Citation Nr: 18153654 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 18-40 995 DATE: November 28, 2018 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a prostate disorder, to include as due to exposure to Agent Orange is remanded. Entitlement to service connection for a disorder resulting in urinary incontinence is remanded. Entitlement to service connection to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial rating in excess of 10 percent for peptic ulcer disease (PUD) with irritable bowel syndrome (IBS) is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from February 1964 to February 1968. His service included service in the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) on appeal from March 2014 and July 2015 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Puerto Rico. In May 2015, the Veteran submitted a claim for several issues, including “right ear conditions.” His right ear condition claim was denied in a July 2015 rating decision. His August 2015 notice of disagreement (NOD) addressed seven issues (PTSD and nervous conditions were listed separately), but did not address his claim for a right ear condition. Although the Veteran did not file a timely NOD for his right ear condition claim, the RO continued to address this issue in the July 2018 SOC. The Veteran and his representative did not provide further argument related to his right ear condition. As he did not provide a timely NOD for the issues of entitlement to service connection for a right ear condition, the Board does not find that this issue is on appeal. The Board notes that the Veteran’s claims of entitlement to service connection for PTSD and a prostate disorder were previously denied in a March 2014 rating decision. However, the electronic record indicates that VA treatment records were added to the claims file on the same date as the March 2014 rating decision. Although the March 2014 rating decision indicates that VA treatment records from 2002 to 2014 were reviewed, the VA treatment records added to the claims file are from 2012 to 2014. Given the discrepancy, it is unclear if these records were added before or after the rating decision was provided. The greater benefit to the Veteran is to presume that the records were added after the rating decision because the records contained relevant records for his PTSD and prostate condition claims, thus continuing his claims for those issues from his initial claim date. 1. Entitlement to service connection for hearing loss and tinnitus is remanded. During the July 2018 audio examination, the examiner cited partial ENT (ear, nose, throat) VA treatment records from March and July 2017. He cited only partial sentences related to a scar on the tympanic membrane of the Veteran’s left ear. The electronic record does not contain the full ENT treatment records. On remand, these records must be obtained. The Veteran’s DD Form 214 indicates that his duty MOS in service was as a supply handler/supply clerk. This MOS has a low probability of exposure to hazardous noise. However, the Veteran served for nearly six months in Cam Ranh Bay, Republic of Vietnam. The Veteran and his representative have argued that he was exposed to hazardous noise during his service in Vietnam, and that his duties included guard duty. The Board concedes that he was exposed to hazardous noise during his six months in the Republic of Vietnam. On remand, the Veteran should be afforded another VA examination, which includes eliciting information regarding his noise exposure in service and post service. VA examiners have opined that the Veteran’s tinnitus is due to his hearing loss. As a result, his claim for tinnitus is intertwined with his hearing loss claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). 2. Entitlement to service connection for a prostate disorder and a disorder resulting in urinary incontinence is remanded. The Veteran served in the Republic of Vietnam for nearly six months. He has indicated his belief that he has a prostate condition due to exposure to Agent Orange. In August 2018, he submitted a tomography examination of the abdomen and pelvis which showed that he had a large prostate and nodular indenting in the urinary bladder, with prominent wall thickening “probably from muscular hypertrophy from chronic obstruction.” He also had two small diverticula laterally in the bladder wall. The RO did not review this evidence and issue a supplemental statement of the case (SSOC), despite the claim not being certified to the Board until September 2018. The Veteran has not been provided a VA examination in conjunction with his prostate and urinary incontinence claims. As the Veteran was exposed to Agent Orange, and he has argued that his prostate condition is due to this exposure, a VA examination with nexus opinion is warranted. The Board notes that medical evidence indicates that there may be a connection between the Veteran’s enlarged prostate and his urinary symptoms. As such, his urinary incontinence claim is intertwined with his prostate claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). 3. Entitlement to service connection to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. The Veteran has argued that he has a psychiatric disorder, claimed as PTSD and “nerves,” as a result of (a) his service in Vietnam, and/or (b) the pain from his service-connected medical conditions (currently peptic ulcer disease with IBS). See August 2015 statement. The Veteran’s service treatment records include complaint of “nerves issues” in March 1964, due to a conflict in the barracks. Another March 1964 record included that the Veteran missed his mother and had been trying to call her. And as early as March 3, 1964, the Veteran was noted to have somatic complaints of back pain and tension headaches, but he was noted to have a “history of hysterical-like episodes.” This record also noted that his father died two months prior and his mother was living alone. The Veteran did not report this history to VA examiners, and it is unclear why this note included that his father died 2 months prior as most records indicate his father died when he was a young child. The Veteran has reported that he was treated by VA and private mental health providers within a year of his discharge from service (1966), and that he was diagnosed with schizophrenia. The earliest post-service treatment records related to mental health in the claims file are from 2013. In July 2013, the Veteran sought mental health treatment, and reported depression and anxiety related to losing his job four months prior. Although he denied a prior history of psychiatric or mental health treatment, the VA psychiatrist noted he had prior orders for psychiatric medication (Sertraline and Clonazepam). The Veteran reported that he had not been taking those medications. There is a February 2013 primary care physician record where the Veteran reported a depressed mood, feeling sad, anxious, and irritable and he was given a trial of Zoloft and Clonazepam. Although these are the earliest post-service VA mental health records in the claims file, the medical history section of a 2013 record included that he had a diagnosis of depression from February 2005 and of anxiety from August 2007. As there are potentially earlier VA mental health treatment records, the claim must be remanded so these records can be obtained, if possible. The RO should also request that the Veteran provide releases for any private treatment providers. After any additional treatment records are obtained, the Veteran should be provided a VA examination with nexus opinion that addresses the 1964 indication of prior “hysterical-like episodes.” 4. Entitlement to an initial rating in excess of 10 percent for peptic ulcer disease with irritable bowel syndrome is remanded. During the July 2018 gastrointestinal (GI) examination, the Veteran reported that he was seeing a private gastroenterologist, Dr. J.H. in Caguas, Puerto Rico. He was also scheduled for a colonoscopy in August 2018. The results of the colonoscopy are not contained in the claims file. Also, there are no private treatment records from Dr. J.H. in the claims file. On remand, the RO should request that the Veteran provide releases for all of his private medical treatment records. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. J.H. (gastroenterologist), a copy of the scheduled August 2018 colonoscopy, and for any private mental health treatment the Veteran has received from 1966 to the present. Make two requests for the authorized records from Dr. J.H. and any other doctors/facilities listed by the Veteran, unless it is clear after the first request that a second request would be futile. 2. Obtain VA mental health treatment records for the Veteran from 1966 to the present, to include the February 2005 and August 2007 records where he was initially diagnosed with depression and anxiety, respectively. All records/responses received must be associated with the electronic claims file. 3. Obtain VA ENT treatment records from March and July 2017, as well as any ongoing VA treatment records from March 2014 to the present. All records/responses received must be associated with the electronic claims file. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his hearing loss. The examiner should elicit a history of noise exposure from the Veteran, to include details of noise exposure during his six months of service in Vietnam, and any post-service noise exposure. The examiner should also elicit information from the Veteran regarding when he subjectively noticed his hearing loss and tinnitus. Note: he denied subjective hearing loss and tinnitus during 2013 primary care treatment “review of systems.” The examiner must opine whether it is at least as likely as not (50/50 probability or greater) that his hearing loss is related to service, to include exposure to hazardous noise during his six months of service in Vietnam. VA concedes that he was exposed to hazardous noise for his six months of service in Vietnam. A full explanation must accompany each opinion. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any prostate condition. The examiner must opine whether it is at least as likely as not (50/50 probability or greater) that he has a prostate condition related to an in-service injury, event, or disease, including exposure to Agent Orange. A full explanation must accompany each opinion. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any disorder resulting in urinary incontinence. The examiner must opine whether it is at least as likely as not (50/50 probability or greater) that he has a condition resulting in urinary incontinence related to an in-service injury, event, or disease, including exposure to Agent Orange. The examiner should state if his urinary incontinence is due to a prostate condition. A full explanation must accompany each opinion. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his psychiatric disorders. The Veteran has been diagnosed with adjustment disorder with anxiety and depressed mood, depressive disorder, and major depression during the appeal process. (a.) Is there clear and unmistakable evidence that the Veteran had a psychiatric disorder prior to service? Note the March 1964 treatment record where the Veteran reported prior “hysterical-like episodes.” (b.) If yes, does the evidence clearly and unmistakably show that a pre-existing psychiatric disorder was not aggravated by service? (c.) If no, is it at least as likely as not (50/50 probability or greater) that the Veteran developed his current psychiatric disorder(s) in service or as a result of his service? The Veteran argues that his psychiatric disorders are a result of his service in Vietnam. (d.) is it at least as likely as not (50/50 probability or greater) that the Veteran’s current psychiatric disorder(s) are due to the pain/symptoms associated with his service-connected peptic ulcer disease with IBS? A full explanation must accompany each opinion. (Continued on the next page)   8. After completing the development requested above, readjudicate the Veteran’s claims. If any of the benefits sought are not granted in full, the Veteran and his representative should be furnished a Supplemental Statement of the Case (SSOC) and given the opportunity to respond thereto. The SSOC must include review of the April 2018 tomography examination that was submitted in August 2018. The case should then be returned to the Board, if otherwise in order. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.H. Stubbs, Counsel