Citation Nr: 18157201
Decision Date: 12/12/18	Archive Date: 12/11/18

DOCKET NO. 15-40 838
DATE:	December 12, 2018
REMANDED
Entitlement to service connection for chronic otitis externa claimed as bacterial ear disease is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the Army from July 1965 to July 1967.
This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).
This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c).  38 U.S.C. § 7107(a)(2).
Entitlement to service connection for chronic otitis externa claimed as bacterial ear disease is remanded.
In December 2017, the Board remanded the case to the AOJ to obtain private treatment records, updated VA treatment records, and an addendum VA medical opinion.  An addendum VA medical opinion was required because, while the October 2014 VA medical opinion concluded that the Veteran’s otitis externa is less likely than not proximately caused by the Veteran’s service connected diabetes, it did not adequately consider whether the Veteran’s diabetes aggravated his otitis externa.  Therefore, an addendum medical opinion was requested in order to consider possible aggravation of otitis externa.
Upon remand, the October 2014 VA examiner provided an opinion in July 2018 that the Veteran’s otitis externa, which he said clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury, or illness.  Part of the opinion’s rationale indicated that there could not be aggravation by diabetes when there was no causal relationship with diabetes.  However, the opinion as a whole is confusing as it is based on a response that the otitis externa preexisted service and is not related to service, rather than clearly addressing the question asked regarding whether service-connected diabetes aggravated the disability.  Therefore, the July 2018 VA opinion with respect to aggravation of otitis externa is inadequate.  Accordingly, a clarifying opinion is required that adequately addresses the etiology of the Veteran’s otitis externa.
The matter is REMANDED for the following actions:
1. Obtain and associate with the claims file any updated VA treatment records from February 2018 to the present.
2. Obtain an addendum medical opinion from the October 2014 and July 2018 examiner, if possible, or another appropriate examiner if the October 2014 and July 2018 examiner is not available.  It is up to the examiner to determine whether another examination is required.
The examiner is requested to review the claims file, to include this remand, and respond to the following question:
Is it at least as likely as not (50 percent or higher degree of probability) that the Veteran’s otitis externa was aggravated by (i.e., any worsening of the disability beyond its natural progression) the Veteran’s service-connected diabetes?
The term “at least as likely as not” does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it.
A detailed explanation (rationale) is requested for all opinions provided.  (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation.  Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.)
 
M. SORISIO
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Dean, Associate Counsel