Citation Nr: 18154093 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-35 660 DATE: November 29, 2018 ORDER Entitlement to service connection for right shoulder arthropathy is denied. Entitlement to service connection for a low back condition, diagnosed as degenerative lumbosacral spine disease with congenital spinal stenosis, is denied. Entitlement to service connection for hallux valgus and degenerative changes in the right metatarsophalangeal joint is denied. Entitlement to service connection for a sinus condition, diagnosed as allergic rhinitis and acute sinusitis is denied. Entitlement to service connection for plantar keratosis is denied. 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 neck condition is denied. FINDINGS OF FACT 1. A chronic right shoulder disorder was not manifested in service, did not manifest within one year from separation from active service, and a current right shoulder disorder is not related to active service. 2. The Veteran's chronic low back disorder, diagnosed as degenerative lumbosacral spine disease with congenital spinal stenosis, did not have its onset during active service, did not manifest within one year of active service, and is not otherwise etiologically related to active service. 3. The Veteran’s hallux valgus and degenerative changes in the right metatarsophalangeal joint did not have onset during service, did not manifest within one year of separation from active service, and are not otherwise related to his active service. 4. The Veteran’s sinus condition, diagnosed as allergic rhinitis and acute sinusitis, was not manifested in active service or for many years thereafter, and the currently diagnosed sinusitis and rhinitis are not etiologically related to active service. 5. The Veteran does not have a current of plantar keratosis disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disorder, claimed as right shoulder arthropathy, have not all been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for a low back disorder, diagnosed as degenerative lumbosacral spine disease with congenital spinal stenosis, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for hallux valgus and degenerative changes in the right metatarsophalangeal joint have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for a sinus condition, diagnosed as allergic rhinitis and acute sinusitis, have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. The criteria for service connection for plantar keratosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1973 to January 1976. This matter comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from an August 2013 rating decision, which denied the Veteran's claims of entitlement to service connection for bilateral hearing loss, tinnitus, low back condition, a neck condition, right shoulder condition, hallux valgus and degenerative changes in the right toe, and allergic rhinitis and acute sinusitis. He perfected a timely appeal to that decision. On December 15, 2016, the Veteran appeared at the Cincinnati, Ohio RO and testified at a videoconference hearing before the undersigned Veterans Law Judge, sitting in Washington, D.C. A transcript of the hearing is of record. At the hearing, the Board held the record open for 60 days in order to allow the Veteran time to submit additional evidence relevant to his claim. The issues of entitlement to service connection for a neck condition, service connection for bilateral hearing loss, and service connection for tinnitus are addressed in the REMAND portion of the decision below and are REMANDED to the Agency of Original Jurisdiction (AOJ). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (a) (2017). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. If the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b) (2017). Certain chronic diseases, including arthritis, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2017). The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for right shoulder arthropathy The Veteran contends that his right shoulder disorder is due to an inservice injury. The Veteran maintains that he sustained an injury to the shoulder as a result of a fall while carrying ammunition in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of right shoulder arthropathy, and evidence shows that he was diagnosed with sore shoulder in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of right shoulder arthropathy began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA and private treatment records show the Veteran was not diagnosed with right shoulder arthropathy until July 2013, more than 38 years after his separation from service. While the Veteran is competent to report having experienced symptoms of pain in the right shoulder since service, he is not competent to provide a diagnosis in this case or determine that this symptom was a manifestation of right shoulder arthropathy. The issue is medically complex, as it requires knowledge of the musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the July 2013 VA examiner opined that the Veteran’s right shoulder arthropathy is less likely as not caused by or a result of service. The examiner explained that the veteran was noted to have right shoulder pain in July of 1975, and he was diagnosed with a "sore shoulder." He also noted that the separation physical examination in December of the same year was normal. There is no evidence of periodic evaluation/treatment for the shoulder following service. The examiner further noted that today's radiograph notes degenerative arthropathy of the shoulder. He stated that there does not appear to be a nexus with service, or a causal relationship between the "sore shoulder" and the arthropathy that was diagnosed approximately 38 years later. