Citation Nr: 19174690 Decision Date: 09/26/19 Archive Date: 09/25/19 DOCKET NO. 16-28 315 DATE: September 26, 2019 ORDER The previously disallowed claim for entitlement to service connection for a right shoulder disability is reopened; to this extent, the appeal is granted. The previously disallowed claim for entitlement to service connection for a bilateral hearing loss disability is reopened; to this extent, the appeal is granted. Entitlement to an initial evaluation for posttraumatic disorder (PTSD), rated as 10 percent disabling from January 21, 2011 to July 18, 2013, is denied. Entitlement to an initial evaluation for PTSD, rated as 50 percent disabling from July 18, 2013 to March 30, 2019, is denied. REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a bilateral hearing loss disability is remanded. FINDINGS OF FACT 1. Service connection for a right shoulder disability and a bilateral hearing loss disability was denied in a July 2011 rating decision. The Veteran was notified of this denial, and informed of his appellate rights, but he did not appeal the decision. 2. Evidence received since the prior final rating in the July 2011 rating decision, by itself, or in conjunction with previously considered evidence, relates to an unestablished fact necessary to substantiate the claim for service connection for a right shoulder disability and a bilateral hearing loss disability and raises a reasonable possibility of substantiating the claim of service connection for a right shoulder disability and a bilateral hearing loss disability. 3. From January 21, 2011, the Veteran’s PTSD did not result in an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 4. From July 18, 2013 to March 30, 2019, the Veteran’s PTSD did not result in reduced reliability and productivity or total occupational and social impairment. CONCLUSIONS OF LAW 1. The July 2011 rating decision denying service connection for a right shoulder disability and a bilateral hearing loss disability is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20.1103. 2. The evidence submitted subsequent to the July 2011 rating decision is new and material, and the issues of entitlement to service connection for a right shoulder disability and a bilateral hearing loss disability are reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to an initial evaluation, in excess of 10 percent for an acquired psychiatric disorder, to include PTSD, from January 21, 2011 to July 18, 2013, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411. 4. The criteria for entitlement to an increased evaluation, in excess of 50 percent for an acquired psychiatric disorder, to include PTSD, from July 18, 2013 to March 30, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served as a member of the United States Army, with active duty service from January 2006 to May 2006 and from January 2010 to January 2011. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision, dated July 2014, issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia (hereinafter Agency of Original Jurisdiction (AOJ)). In its decision, the RO denied service connection for a right shoulder disability and a bilateral hearing loss disability because the evidence submitted was not new and material. Claims to Reopen The Veteran seeks service connection for a right shoulder disability and a bilateral hearing loss disability. The Veteran’s claims for service connection right shoulder disability and a bilateral hearing loss disability were initially considered and denied by the AOJ in a July 2011 rating decision. The Veteran did not appeal this decision, and it became final. 38 C.F.R. § 20.1103. As such, the Veteran’s claims may be reopened only if new and material evidence has been secured or presented since the last final rating decision. 38 U.S.C. § 7105. As a general rule, a claim shall be reopened and reviewed if new and material evidence is presented or secured with respect to a claim that is final. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 20.1105. Under 38 C.F.R. § 3.156(a), new evidence means evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). 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. Id. The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Moreover, the Veteran need not present evidence as to each element that was a specified basis for the last disallowance, but merely new and material evidence as to at least one of the bases of the prior disallowance. Id. at 120 (noting the assistance of 38 C.F.R. § 3.159(c)(4) would be rendered meaningless if new and material evidence required a claimant submit medical nexus evidence when he has provided new and material evidence as to another missing element). In determining whether evidence is new and material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence received since the July 2011 rating decision includes evidence that is both new and material to the claims for service connection for a right shoulder disability and a bilateral hearing loss disability. See 38 C.F.R. § 3.156. The initial denial of the Veteran’s claims was made as there was no current medical evidence received that showed symptoms, treatment, or a diagnosis of either of these conditions. Medical evidence from October 2015 from Beckley VA Medical Center includes an MRI report of his right shoulder. The MRI revealed a small tear and osteoarthropathy in his right shoulder. See MRI Report from October 2015. The physician reported that the Veteran’s symptoms were consistent with mild subacromial impingement and torn labrum. Furthermore, evidence of a December 2014 VA Medical Center audiogram shows that hearing loss was present. The Veteran’s right ear was reported as clinically normal; however, his left ear was noted as sensorineural and the degree of loss was reported as normal to mild. Bilateral amplification was recommended. Subsequent treatment records show that the Veteran was fitted with hearing aids. Therefore, as these medical records show the Veteran has a current right shoulder disability and a current bilateral hearing loss disability, the Board finds these raise a reasonable possibility of a current disability, and the Board concludes that these medical records are new and material evidence in support of the claims. Accordingly, the claims for service connection are reopened. Increased Rating A disability rating is determined by applying VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board may consider whether separate ratings may be assigned for separate periods of time - a practice known as “staged ratings,” - whether or not the claim concerns an initial rating. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. The criteria authorize the Veteran’s a 10 percent rating for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. The use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Entitlement to an initial evaluation, in excess of 10 percent for PTSD from January 21, 2011 to July 18, 2013 The Veteran had his first psychiatric examination in July 2011. The Veteran reported stressors as mortar attacks and that he was at two places, Skenya and Talil, in Iraq and he used to be in mortar alert, which kept him on constant alert. See VA Examination dated July 2011. He said there were few minor injuries with early mortars with his friends. He reported another stressor of his squadron lead, Major Culver, who died secondary to EFP. The Veteran reported no IED attacks. He reported there were sniper attacks on his convoys as they would pass. The Veteran reported that he was stressed the whole time he was there. He also stated that after he had come back from service, his friend, Brian, died a couple months ago by suicide in Florida. He was not sure how he died. At the time of the VA examination, the Veteran was not on any medications. He reported that since he had come back from service he had problems relating to anger. His wife told him that he got angry easily. He continued to have some sleep problems. He slept about five to six hours at night. He had nightmares and dreams about being in Iraq and getting mortared once a week or once in a couple weeks. He reported a few times he had woken up feeling sweaty and nervous. The Veteran had flashbacks about the past about two to three times a week. He thought about the times there and he thought about his friend who died recently. The Veteran had watched shows relating to the military on TV which did not bother him. The Veteran got hypervigilant with any loud bangs or thumps. It reminded him of the explosion and confusion. The Veteran had difficulty around crowds. He got watchful. He tried to figure out what they were doing. He kept his back to the wall if he had to sit somewhere in public. The Veteran reported no major problems with depression and no suicidal thoughts. He reported some irritability and anger-related issues at home which his wife had noticed. He continued to have intrusive thoughts and flashbacks. The Veteran had no problems with alcohol or other drugs. The examiner noted that the Veteran was seen to be a pleasant gentleman who made good eye contact. He was seen to be shaven, and his speech and language were normal. His behavior was appropriate and personal hygiene was good. His thought processes were coherent. Thought contents showed no delusions, no active suicidal or homicidal thoughts, and no audiovisual hallucinations. He was well oriented to the day, date, month, year, place, person, and situation. Cognitively, he was intact. His immediate memory was three out of three, and his recent and remote memory was intact. His mood was rated as an eight to nine on a scale of one to 10, 10 feeling the happiest, one feeling depressed. His anxiety was rated as a three on a scale of one to 10, 10 feeling high anxiety, one feeling calm. He was able to say the days of the week backwards starting on Sunday. He was able to name the present President going back to Senior President Bush. He showed fair intact insight and judgment. As addressed above, in order for a Veteran to be eligible for a 30 percent rating, he must have occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. The July 2011 psychiatric examination noted that the Veteran was anxious when in public and around large crowds and he had some sleep impairment. The examiner did not report that the Veteran had a depressed mood, suspiciousness, panic attacks, or any memory loss as articulated by the 30 percent disability rating. 38 C.F.R. § 4.130, Diagnostic Code 9411. The examiner did not suggest that the Veteran’s symptoms caused occupational impairment. With respect to social interactions, social impairment as a result of his PTSD was not shown. At the time of the July 2011 examination, the Veteran reported that he had been married since September 2010 and had been with his girlfriend in the last four to five years and he also had a daughter who was two years old. He spent time with his family and enjoyed hunting and fishing. With respect to occupational impairment, the Veteran had been working on the railroads the past three years. He got along okay with people there. He also had been working at another job prior to his current railroad job. Additionally, the examiner did not report that the Veteran’s symptoms caused occupational impairment. As the Veteran did not have occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to symptoms such as depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, or mild memory loss as contemplated by a 30 percent disability rating, he is not eligible for a higher rating during this period. The medical evidence demonstrates that the Veteran’s social and occupational functioning is limited by several PTSD symptoms – anxiety when in public and around large crowds and had some sleep impairment – but those symptoms did not cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. There is no credible evidence that the Veteran has chronic symptoms of any of the criteria for a higher rating or symptoms that are similar in severity to the criteria for a 30 percent rating. Accordingly, his request for a schedular