Citation Nr: 18154400 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-55 295 DATE: November 29, 2018 REMANDED Entitlement to service connection for cervical stenosis (claimed as neck pain) is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1973 to March 1976. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This case has since been transferred to the RO in Atlanta, Georgia. Entitlement to service connection for cervical stenosis is remanded. The Veteran seeks service connection for cervical stenosis. During a February 2013 VA examination, the Veteran was diagnosed with cervical spine stenosis and degenerative joint disease; however, no opinion as to etiology was provided. The Veteran reported that in approximately 1990 he began to have increasing problems with his neck. In an April 2013 buddy statement, a fellow soldier explained the circumstances in which a drill instructor had him hit the Veteran in the back of the head with “pugilistic sticks”. In light of the fact that the February 2013 VA examiner did not provide an opinion as to etiology of the diagnosed cervical spine disabilities and the April 2013 buddy statement, the Board finds that a new VA examination and opinion is warranted. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001), 38 C.F.R. § 4.2. Entitlement to service connection for bilateral hearing loss and tinnitus is remanded. The Veteran seeks service connection for bilateral hearing loss and tinnitus. The Veteran’s DD-214 identified his military occupational specialty (MOS) as an armorer. A February 2013 VA examination reflects that the Veteran has bilateral hearing loss for VA purposes. The VA examiner opined that the Veteran’s bilateral hearing loss and tinnitus were less likely than not related to his active duty service as the Veteran did not have a worsening significant hearing threshold shift in hearing during service. However, the Board notes that on entrance examination in March 1973, the Veteran’s puretone thresholds were reported as HERTZ 500 1000 2000 3000 4000 RIGHT 5 5 5 5 5 LEFT 10 5 15 15 10 On separation examination in November 1975, his puretone thresholds were reported as HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 15 - 15 LEFT 10 10 15 - 20 The examiner fails to explain the significance, if any, of these threshold shifts from the Veteran’s entrance examination to his separation examination in service. Further, the examiner failed to address the Veteran’s MOS of Armor Unit Supervisor Specialist and the Veteran’s lay statements. Lastly, the Board notes that it is not a sufficient rationale for a negative nexus opinion merely to state that the Veteran’s hearing was within normal limits on audiometric testing during service. In such a case, service connection is not precluded if there is sufficient evidence to demonstrate a relationship between the appellant’s service and a current disability which satisfies 38 C.F.R. § 3.385. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Board finds that the February 2013 VA examination regarding the Veteran’s bilateral hearing loss and tinnitus is inadequate. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001), 38 C.F.R. § 4.2. These matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA medical examination with the appropriate medical professional to determine the nature and etiology of the Veteran’s cervical stenosis and degenerative joint disease. The claims file and all pertinent records must be made available to the VA examiner for review. The VA examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any diagnosed cervical spine disability, to include the Veteran’s cervical stenosis and degenerative joint disease, had onset in service, or within one year following separation from service, or was causally related to service. The April 2013 buddy statement and the Veteran’s lay assertions as to onset and continuity of symptomatology should be recorded and considered. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it. If the VA examiner finds that he/she cannot provide an opinion without resorting to speculation, he/she should explain the inability to provide an opinion. A complete rationale for all opinions should be provided. 2. Schedule the Veteran for an appropriate audiological examination, by a VA examiner who has not previously examined him, to determine the nature and etiology of his bilateral hearing loss and tinnitus. The claims file and all pertinent records must be made available to the VA examiner for review. The VA examiner should indicate whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral hearing loss and tinnitus had its onset during service or is otherwise related to his active military service. The examiner must address the significance, if any, of the threshold shifts audiometric results as reported on the Veteran’s entrance and separation examination reports. The examiner must consider statements from the Veteran regarding his MOS, the onset and continuity of symptomatology. The examiner must not rely solely on the fact that the Veteran's hearing was within normal limits for VA purposes at the time of separation from service, as the basis for any opinion provided. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it. If the VA examiner finds that he/she cannot provide an opinion without resorting to speculation, he/she should explain the inability to provide an opinion. A complete rationale for all opinions should be provided and the examiner should reconcile his opinion with the prior February 2013 VA opinion. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Mahaffey, Associate Counsel