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes that his right shoulder disorder is related to an in-service injury, event, or disease, including a fall while carrying ammunition, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires knowledge of the musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran has not demonstrated that he has expertise in medical matters. As such, his nexus opinion is not competent evidence. Consequently, the Board gives more probative weight to the July 2013 VA medical opinion. Put simply, the evidence does not establish that the Veteran had a chronic right shoulder condition during active service or that a current right shoulder disorder is otherwise related to active service. Because there is no approximate balance of positive and negative evidence, the rule affording the Veteran the benefit of the doubt does not help the claimant. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2017). The appeal as to this issue must be denied. 2. Entitlement to service connection for a low back condition, diagnosed as degenerative lumbosacral spine disease with congenital spinal stenosis The Veteran contends that he developed a low back disorder as a result of a fall he suffered in service. At his personal hearing, in December 2016, the Veteran indicated that he was climbing up a hill and carrying a lot of materials when he fell and rolled down the hill. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current diagnoses of congenital spinal stenosis and degenerative joint disease/degenerative disc disease of the lumbar spine, and evidence shows that he was diagnosed with soreness of muscles, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of congenital spinal stenosis and DJD/DDD of the lumbar spine began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Private treatment records show that the Veteran was not diagnosed with congenital spinal stenosis and DJD/DDD of the lumbar spine until February 2012, approximately 36 years after [his/her] separation from service. While the Veteran is competent to report having experienced symptoms of lower back pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of spinal stenosis and DJD/DDD of the lumbar spine. The issue is medically complex, as it requires knowledge of the musculoskeletal system and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the July 2013 VA examiner opined that the Veteran’s spinal stenosis is congenital and not related to service. The examiner noted that the degenerative changes are most likely age and body habitus related; therefore, the examiner opined that the degenerative lumbosacral spine disease is less likely as not caused by or a result of service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Based on the pertinent evidence of record, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a lumbar spine disability. While the evidence of record shows that he has a current diagnosis of congenital spinal stenosis and DJD/DDD of the lumbar spine, the probative evidence of record demonstrates that the injury is unrelated to his service. The examiner based the negative nexus opinion on the evidence of record as well as his assessment of the Veteran. The examiner explained that the Veteran was evaluated in November of 1975 for back pain and diagnosed with sore muscles; however, a separation examination the following month records a normal spine examination. The examiner further noted that there was no evidence of periodic treatment for the back following service Sore back muscles are ubiquitous and self-limiting; he noted that the records do not portend permanent residuals or chronic disability, and an MRI performed last year noted congenital spinal stenosis and mild to moderate degenerative changes. Consequently, the degenerative lumbosacral spine disease is less likely as not caused by or a result of service. The Board has also considered the Veteran's testimony and contentions asserting a nexus between his low back disability and a fall in service. As a lay person, however, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorders of congenital spinal stenosis and DJD/DDD of the lumbar spine. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011) (recognizing ACL injury is a medically complex disorder that required a medical opinion to diagnose and to relate to service). Further, the etiology of the Veteran's low back disorder is a question involving internal and unseen system processes unobservable by the Veteran. As the record does not reflect that the Veteran has such understanding or ability to relate a low back disorder to his military service, any contention regarding the claimed relationship does not have probative value. The Board places great weight upon the July 2013 VA examination and opinion, in part, because a competent medical opinion on how a low back disability is related to service requires expert understanding of anatomy and the largely unseen, unobservable mechanics within the musculoskeletal system. In sum, review of STRs, post-service treatment records, and the examination weigh against finding that there is a relationship (either causation or