Citation Nr: 18159629 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 17-52 595 DATE: REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to January 1968 in the United States Marine Corps. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision by 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).   1. Entitlement to service connection for bilateral hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. The Veteran contends that he incurred hearing loss and tinnitus because of in-service noise exposure while working in a noisy kitchen as a cook. His service treatment records (STRs) are silent for any complaints, findings, or diagnoses related to hearing loss. The Veteran claims that his hearing loss and tinnitus are due to service because his post-service employment involved hearing conservations measures. Given the Veteran’s competent reports of decreased hearing and tinnitus and the circumstances of his service, a medical opinion is needed to decide the claim. 38 C.F.R. § 3.159(c)(4) (2017). 3. Entitlement to service connection for bilateral pes planus is remanded. The Veteran seeks service connection for bilateral pes planus which he contends was aggravated by service. The Veteran expressed complaints of pain in his feet in service due to standing long periods of time while on active duty. See December 2016 notice of disagreement. He said his STRs do not include any complaints of foot pain because he was discouraged from going to sick call. The report of a July 1965 induction examination noted normal feet. However, on reexamination in January 1966, the Veteran was noted ot have 2nd degree bilateral asymptomatic pes planus, not considered disabling. Thus, the current claim is for service-connected aggravation of that disability. U.S.C. § 1153; Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994). A medical opinion is needed to decide the claim. 38 C.F.R. § 3.159(c)(4). The opinion must address whether there was an increase in disability during service, and if so, whether that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). Clear and unmistakable (obvious or manifest) evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306 (b). Cir. 1994). On remand, any pertinent, updated treatment records should be obtained. The matters are REMANDED for the following action: 1. Take all apporpriate action needed to obtain any VA or private treatment records dated since September 2017. 2. After the completion of (1) schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hearing loss and tinnitus disability. The entire record, including this remand, must be reviewed by the examiner. Any indicated tests and studies should be performed. Based on the record, the examiner should provide an opinion to the following: (a) Is it at least as likely as not that any currently diagnosed hearing loss was incurred in or is otherwise related to service, to include the Veteran’s reported in-service noise exposure? (b) Is it at least as likely as not that any currently diagnosed tinnitus, was incurred in or is otherwise related to service, to include his reported in-service noise exposure? A complete rationale must be provided for the opinion. 3. Schedule the Veteran for an examination by an appropriate clinician to determine whether the pre-existing asymptomatic, bilateral pes planus was aggravated during service. The examiner should answer the following: (a) Does the evidence show that the pre-existing pes planus was aggravated by service? The examiner should specifically consider the Veteran’s credible report that his duties in service involved long periods of standing and he was discouraged from going to sick call. Temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered "aggravation in service” unless the underlying condition itself, as contrasted with mere symptoms, has worsened. (b) If aggravation is shown in service, does the evidence of record clearly and unmistakably show (it is undebatable) that any increase during service was due to the natural progression of the disease? A complete rationale must be provided for any opinion offered. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs