Citation Nr: 18159130 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 15-19 766 DATE: December 18, 2018 ORDER Service connection for tinnitus is granted. REMANDED Entitlement to service connection for degenerative joint disease of the knees (“bilateral knee disability”) is remanded. FINDING OF FACT The competent and credible evidence of record demonstrates that the Veteran’s tinnitus is related to his in-service noise exposure. CONCLUSION OF LAW The criteria for service connection for tinnitus disability are met. 38 U.S.C. §§ 1110, 1131, 1154, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran testified before the undersigned Veterans Law Judge in a November 2018 Travel Board Hearing. A transcript of that hearing has been associated with the file. 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, 1131 (2012); 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to establish direct service connection 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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009). Depending on the evidence and the contentions of record in a particular case, lay evidence can be competent and sufficient to establish a diagnosis and medical etiology of a condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran provided competent, credible testimony detailing his exposure to noise in service and describing the onset of his tinnitus symptoms. He testified that first he experienced ringing in his ears shortly after service as a result to in-service noise exposure. He also testified openly and honestly when describing his post-service noise exposure. However, while in service he was never given protective gear and post-service he always used protective equipment for his ears. He served as a cannon crewman and received the Army Service Ribbon Medal, Sharpshooter (Hand Grenade) Medal, Overseas Ribbon Medal, and the Marksman (Rifle). Given the Veteran’s credible testimony it is conceded that the Veteran has a current diagnosis. In addition, the Board conceded in-service noise exposure. See November 2018 transcript. In a March 2013 VA examination, the examiner concluded that an opinion regarding the etiology of the Veteran’s tinnitus could not be provided without resorting to speculation. Another VA examiner provided an addendum opinion in June 2013. She opined that the Veteran’s tinnitus was not caused by his military service. The rationale was based on the examiner’s finding that the Veteran had normal hearing at entrance and separation, and her conclusion that the Veteran reported the onset of symptoms as occurring after service. First, despite noting the audiograms at entrance and separation, she failed to note how comparing the separation audiogram to the entrance audiogram shows some decline in hearing at 1000Hz, 2000Hz and at 4000Hz. Additionally, there is no indication that this examiner conducted a personal examination of the Veteran and as such it is unclear as to how she concluded that the Veteran reported the onset of his tinnitus symptoms as occurring after service. Lastly, as mentioned above, the Veteran has provided competent, compelling testimony regarding the onset of his symptoms as happening soon after service. Therefore, the Board finds this opinion to be inadequate and will place no weight on it. As the Board has found the Veteran’s testimony to be credible and conceded in-service noise exposure, the Board finds that service connection is warranted. REASONS FOR REMAND The record indicates a current diagnosis of status post patellar repair of the bilateral knee, and degenerative joint disc disease (DJD) of the right knee, with probable DJD of the left knee. See March 2013 VA examination. Service treatment records indicate complaints of and treatment for bilateral knee pain. See October 1979 and April 1981 service treatment records. A VA examiner treated and diagnosed a bilateral knee disability in March 2013. However, the examiner did not review the file and did not provide an opinion. In May 2013 the same examiner provided an addendum and concluded that the Veteran’s bilateral knee disability is not related to his military service. This examiner provided no rationale. Her stated rationale was simply that the evidence did not show significant evidence. She completely omitted the Veteran’s reporting and the service treatment records showing bilateral knee pain. As a result, another examination is required. The matter is REMANDED for the following action: 1. Obtain and associate any outstanding VA treatment records documenting treatment for bilateral knee disability—to include VA records from Alexandria, Louisiana and Texas. The Veteran should also be afforded the opportunity to identify and/or submit any outstanding private treatment records. 2. The AOJ should schedule the Veteran for a VA examination with an appropriate examiner, preferably an examiner other than the one who performed the examination in March 2013, to determine the current nature and etiology of his bilateral knee disability. The claims file must be made available to the examiner for review, and the examiner should note that it has been reviewed in full. The examiner should elicit from the Veteran a complete history of his bilateral knee disability. Any tests or studies deemed necessary should be conducted. The examiner is asked to diagnose each disability during the appeal period for each knee. After reviewing the file, obtaining a complete history from the Veteran, and conducting a physical examination, and all necessary diagnostic testing, the examiner should respond to the following: For any established knee disability, the examiner is requested to provide an opinion as to whether it is at least as likely as not (i.e., at least a 50 percent probability or higher) that any such disability had its onset in service; or is otherwise related to service, to include an in-service injury. Review of the entire file is required; however, attention is invited to the following: An October 1979 service treatment record showing injury to the right patella and an April 1981 service treatment record indicating bilateral knee pain (VBMS, document labeled STR-Medical, receipt date March 6, 2014, page 38 and page 42 of 85). A complete rationale for all opinions should be provided. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Talamantes, Associate Counsel