Citation Nr: 18154952 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 16-48 490 DATE: December 3, 2018 REMANDED Entitlement to a compensable rating for bilateral hearing loss is remanded. Entitlement to a rating in excess of 20 percent for a duodenal ulcer is remanded. Entitlement to a rating in excess of 30 percent for painful scars to the right thigh and left elbow/forearm is remanded. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1966 to September 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions in August 2012, February 2013, and March 2014 by the Atlanta, Georgia, Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran withdrew his request for a Board hearing in August 2017. 1. Entitlement to a compensable rating for bilateral hearing loss is remanded. The Veteran contends that his bilateral hearing loss warrants a compensable rating and in correspondence dated in May 2013 stated that his hearing loss and tinnitus disabilities had gotten worse since his January 2013 VA audiology examination. He also asserted that his loss of hearing in the left ear was affecting his job which required that he wear an ear piece. The Board finds that a VA audiology examination is required for an adequate determination. 2. Entitlement to a rating in excess of 20 percent for a duodenal ulcer is remanded. The Veteran contends that a rating higher than 20 percent is warranted for his service-connected duodenal ulcer. In his September 2016 VA Form 9 he reported that he was experiencing more problems with his ulcer as he aged and that he had recurring symptoms more than four times per year. Although he did not described the specific symptoms be believed to be recurring, the Board finds an additional examination is required to address any increase in symptoms attributed to this disability since his last VA examination in January 2013. 3. Entitlement to a rating in excess of 30 percent for painful scars to the right thigh and left elbow/forearm is remanded. The Veteran contends that his right thigh and left elbow/forearm disabilities are more severely disabling than reflected by the present evaluation. In statements in support of his claim he described experiencing painful motion, loss of strength, and neurological symptom involvement. A July 2013 private treatment report noted deformity and atrophy to the left bicep muscle, paresthesia to the lower left arm due to biceps swelling, and diminished left hand grasp. A March 2014 VA examination noted injuries to muscle groups VII, XIV, and XV and noted X-ray evidence of small metallic densities to the right thigh and to the left elbow and forearm. There was no evidence of muscle atrophy. Although the March 2014 rating decision only addressed the evaluation for painful scars, the Veteran’s claims of increased and more severe symptoms are more appropriately attributable to his residuals of shell fragment wound muscle injuries to the right thigh and left arm. These matters are inextricable intertwined with the issue on appeal. The Board notes that an April 1969 rating decision established service connection including for residuals of a right thigh wound, assigned a 20 percent rating under the criteria for injury to muscle group XV, and for residuals of a left arm wound, assigned a 10 percent rating under the criteria for injury to muscle group V. An April 1974 rating decision, among other things, apparently included a typographical error in reference to diagnostic code to 5215 for the service-connected residuals of a right thigh wound and assigned a 0 percent rating under diagnostic code 5305 for the residuals of a left arm wound. A January 1997 rating decision revised the diagnostic code for the residuals of a right thigh wound to 5255-5252. A December 2007 rating decision, among other things, granted an increased 10 percent rating for residuals of a left arm wound under diagnostic code 5305-7804. In light of the inconsistent evidence of record as to the specific muscle groups involved and the specific nature of the injuries sustained in service, the Board finds that an additional examination is required. 4. Entitlement to a rating in excess of 50 percent for PTSD is remanded. The Veteran contends that his service-connected PTSD warrants a 70 percent rating or higher. In his January 2017 VA Form 9 he reported having worsening PTSD symptoms, including beginning to have problems maintaining an effective relationship. Additional VA examination as to this matter is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an audiologist to determine the current severity of his service-connected bilateral 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. To the extent possible, the examiner should identify any symptoms and functional impairments due to hearing loss alone and discuss the effect on any occupational functioning and activities of daily living. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected duodenal ulcer. 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. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected duodenal ulcer disability alone and discuss the effect on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected painful scars to the right thigh and left elbow/forearm. The examiner should provide a full description of the residual scars and muscle injuries sustained as a result of the Veteran’s combat wounds in May 1968. Report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The specific muscle groups involved must be reconciled with the evidence of record, including in service treatment records and VA examinations in March 1969, January 1970, March 1974, August 2007, and March 2014. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected disability alone and discuss the effect on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD. 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. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his service-connected psychiatric disorder alone. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Douglas, Counsel