aggravation) between the currently diagnosed low back disorder and service. Therefore, service connection for a low back disorder is not warranted. No other evidence of record relates a low back disorder to the Veteran's service. The Board therefore finds that a preponderance of the evidence is against the claim of service connection for a low back disorder. As there is a preponderance of the evidence against the claim, reasonable doubt may not be resolved in the Veteran's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for a bilateral foot disorder, including hallux valgus and degenerative changes in the right metatarsophalangeal joint and plantar keratosis The Veteran maintains that service connection is warranted for a bilateral foot disorder which had its onset in service. At the personal hearing in December 2016, it was reported that the Veteran was seen on several occasions in service for bunions and callouses. The Board has reviewed the above evidence and finds that there is no indication of a current diagnosis of plantar keratosis. Indeed, the July 2013 VA examiner stated that the plantar keratosis resolved without sequelae. After further review of the evidence of record, the Board finds that although the Veteran currently has a diagnosis of the feet, namely hallux valgus and DJD of the right great toes, and was seen in-service for callouses on both feet and plantar keratosis of the left foot, the preponderance of the probative evidence is against a finding that any bilateral foot disability is related to his military service. First, the Board finds that there is no evidence of record that the Veteran has a current diagnosis of plantar keratosis. Therefore, the Veteran has not met his threshold preliminary evidentiary burden of establishing he has current disability. Indeed, the July 2013 VA examiner specifically found that the Veteran was diagnosed with plantar keratosis of the left foot in service, it has resolved without sequelae. The examiner also concluded that there is no evidence of a current chronic disability related to service. Without this required proof of a current disorder, the claim for service connection necessarily fail. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328, 1332 (1997) (holding that VA compensation only may be awarded to an applicant who has disability existing on the date of application, not for a past disability); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (further clarifying that this requirement of current disability is satisfied when the claimant has disability at the time a claim for VA disability compensation is filed or during the pendency of the claim and that a claimant may be granted service connection even though the disability resolves prior to VA's adjudication of the claim); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Here, the evidence does not show that the Veteran had a current diagnosis of plantar keratosis, either when filing his claim or at any time since. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer, 3 Vet. App. at 225. Accordingly, service connection for plantar keratosis is not warranted because the Veteran has not satisfied the first requirement of service connection, i.e., a current diagnosis. See 38 C.F.R. § 3.303; see again Gilpin, 155 F.3d at 1353; Brammer, 3 Vet. App. at 225. The Board has also considered whether service connection is warranted for other foot disabilities, to include hallux valgus and DJD of the right great toes. Although the Veteran contends that he has a bilateral foot disability is related to service, the diagnosis of any such disability and the etiology of such require medical testing and expertise to determine. Thus, as a lay person, the Veteran's opinion on the etiology of his bilateral foot disability is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his currently diagnosed disability is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) ("Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with."). The Board finds the medical opinion rendered by the July 2013 VA examiner to be significantly more probative than the Veteran's lay assertions. In this case, there is no competent evidence that the Veteran's current bilateral foot disability is related to his active service. The only examiner to directly comment on this disability - the examiner from the July 2013 examination - determined that the Veteran's hallux valgus and DJD of the right great toe are not caused by or a result of service. The examiner further explained that there is no evidence of a permanent residual or chronic disability associated with callouses. Consequently, there are no competent opinions or other medical evidence relating the etiology of hallux valgus and DJD of the right great toe or any other bilateral foot disability to any injury or disease in service or otherwise linking a bilateral foot condition to service. Thus, the preponderance of the evidence is against the claim, and the claim for service connection for a bilateral foot disability is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57. 4. Entitlement to service connection for a sinus condition, diagnosed as allergic rhinitis and acute sinusitis The Veteran maintains that his sinus condition had its onset while on active duty. At his personal hearing in December 2016, the Veteran testified that he was seen on several occasions during service for nasal congestion and other problems with his sinuses. The Veteran related that he has continued to experience problems with his sinuses since service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current diagnoses of allergic rhinitis and acute sinusitis, and evidence shows that he was treated for sinus congestion in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of allergic rhinitis and acute sinusitis began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Private treatment records show the Veteran was not diagnosed with a sinus condition until January 2011, approximately 35 years after his separation from service. While the Veteran is competent to report having experienced symptoms of nasal congestion and sinus pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of allergic rhinitis and acute sinusitis. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the July 2013 VA examiner opined that the Veteran’s allergic rhinitis and acute sinusitis are less likely as not caused by or a result of service. The examiner noted that the STRs reflect that the Veteran was evaluated for a sinus for a 'sinus problem in September of 1975; however, a diagnosis was not given. The examiner further noted that the Veteran was again evaluated in July of 1975 for sinus trouble' and was diagnosed with an upper respiratory infection; however, at separation in December of 1975, clinical findings were normal. The examiner indicated that there is no evidence of periodic evaluation or treatment for a sinus condition following service, although the Veteran has reported that he has been treated for acute sinus infections in recent years. The examiner stated that there is no evidence of a current chronic sinus disability related to service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran contends that his allergic rhinitis and acute sinusitis are related to service, the Board finds that as a lay person the Veteran is not competent to offer such an etiology opinion. The etiology of the sinus condition is a complex medical question not capable of lay observation and is not the type of medical issue for which a lay opinion may be accepted as competent evidence. As a lay person, the Veteran does not have the education, training and experience to offer an etiology opinion as to the onset or etiology of these conditions. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). Accordingly, the Veteran's lay statements in this regard are not competent or probative evidence supporting his claims. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau, 492 F.3d at 1376-77. Based on a review of the record evidence, the Board concludes that service connection for allergic rhinitis and acute sinusitis is not warranted. Although the record evidence shows that the Veteran currently has diagnoses of allergic rhinitis and acute sinusitis, it does not indicate that the Veteran's conditions have a causal connection to or are associated with his active service. In light of the foregoing, the Board must conclude that the preponderance of the evidence is against the claims. In reaching this conclusion, the Board considered the applicability of the benefit of the doubt doctrine. However, that doctrine is not applicable in the instant appeal as the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102 (2017). REASONS FOR REMAND A remand is necessary so that VA can meet its duty to assist the Veteran in obtaining evidence to substantiate his claims. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (c). 1. Entitlement to service connection for bilateral hearing loss is remanded. In this regard, the Veteran contends that his bilateral hearing loss is related to his period of active service, and in particular, to in-service noise exposure from his duties in the armor division. During his December 2016 hearing before the Board, the Veteran testified that he started experiencing hearing loss back in service from being around the area where they were testing the rifles and shells. It was noted that the Veteran’s hearing loss is secondary to noise exposure from the M60 machine guns. In conjunction with his claim, the Veteran was afforded a VA audiological examination in July 2013, at which time puretone thresholds again could not be obtained and the VA examiner noted that the testing results obtained was unreliable and not suitable for rating purposes. The diagnosis is noted to be sensorineural hearing loss. The examiner stated that the Veteran has a non-organic hearing loss bilaterally. The examiner further stated that it is suspected that the Veteran has some sensorineural hearing loss, but he was unable to determine degree and configuration today due to non-organic hearing loss. However, the examiner also stated that the Veteran should be rescheduled and retested, optimally with a different audiologist to elicit valid and reliable results. However, there is no indication that this additional testing was conducted. Consequently, the Board is unable to determine at this time whether the Veteran has a current hearing loss disability under 38 C.F.R. § 3.385. As such, the Board finds remand is warranted in order to obtain another VA audiological examination and opinion, that includes all recommended testing, in order to determine whether the Veteran has a hearing loss disability for VA purposes and whether it is related to service. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). 2. Entitlement to service connection for tinnitus is remanded. The Veteran is claiming service connection for tinnitus which he believes developed as a result of his exposure to artillery noise while on active duty. On the occasion of a VA examination in July 2013, the examiner indicated that the Veteran had recurrent tinnitus. However, the examiner stated that he was unable to provide a medical opinion regarding the etiology of the Veteran’s tinnitus without resorting to speculation. The examiner explained that the Veteran exhibited a non-organic hearing loss bilaterally. The examiner further stated that the Veteran provided unreliable results which should not be used for rating, and that the results suggested a non-organic hearing loss. However, the examiner also stated that the Veteran should be rescheduled and retested, optimally with a different audiologist to elicit valid and reliable results. However, there is no indication that this additional testing was conducted. As such, the Board finds that a remand is warranted in order to obtain another VA audiological examination and opinion regarding the etiology of the Veteran’s tinnitus. 3. Entitlement to service connection for a neck condition The Veteran maintains that he developed a neck condition in service from carrying a lot of heavy weight. Records from Mount Carmel Health System from October 2001 to February 2012. Private treatment report dated February 2012 indicates that the Veteran was seen for complaints of neck pain, with right-sided radiculopathy. MRI of the cervical spine revealed findings of a moderate canal stenosis from C2-3 through C6-7. That is most pronounced at C3-4 where the flattening of the cord is most severe. There was also a large amount of foraminal narrowing related to osteophytes. A VA progress note, dated December 17, 2015, indicates that the Veteran was seen for complaints of pain in his neck. No diagnosis was noted. The Veteran was again seen in February 2016 for complaints of neck pain; the diagnosis was right neck pain, likely myofascial. In light of the foregoing, the Board finds that the evidence of record clearly demonstrates that the Veteran has a cervical spine disorder. And, during his hearing, he testified that he injured his cervical spine from carrying the ammunition and other heavy loads in service. To date, the Veteran has not undergone a VA examination on this issue. The July 2013 VA spine examination focused on the lumbar spine, it did not include a complete physical examination of the cervical spine or a medical nexus opinion. As such, it was inadequate with regard to the Veteran's cervical spine claim. Although the service treatment records do not reflect treatment for a cervical spine, the Board nevertheless finds that the low threshold for obtaining a VA examination in this case exists and a remand in order to accomplish such is necessary at this time. See 38 U.S.C. § 5103A (d) (2012); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Obtain any and all VA treatment records not already associated with the claims file. Thereafter, the Veteran must be afforded a VA audiological examination, by an examiner other than the July 2013 examiner, to determine whether any current bilateral hearing loss and tinnitus is related to service. The Veteran's claims file must be made available to an appropriate examiner for review prior to the examination. All pertinent symptomatology and findings must be reported in detail. Any indicated diagnostic tests and studies, to include an audiogram must be accomplished. Specifically, the results of the audiological evaluation must state, in numbers, the findings of pure tone decibel loss at 500, 1000, 2000, 3000, and 4000 Hertz, provide the pure tone threshold average, and must also state the results of the word recognition test, in percentages, using the Maryland CNC test. If the results of any test are unreliable, the examiner must so state and provide an explanation as to why the results are unreliable. Based on the clinical examination, a review of the evidence of record, and with consideration of the Veteran's statements, the examiner should opine whether the Veteran has bilateral hearing loss and tinnitus, and if so, is it at least as likely as not that the Veteran's bilateral hearing loss and tinnitus are related to service. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall explain whether additional information is needed or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question. 2. Ensure that the Veteran is scheduled for a VA examination to determine the nature and etiology of his cervical spine condition. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner must specifically state any cervical spine disorder found, to include any arthritic condition thereof. Then, the examiner must opine whether any cervical spine disorder found at least as likely as not (50 percent or greater probability) began in or is otherwise related to his period of military service. The examiner must consider the Veteran's lay statements regarding onset of symptomatology and his contention that his cervical spine disability is due to carrying heavy weight during service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 3. Following any additional indicated development, the AOJ should review the claims file and readjudicate the Veteran's claims on appeal. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and given the opportunity to respond thereto before the case is returned to the Board. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs