Citation Nr: 18154530 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 14-41 212 DATE: November 30, 2018 REMANDED Entitlement to service connection for a left knee disability 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 had active military service from September 1972 to September 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in Boise, Idaho. 1. Entitlement to service connection for a left knee disability is remanded. The Veteran asserts that service connection for a left knee disability is warranted. He contends that the claimed disability had its onset during military service and has continued since that time. Service treatment records confirm treatment for a knee disability. Notably, in November 1974, the Veteran sought medical treatment for knee pain. However, an arthrogram conducted at that time revealed normal results. Notwithstanding, the Veteran was placed on a physical profile for possible torn meniscus with left knee swelling. Subsequently, in April 1975, he presented with complaints of recurrent left knee problems. Following evaluation, the Veteran was diagnosed with patellofemoral syndrome. At the time of the June 1975 military separation examination, the Veteran’s knee was found to be abnormal. The examining physician assessed left knee weakness. The Veteran was provided a VA examination in May 2013 at which time possible meniscus injury, patellofemoral syndrome, and mild osteoarthritis were assessed. The examiner noted that in 1972, the Veteran injured his left knee while running an obstacle course during basic training. The Veteran was seen in November 1974 complaining of left knee pain, locking, and instability. Examination was suggestive of a possible meniscus injury. She noted that an arthrogram was done, but the results were not available. The Veteran was seen again in April 1975 with recurrent left knee problems – pain and instability. She noted that x-rays were done, but the results were not of record. However, it was noted that the Veteran was diagnosed with patellofemoral syndrome. The examiner noted that the Veteran’s history in 1974 and 1975 is suggestive of meniscus injury. The Veteran’s current history is also possible for meniscus injury. In an October 2013 medical opinion, however, the clinician opined that the Veteran’s left knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, he noted that while the prior examiner mentioned a left knee x-ray and arthrogram done in service, she was unable to find records for reports/results of either. However, he noted that the November 1974 arthrogram noted that multiple views of the medial and lateral menisci were obtained and that no significant abnormality was visualized. Hence, the Veteran did not have a torn meniscus in service. The clinician also noted that the Veteran has mild symmetrical degenerative joint disease, with the left knee no worse than the right. He noted that the x-ray findings are appropriate with age. Further, the Veteran’s obesity is increasing the wear and tear on his knees. The clinician observed that the Veteran has been out of service since 1975 and supplied no records confirming a chronic left knee condition since that time frame. After a review of the evidence, the Board finds that the VA medical opinion are insufficient to determine the left knee disability claim on appeal. With regards to the May 2013 VA medical opinion, the examiner noted that the Veteran’s military history is suggestive of meniscus injury, however results from the November 1974 arthrogram revealed normal left knee findings. As for the October 2013 VA medical opinion, the clinician opined that the Veteran’s left knee disability is not related to military service. In support of his conclusion, he noted that the Veteran did not have a torn meniscus in service and that his current osteoarthritis was due to age and obesity. However, he did not discuss the diagnosis of patellofemoral syndrome during service and left knee weakness at separation from service and the impact of such disabilities on any current left knee disability. Additionally, there is no indication that the examiner considered the Veteran’s lays assertions regarding left knee pain since military service. In light of the foregoing, an additional medical opinion must be obtained on remand. 2. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that service connection is warranted for bilateral hearing loss. The Veteran was provided a VA examination in May 2013 at which time sensorineural hearing loss was assessed. The examiner opined that the diagnosed disability is not caused by or a result of military service. In so finding, she noted that the Veteran had normal hearing sensitivity in both ears at the time of his June 1975 military separation examination date. The Board finds that the May 2013 VA medical opinion is insufficient to adjudicate the hearing loss claim on appeal. The examiner’s opinion was based on the Veteran having hearing within normal limits at separation from military service. The Board notes that the absence of in-service evidence of a hearing disability is not fatal to a claim of service connection for hearing loss. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The Board finds that this examiner’s rationale is inadequate as she solely relied on the absence of a hearing loss disability at separation from service. As such, an additional VA examination must be provided on remand. 3. Entitlement to service connection for tinnitus is remanded. With regard to tinnitus, the May 2013 VA examiner opined that the Veteran’s tinnitus is at least as likely as not a symptom associated with his hearing loss. Thus, based on the examiner’s opinion, the issue is also inextricably intertwined with the appellant’s hearing loss claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his left knee disability. Access to records in the Veteran’s electronic claims file should be made available to the examiner for review in connection with his or her opinion. The examiner should identify all left knee disabilities found on examination and diagnosed since December 2012. Thereafter, the examiner is to provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any current left knee disability was incurred in service or is otherwise causally related to his active service or any incident therein? The examiner should provide a rationale for all opinions rendered, including reference to the pertinent evidence of record. In rendering the requested opinion, the examiner must discuss the left knee disabilities treated during military service and their relationship, if any, to any current knee disability. The examiner must also discuss the Veteran’s assertion regarding the onset of his left knee symptoms and the continuity of such symptoms. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his hearing loss and tinnitus disabilities. Access to records in the Veteran’s electronic claims file should be made available to the examiner for review in connection with his or her opinion. After examining the Veteran and reviewing the record, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral hearing loss and/or were incurred in service or are otherwise causally related to the Veteran’s active service or any incident therein. The examiner should provide a rationale for all opinions rendered, including reference to the pertinent evidence of record. In rendering the opinion, the examiner must discuss the: (a) Veteran’s reports regarding the onset of hearing loss symptoms; (b) The shifts in hearing acuity noted at entrance to and separation from military service and the relationship, if any, to the current hearing disability; and (c) The impact of in-service and post-service noise exposure on the current hearing loss disability. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel