Citation Nr: 19138317 Decision Date: 05/17/19 Archive Date: 05/17/19 DOCKET NO. 15-05 613 DATE: May 17, 2019 ORDER 1. New and material evidence has been received to reopen a claim of entitlement to service connection for foreign body in left eye and to that extent only the claim is allowed. 2. Service connection for bilateral hearing loss is denied. 3. Service connection for tinnitus is granted. REMANDED Service connection for foreign body in left eye is remanded. Service connection for multiple sclerosis is remanded. FINDINGS OF FACT 1. The August 1977 rating decision which continued a denial of service connection for foreign body in left eye is final. 2. The evidence received since the August 1977 rating decision, by itself, or in conjunction with previously considered evidence, is new and material. 3. The Veteran does not have a current right ear hearing loss disability as defined by regulation. 4. The Veteran’s left ear hearing loss disability did not manifest during active service or within one year following separation from service and is not shown to have developed as a result of an established event, injury, or disease during active service. 5. Resolving all reasonable doubt in favor of the Veteran, the probative evidence of record shows that the Veteran has continuously had symptoms of tinnitus since service. CONCLUSIONS OF LAW 1. The August 1977 rating decision, which denied reopening the claim for service connection for foreign body in left eye is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103. 2. The evidence received after the August 1977 rating decision is new and material, and the claim for service connection for foreign body in left eye is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306, 3.309, 3.385. 4. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1110, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1974 to January 1977 with additional service in the National Guard from March 1979 to February 2005. These matters come before the Board of Veterans Appeals (Board) on appeal from December 2010 and November 2011 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection will be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.30. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection will also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in-service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. VA is to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Medical evidence is not always or categorically required in every instance to establish a medical diagnosis or the required nexus between the claimed disability and service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and may provide sufficient support for a claim of service connection. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran is competent to provide testimony concerning factual matters of which she has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Therefore, the Board must assess the competence and credibility of lay statements. Barr v. Nicholson, 21 Vet. App. 303 (2007). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Whether new and material evidence has been received to reopen a claim for service connection for foreign body in left eye. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In general, rating decisions that are not timely appealed or for which new and material evidence is not received within one year of the rating decision are final. U.S.C. § 7105; 38 C.F.R. § 3.156(b), 20.200, 20.201, 20.302, 20.1103. A finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108. The Board has a jurisdictional responsibility to determine whether a claim previously denied by the RO is properly reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001) Accordingly, the Board must initially determine whether new and material evidence has been submitted to reopen the claim before proceeding to adjudicate the underlying merits. If the Board finds that no new and material evidence has been offered, that is where the analysis must end. New evidence is defined as evidence not previously submitted to agency decision-makers. New evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). There is a low threshold for determining whether evidence raises a reasonable possibility of substantiating a claim, for purposes of reopening the claim. An adjudicator must follow a two-step process in evaluating a previously denied claim. First, the adjudicator must determine whether the evidence added to the record since the last final decision is new and material. If new and material evidence is presented or secured with respect to a claim that has been finally denied, the claim will be reopened and decided upon the merits. Once it has been determined that a claimant has produced new and material evidence, the adjudicator must evaluate the merits of the claim in light of all the evidence, both new and old, after ensuring that the VA’s statutory duty to assist the appellant in the development of her claim has been fulfilled. 38 U.S.C. § 5108. The claim to reopen does not require the submission of new and material evidence as to each previously unproven element of a claim for that claim to be reopened. Shade v. Shinseki, 24 Vet. App 110 (2010). The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. The Board has an obligation to provide reasons and bases supporting a decision. However, there is no need to discuss, in detail, all the evidence submitted by the Veteran or on her behalf. The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000) (Board must address its reasons for rejecting evidence favorable to the Veteran). In this case, the Department of Veterans Affairs Regional Office (RO) previously considered and denied a claim for service connection for foreign body in left eye in an August 1977 rating decision. At that time, the evidence of record included the Veteran’s service medical records and a July 1977 VA Medical examination. In the decision, the RO observed that the Veteran’s in-service left eye injury did not result in permanent damage or residuals. The Veteran was notified of the August 1977 rating decision and her appellate rights. However, the Veteran did not submit a notice of disagreement or new and material evidence within one year of the notification. The July 1977 rating decision is now final. 38 U.S.C. §§ 7104, 7105. The evidence received since the August 1977 rating decision includes additional VA treatment and personnel records, private treatment records, and lay statements from the Veteran. A September 2010 VA eye examination has also been submitted into the record. The credibility of the newly submitted evidence is presumed in determining whether the new evidence is material. Justus v. Principi, 3 Vet. App. 510 (1992). As the medical examination is presumed to be credible for the limited purpose of attempting to reopen a previously denied claim, that evidence raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the additional evidence is also material. As new and material evidence has been received, the claim for service connection for service connection for foreign body in the left eye is reopened. 2. Service connection for bilateral hearing loss Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247 (1999). Service connection may be presumed for certain chronic diseases, including sensorineural hearing loss, as an organic disease of the nervous system, which develop to a compensable degree within one year after separation from service, even though there is no evidence of the disease during the period of service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App 370 (2002). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the Veteran. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran claims that her hearing loss disability is due to acoustic trauma during her time in the reserves. A review of the evidence of record, to include VA medical records, VA audiological examinations, and lay statements shows that the preponderance of the evidence is against a finding that hearing loss disability in the left ear is etiologically related to any aspect of active service, was caused or aggravated by service-connected disabilities, or manifested to a compensable degree within one year following separation from service. The preponderance of the evidence is also against a finding that the Veteran has a right ear hearing loss disability. Therefore, the claim for service connection must be denied. Impaired hearing is considered to be a disability for VA purposes if the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 hertz is 40 decibels or greater; the auditory thresholds for at least three of those frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. To constitute a hearing loss disability, for which service connection can be granted, the requirements of 38 C.F.R. § 3.385 must be met. The Veteran has not provided any audiology examination, VA or private, which shows that the Veteran has a hearing loss disability in the right ear. 38 C.F.R. § 3.385. A September 2010 VA audiology examination found that the Veteran did not meet the criteria of 38 C.F.R. § 3.385 in the right ear. Thus, the Board finds that the preponderance of the evidence is against a finding that there is a right ear hearing loss disability, and a claim for service connection for right ear hearing loss must be denied. The evidence of record shows that the Veteran has a hearing loss disability in the left ear. 38 C.F.R. § 3.385. A VA audiology examination in September 2010 found that the Veteran’s puretone thresholds exceeded those levels required to constitute a hearing loss disability in the left ear only. 38 C.F.R. § 3.385. The Veteran’s service occupation in the National Guard was Air Transportation Craftsman, confirmed by service personnel records. The Board concedes that the Veteran likely was exposed to noise trauma while serving in this capacity. Therefore, the question that remains is whether there is an etiological link between current left ear hearing loss disability and service noise trauma. The Board finds that the preponderance of the competent medical evidence of record is against a finding of a relationship between active service and current hearing loss. At a September 2010 VA audiology examination, the Veteran was not found to have right ear hearing loss. While the Veteran was diagnosed with left ear hearing loss at that examination, the examiner opined that the Veteran’s left ear hearing loss was not at least as likely as not (50 percent probability or greater) caused by or a result of an event in active service as well as her reserve service noise exposure. The examiner explained that the Veteran’s current hearing loss for the left ear is primarily conductive in nature and quite possibly the result of otosclerosis or some other condition unrelated to noise exposure. The Board notes that a review of the additional medical evidence of record, to include VA medical records shows no additional evidence that speaks to the nature and etiology of the Veteran’s hearing loss, as it relates to service. The Board acknowledges that the Veteran has asserted that her hearing loss is related to reserve service noise trauma. While the Board acknowledges that the Veteran may be competent address the fact that her hearing has worsened through the years, when she first noticed hearing loss, or that she has difficulty hearing in certain situations, she is not competent to address the fact that circumstance of active service caused a current hearing loss disability. The Board finds the lay claims as to the etiology of the hearing loss disability to be not competent. The Veteran, as a layperson, is not competent to provide evidence on such complex matters such as the etiology of hearing loss because she is not shown to have the required medical training or expertise. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay evidence is competent when it does not require the proponent to have specialized education, training, or experience. 38 C.F.R. § 3.159(a)(2); Bruce v. West, 11 Vet. App. 405 (1998) (one not a medical expert is nevertheless competent to offer evidence of his symptoms in support of a claim for an increased disability evaluation); Layno v. Brown, 6 Vet. App. 465 (1994). Here, competent evidence concerning the etiology of the Veteran’s hearing loss has been provided by a medical professional. The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). Therefore, the Board finds the opinion from the September 2010 VA examination to be the most probative and persuasive in determining the nature and etiology of the Veteran’s hearing loss. The Veteran has not submitted any competent medical evidence linking any current hearing loss to service. In addition, any claim of having hearing loss during and immediately after service are rebutted by the normal audiology findings contained within all enlistment and separation examinations currently of record, which serve as evidence against a finding of a continuity of symptomatology since service. Service connection may also be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110. With chronic disease shown as such in-service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. As sensorineural hearing loss, as an organic disease of the nervous system, is among the chronic disease under § 38 C.F.R. § 3.309(a), the Board finds that continuity of symptomatology may serve in lieu of a medical nexus. 38 C.F.R. § 3.303(b). The Board finds that a review of the evidence of record, to include the Veteran’s lay statements does not demonstrate a continuity of symptomatology of hearing loss. Specifically, the Board notes that there is no objective medical evidence that the Veteran began having hearing loss, as defined by regulation, during service or within one year following separation from service and has continued to experience that hearing loss since. The Board notes that to constitute a hearing loss disability, the Veteran’s hearing must achieve certain objective levels of severity. Impaired hearing is considered to be a disability for VA purposes if the auditory threshold for any of the frequencies of 500, 1000, 2000, 3000, and 4000 hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Board notes that a review of the competent medical evidence of record shows no evidence that the Veteran’s hearing acuity reached that level of severity during the presumptive period within one year after service, or to the higher level required for a compensable rating. 38 C.F.R. § 4.86, Diagnostic Code 6100. The Veteran was not officially diagnosed with left ear hearing loss until a September 2010 VA examination, approximately 5 years after separation from service. Therefore, as the preponderance of evidence is against a finding that Veteran had a hearing disability as defined by regulation, during or within one year after service, the claim for service connection for hearing loss on a presumptive basis must be denied. Accordingly, the Board finds that the preponderance of evidence is against a finding of a relationship between current left ear hearing loss and active service, or that sensorineural hearing loss manifested to a compensable rating within one year following separation from service. The preponderance of the evidence is also against a finding that right ear hearing loss disability is shown. 38 C.F.R. § 3.385. Therefore, the Veteran’s claim for service connection for bilateral hearing loss must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service connection for tinnitus The Veteran contends that her tinnitus is the result of noise exposure during service in the reserves. Specifically, she contends that her duties in the reserves included loading and unloading cargo in and out of aircrafts including the C-14, C-5, C-17, C-130 and C-135. The Veteran's military personnel records confirm that the Veteran was an air transportation craftsman during her service in the reserves. During a September 2010 VA examination, the Veteran was diagnosed with intermittent tinnitus. However, the examiner opined that the Veteran's tinnitus was less likely than not caused by or the result of her military noise exposure because no report of tinnitus was found in her service treatment records. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an “absolute bar” to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) (“Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms”). Therefore, although, a September 2010 VA examination contains a negative opinion, this opinion is inadequate as it relies on the lack of documentation in service treatment record without adequately considering the Veteran’s lay statements. A review of the competent evidence of record shows the Veteran has credibly reported symptoms of tinnitus continuously. Therefore, the Board finds that tinnitus can be service-connected based on continuity of symptomatology. Therefore, the claim for service connection for tinnitus must be granted. Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§1110. With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. Tinnitus, as an organic disease of the nervous system, is among the chronic diseases listed at 38 C.F.R. §3.309(a), the Board finds that continuity of symptomatology may establish relationship to service. 38 C.F.R. §3.303(b). Medical evidence is required to demonstrate a relationship between a current disability and the continuity of symptomatology demonstrated if the condition is not one where a lay person’s observations would be competent. Clyburn v. West, 12 Vet. App. 296 (1999). Whether lay evidence is competent and sufficient in a particular case is an issue of fact and lay evidence can be competent and sufficient to establish a diagnosis when (1) a layperson is competent to identify the medical condition (sometimes the layperson will be competent to identify the condition where the condition is simple, for example, a broken leg, and sometimes not, for example, a form of cancer, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay evidence presented by a Veteran concerning continuity of symptoms after service may generally be considered credible and ultimately competent, regardless of a lack of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (2006). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. §3.102. Here, the Board finds that the Veteran, as a lay person, is both credible and competent to speak to the medical condition of tinnitus, and the fact that it has been continuous since active service. Specifically, the Board finds that, tinnitus, which manifests as ringing in the ears, is not the type of medical condition which requires specialized medical knowledge or training to assess. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A lay person, such as the Veteran, may competently state that she perceives ringing in her ears. Similarly, the Veteran may also competently state when that condition started and if it has continued to the present. The Veteran has consistently asserted that she began experience ringing in the ears during her reserve service as a result of loud conditions while working as an air transportation craftsman. The Board also finds the Veteran’s lay statements regarding the continuity of tinnitus symptoms to be credible. The Board notes that the Veteran has consistently noted that the ringing in the ears began during service and that those symptoms have continued to the present. She has stated this consistently during medical examinations, and in written statements to VA. The Board finds the Veteran credible with regard to the assertions of continuity of tinnitus symptomatology since service. Therefore, based on the evidence and arguments presented, the Board finds that the Veteran’s tinnitus was present during service and has a continuity of symptomatology since service. As the Board finds that the Veteran’s lay statements have competently and credibly established continuity of symptomatology, and resolving reasonable doubt in favor of the Veteran, the claim for service connection for tinnitus must be granted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. §5107; 38 C.F.R. §§3.102, 3.303(b). REASONS FOR REMAND 1. Service connection for foreign body in the left eye is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claim of entitlement to service connection for foreign body in the left eye. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a left eye disability because no VA examiner has adequately opined whether any diagnosed left eye disability is etiologically related to or aggravated by the Veteran's service or service-connected disabilities. The Veteran has asserted she experiences sharp pain in her left eye once a month stemming from an event in-service where mercury flew into her left eye while performing her duties as a dental assistant. Therefore, remand is required for VA to address the nature and etiology of any current left eye disability that the Veteran may have. The Veteran was provided VA examination in September 2010. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). As it pertains to the Veteran's claim for service connection for foreign body in the left eye, the Board finds the September 2010 VA examination to be incomplete because the examiner did not address the Veteran's in-service injury in relation to her current left eye complaints. Specifically, the examiner found that the Veteran's symptoms were consistent with the diagnosis of multiple sclerosis. The examination report did not address any relation between the Veteran's in-service eye injury and her claimed current left eye disability. Therefore, the Veteran’s claim must be remanded for additional opinion. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). The Veteran is notified that it is her responsibility to report for any scheduled examination and to cooperate in the development of the 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. 2. Service connection for multiple sclerosis is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claim for entitlement to service connection for multiple sclerosis. The record as it currently stands is not ready for appellate review. The Veteran was last provided a VA examination in October 2010. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The October 2010 VA examination did not address whether the Veteran’s multiple sclerosis was aggravated by her service or any service-connected disabilities. Therefore, the Board finds that further examination to determine the etiology of multiple sclerosis is needed. The Veteran is notified that it is her responsibility to report for any scheduled examination and to cooperate in the development of the 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. The matter is REMANDED for the following action: 1. Contact the Veteran and request that she provide information as to treatment for any and all left eye disabilities and multiple sclerosis, including the names and addresses of all health care providers whose records have not already been provided to VA. On receipt of the requested information and the appropriate releases, contact all identified health care providers and request copies of all available records pertaining to treatment of the Veteran, not already of record. If identified records are not obtained, then notify the Veteran. 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for a VA examination to diagnose and determine the nature and etiology of any left eye disabilities, if any. The examiner must review the claims file and should note that review in the report. Based on a review of the claims file and the clinical findings of the examination, the examiner is requested to offer the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that any left eye disability was present in service, was incurred in-service, or was the result of any disease, injury, or event during service? (b) Is it at least as likely as not (50 percent or greater probability) that any left eye disability is proximately due to or the result of the service-connected disabilities, or any medications or treatment for the service-connected disabilities? (c) Is it at least as likely as not (50 percent or greater probability) that any left eye disability has been aggravated (permanently increased in severity beyond the natural progression of the disorder) by the Veteran's service or the service-connected disabilities, or any medications or treatment for the service-connected disabilities? (d) A complete rationale should be provided for all opinions and conclusions. The examiner should specifically address the lay statements contained in the record. The examiner must consider and discuss those lay statements and should reconcile the opinion with any previous opinions of record. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of her multiple sclerosis. The examiner must review the claims file and should note that review in the report. Based on a review of the claims file and the clinical findings of the examination, the examiner is requested to offer the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran has multiple sclerosis that was present in service, or was incurred in-service, or was the result of any disease, injury, or event during service? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran has multiple sclerosis that is proximately due to or the result of the service-connected disabilities, or any medications or treatment for the service-connected disabilities? (c) Is it at least as likely as not (50 percent or greater probability) that the Veteran has multiple sclerosis that has been aggravated (permanently increased in severity beyond the natural progression of the disorder) by the Veteran's service, service-connected disabilities, or any medications or treatment for the service-connected disabilities? (d) A complete rationale must be provided for all opinions and conclusions. The examiner should specifically address the lay statements contained in the record. The examiner must consider and discuss those lay statements and should reconcile the opinion with any previous opinions of record. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mondesir, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.