gulf War.” It is unclear whether the Veteran is claiming an undiagnosed illness of the eyes related to service in Southeast Asia under 38 C.F.R. § 3.317 or whether he is more generally claiming that exposure to dust, smoke, and other environmental hazards during tours in Iraq and Afghanistan permanently aggravated his vision. Regardless, the RO does not appear to have addressed this theory of entitlement. On remand, the Veteran should be afforded a VA examination of his eyes to identify any current bilateral eye conditions. The examiner is asked to opine whether any of these current conditions are caused by in-service disease or injury, to include whether exposure to environmental hazards permanently aggravated any congenital defect or refractive error of the eye. 3. Service connection for left paracardiac fibrosis, to include subsegmental atelectasis, is remanded. The Veteran is seeking entitlement to service connection for paracardiac fibrosis, to include subsegmental atelectasis. An April 2016 MRI showed paracardiac fibrosis versus subsegmental atelectasis. The RO denied service connection for this condition because it was not noted during service. However, in October 2016, the Veteran contended that his claimed condition is related to “environmental hazard in Gulf War.” It is unclear whether the Veteran is claiming an undiagnosed illness related to service in Southeast Asia under 38 C.F.R. § 3.317 or whether he is more generally claiming that exposure to dust, smoke, and other environmental hazards during tours in Iraq and Afghanistan caused his paracardiac fibrosis. Regardless, the RO did not address this theory of entitlement. On remand, the Veteran should be afforded a VA examination to determine whether he has paracardiac fibrosis or subsegmental atelectasis, and, if so, whether this condition is related to his service in Southeast Asia, to include as due to an undiagnosed illness or directly from exposure to environmental hazards. 4. Entitlement to a compensable disability evaluation for service connected right ear hearing loss is remanded. Lastly, the Veteran is seeking a compensable disability evaluation for his service connected right ear hearing loss. Although the Veteran was last afforded a VA examination in May 2017, the Veteran has alleged that his condition has worsened since that time in a November 2018 brief. Accordingly, on remand, the Veteran should be afforded a new VA examination. 38 C.F.R. §§ 3.326, 3.327 (reexaminations will be requested whenever VA determines there is a need to verify the current severity of a disability, such as when the evidence indicates there has been a material change in a disability or that the current rating may be incorrect); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right and left shoulder disabilities. For each identified condition, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including frequently carrying and lifting heavy gear as part of his military duties. If arthritis is shown, then the examiner is also asked to opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any disability or disabilities of the right and left eye. For each identified condition, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including an undiagnosed illness under 38 C.F.R. § 3.317 or from exposure to environmental hazards in Iraq and Afghanistan. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any paracardiac fibrosis and subsegmental atelectasis shown during this appeal. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including an undiagnosed illness under 38 C.F.R. § 3.317 or from exposure to environmental hazards in Iraq and Afghanistan. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ear hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. (Continued on the next page)   5. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. D. Anderson, Counsel