Citation Nr: 18137294 Decision Date: 09/20/18 Archive Date: 09/20/18 DOCKET NO. 15-17 418 DATE: September 20, 2018 REMANDED The issue of entitlement to service connection for a bilateral hearing loss disability is remanded. The issue of entitlement to an initial rating in excess of 10 percent for a duodenal ulcer is remanded. The issue of entitlement to an initial compensable rating for hemorrhoids is remanded. REASONS FOR REMAND The appellant served on active duty from November 1954 to August 1958. In August 2018, the appellant had a video conference with the undersigned Veterans Law Judge. The appellant claims entitlement to service connection for a bilateral hearing loss disability due to inservice noise exposure, particularly the sounds of Naval gunfire. The appellant’s service medical records are negative for any complaints or clinical findings of a hearing loss disability. During his November 1954 service entrance examination and his August 1958 service separation examination, his hearing acuity for the whispered voice was normal at 15/15, bilaterally. However, in November 2013, B. L. S., M.D., a board-certified otolaryngologist, opined that the appellant could easily pass a whisper test and still have significant damage to the high frequencies caused from noise exposure during his military service. In 1961, the appellant went to work for the Monsanto Company, and in 1972, he began a twenty-year period of regular audiometric testing. It was noted that he had had noise exposure at work for which he use ear plugs. The record notes the appellant’s inservice noise exposure, as well as postservice exposure due to recreational activities as a hunter. During his 1972 audiometric examination, the appellant demonstrated normal hearing for VA purposes at 2000 hertz and below but had significant hearing impairment for VA purposes at 3000 and 4000 hertz, bilaterally. In August 2012, the appellant was evaluated at the Auburn University Speech and Hearing Clinic. The examiner noted the appellant’s history of noise exposure inservice and history of recreational noise exposure thereafter. The appellant reported that he began to notice hearing problems approximately two to three years after his separation from service. The appellant reported that upon his discharge from service, he worked in a supply house and as a milk truck driver before being hired by Monsanto. He stated that he worked in an office at Monsanto until he retired in 1992. Following the examination, the examiner opined that it was at least as likely as not caused by, or was a result of, the appellant’s inservice noise exposure. The examiner noted that there were no other reported conditions or situations that would predispose him to have his degree of hearing loss. Significantly, the appellant’s history of noise exposure at Monsanto was not reported and effectively led to a medical opinion based upon an inaccurate factual premise. Accordingly, the opinion is of no probative value. Reonal v. Brown, 5 Vet. App. 458 (1993). In January 2013, the appellant was examined by VA to determine the nature and etiology of his hearing loss disability, however, the examiner was unable to provide a medical opinion regarding the etiology of the appellant’s hearing loss without resorting to speculation. Medical evidence that is speculative, general or inconclusive in nature is also of no probative value. Obert v. Brown, 5 Vet. App. 30 (1993). In light of the foregoing, further development is in order. In March 2016 and June 2017, during the course of the appeal, the agency of original jurisdiction granted entitlement to service connection for a duodenal ulcer and hemorrhoids and assigned 10 percent and noncompensable ratings, respectively. In July 2016 (VA Form 21-526EZ) and July 2017, the appellant submitted timely notices of disagreement with those ratings. To date, the appellant has not been issued a statement of the case with respect to either of those issues. Manlincon v. West, 12 Vet. App. 238 (1999). Hence, further development is required. In light of the foregoing, the case is remanded for the following action: 1. Issue a statement of the case addressing the appellant’s claims of entitlement to increased ratings for a duodenal ulcer and hemorrhoids. If, and only if, the appellant completes his appeal by filing a timely substantive appeal on either or both of the aforementioned issues should those claims be returned to the Board. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.202. 2. Schedule the appellant for an examination by an audiologist to determine the etiology of his hearing loss disability. The Veteran’s VBMS and Virtual VA/Legacy files, and a copy of this remand must be made available to the examiner for review in conjunction with the examination, and the examiner must acknowledge receipt and review of these materials in any report generated as a result of this remand. Following the examination, the examiner must opine to whether it is at least as likely as not that the appellant’s hearing loss disability is related to his noise exposure in service. In so doing, the examiner must address the November 2013 statement by November 2013, B. L. S., M.D., regarding the whispered voice test. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 3. A copy of the notice informing the Veteran of the date, time, and location of the examination must be associated with the Veteran’s VBMS and Virtual VA/Legacy files. If that notice is returned by the Post Office as undeliverable, that fact must be noted in writing and associated with those files. 4. The Veteran is advised that it is his responsibility to report for all scheduled VA examinations and to cooperate in the development of his claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. By this remand, the Board intimates no opinion as to the final disposition of any unresolved issue. The Veteran need take no action unless he is notified to do so. He has the right to submit any additional evidence and/or argument on the matters the Board has remanded to the AOJ. Kutscherousky v. West, 12 Vet. App. 369, 372-73 (1999). Please note: This case has been advanced on the Board’s docket. As with all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action, it must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Harold A. Beach, Counsel