rating higher than 10 percent for service-connected PTSD is denied for the period from January 21, 2011 to July 18, 2013. Entitlement to an increased evaluation, in excess of 50 percent for PTSD, from July 18, 2013 to March 30, 2019 The Veteran had another psychiatric examination in June 2014. During this examination, the Veteran reported that he noticed change in himself after coming back from his active duty service. He reported getting hostile and irritable, and his mood changed frequently during the day. He had intrusive thoughts and dreams and nightmares of the past. He talked about how his squadron leader was killed with EFP attacks and he was exposed to mortars, and injured, and dead people in Iraq. He reported waking up in cold sweats, he had anxiety, and he could not tolerate crowds. He did not sleep well, had some panic attacks, reported getting hypervigilant with loud sounds, thunderstorms, and even when a door creaked. The Veteran’s symptoms included a depressed mood, anxiety, panic attacks that occurred weekly or less often, chronic sleep impairment, and disturbances of motivation and mood. The examiner found that the Veteran was a pleasant young gentleman. He was well oriented and a good historian. He made good eye contact and his mood was euthymic and affect was broad. He had no suicidal or homicidal thoughts, no delusions or audio-visual hallucinations. He showed age appropriate memory, insight, and judgment. He was not in counselling or on medication at the time of the examination. The Veteran made efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events. He had markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, and persistent inability to experience positive emotions. He also had irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects, an exaggerated startle response, problems with concentration, and sleep disturbance. During his September 2015 hearing before a Decision Review Officer, the Veteran testified that his symptoms had worsened since 2014. In particular, he testified that his anger and anxiety had worsened. He reported felling anxious with big crowds or meeting new people. When in a group setting, he would withdraw, keep his back in the corner, and watch others. He reported feelings of fear when going to the mall. He had problems with people at work, finding them lazy. He did not hand out with friends as he could not tolerate them. He reported panic attacks where he would get a tightness in his chest and increased pulse. These lasted five to ten minutes and occurred two or three times per week. He reported nightmares once or twice a week. He also reported mood swings. While he reported a past history of suicidal thoughts 2 or 3 times a month, he was currently having suicidal thoughts once a month. As addressed above, in order for a Veteran to be eligible for a 70 percent rating, he must have occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. The June 2014 mental status examination did not show that the Veteran struggled with suicidal ideations or obsessional rituals that interfered with routine activities. Additionally, the Veteran’s speech was not reported as intermittently illogical or obscure. While the Veteran reportedly struggled with panic attacks and depression, it did not appear to affect the Veteran’s ability to function independently, appropriately, and effectively. The Veteran was also well groomed, and he did not struggle with impaired impulse control or spatial disorientation. The Veteran did not suffer from psychotic symptoms. With respect to social interactions, the Veteran did not have an inability to establish and maintain effective relationships as a result of his PTSD. The Veteran was married and had a five-year-old daughter. This did not show an inability establish and maintain effective relationships. With respect to occupational impairment, the Veteran was going to start school to become an EMT. He had worked with the railroad as a conductor and was presently doing a temporary job with Lowe’s driving a truck. He supported himself with his work as a firefighter by taking paid call. Additionally, the examiner did not report that the Veteran’s symptoms caused occupational impairment. The VA examiner concluded that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Furthermore, the Veteran had a psychiatric examination in October 2015. During this examination, the Veteran showed symptoms of recurrent, involuntary, and intrusive distressing memories of the traumatic events, and avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events. He had markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, and persistent inability to experience positive emotions. He also had irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects, an exaggerated startle response, problems with concentration, and sleep disturbance. The examiner found that the Veteran well-oriented and his mood was euthymic, and affect was broad. The Veteran indicated fleeting suicidal ideations with stress at times, when he gets into an argument. There was no intent or plan and no history of suicide attempts or hospital admissions related to it and no homicidal thoughts. The Veteran did not experience delusions or hallucinations. He showed age appropriate memory, insight, and judgment. As addressed above, in order for a Veteran to be eligible for a 70 percent rating, he must have occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. While the October 2015 mental status examination indicates that the Veteran reported fleeting suicidal ideations with stress at times when he gets into an argument, he did not express any intent or plan and had no suicide attempts. The Board recognizes that suicidal ideation is one of the listed in the criteria for a 70 percent evaluation. However, even though he had suicidal ideations, the record does not show that the Veteran’s suicidal ideation either alone, or in combination with his other symptoms resulted in occupational and social impairment with deficiencies in most areas. The record does not show obsessional rituals that interfered with routine activities. Additionally, the Veteran’s speech was not reported as intermittently illogical or obscure. While the Veteran reportedly struggled with panic attacks and depression, it did not appear to affect the Veteran’s ability to function independently, appropriately, and effectively. The Veteran was also well groomed and did not struggle with impaired impulse control or spatial disorientation. The Veteran did not suffer from psychotic symptoms. With respect to social interactions, the Veteran did not have an inability to establish and maintain effective relationships as a result of his PTSD. The Veteran had been married for the last two years prior to the time of this VA examination. He had a seven-year-old daughter. The Veteran and his wife indicated that he had been having issues with irritability at home with his wife and at work with coworkers as well as associated mood and anxiety. His wife reported that when she first married him, he used to be happy and easy to get along with. While this may show difficulty in establishing and maintaining effective relationships, it does not show an inability to do so. With respect to occupational impairment, the Veteran was working with the firefighting department, which he had been for the last 11 years and used to be on paid call, but at the time of the VA examination, he had worked for them professionally in the last six months. He worked four days a week with 12-hour night shifts with one on-call day. He tended to get irritable with staff at work but did not miss work. He supported himself with VA disability and his work. Additionally, the examiner did not report that the Veteran’s symptoms caused occupational impairment. The examiner concluded that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The medical evidence demonstrates that the Veteran’s social and occupational functioning is limited by several PTSD symptoms – depressed mood, anxiety, panic attacks, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood – but those symptoms are specifically listed in the criteria for the rating of 50 percent. Other than intermittent suicidal ideations, there is no credible evidence that the Veteran has chronic symptoms of any of the criteria for a 70 percent rating or symptoms that are similar in severity to the criteria for a 70 percent rating. As discussed above, even with consideration of the Veteran’s occasion suicidal thoughts or ideation, the weight of the evidence does not show that his symptoms resulted in occupational and social impairment with deficiencies in most areas prior to March 30, 2019. Accordingly, his request for a schedular rating higher than 50 percent for service-connected PTSD from July 18, 2013 to March 30, 2019 is denied. REASONS FOR REMAND 1. Entitlement to service connection for a right shoulder disability is remanded. Although the Board regrets the additional delay, the Veteran’s remaining claims must be remanded before the Board is able to make a determination on the merits. Specifically, the Board finds that additional supporting evidence is required in developing the Veteran’s claims. The Veteran reported that he believed his right shoulder disability began in service while working as a cannon crew member. See Hearing Testimony dated September 2015. The Veteran contended that loading the rounds into the cannon with a lot of repetitive motion made his shoulder start to hurt. His right shoulder started hurting right before deployment, before 1996, but there was not a specific injury to it at the time. He reported that he continued to have problems with his shoulder after service and he saw a doctor while he was in the country and the doctor said that he figured his shoulder was probably injured from wearing body armor all the time because it was inflamed and aggravated even more so while he was in the service. It has decreased a lot of his strength, limited the range of motion, and affected his ability to do things repetitively. He currently takes Tylenol and Ibuprofen to help manage the pain. The Veteran has not undergone a VA examination specifically addressing his right shoulder disability. The Board finds that a remand is required in order to obtain a VA examination which fully addresses the etiology of any current right shoulder condition. As the Veteran’s claim is being remanded, the Board requests that the AOJ contact the Veteran to ensure all available medical records have been obtained and associated with the claims file. The VA’s duty to assist includes obtaining records of relevant VA medical treatment. 38 U.S.C. § 5103A(c)(2); 38 C.F.R. § 3.159(c)(2), (c)(3). See also Bell v. Derwinski, 2 Vet. App. 611 (1992) (The VA is charged with constructive, if not actual, knowledge of evidence generated by the VA). Therefore, the AOJ should obtain and associate with the claims file any outstanding VA medical records, assuming they are adequately identified by the Veteran after any necessary clarification. 2. Entitlement to service connection for a bilateral hearing loss disability is remanded. Although the Board regrets the additional delay, the Veteran’s remaining claims must be remanded before the Board is able to make a determination on the merits. Specifically, the Board finds that additional supporting evidence is required in developing the Veteran’s claims. The Veteran reported that he believed his hearing loss began while he was in service working as a cannon crew member. See Hearing Testimony dated September 2015. He also contended that he was exposed to loud noises while he was in combat. The Veteran reported that he noticed his hearing loss while in service. He was prescribed hearing aids during an examination in January 2015. The Veteran has not undergone a VA examination specifically addressing his bilateral hearing loss. The Board finds that a remand is required in order to obtain a VA examination which fully addresses the etiology of any current bilateral hearing loss disability. As the Veteran’s claim is being remanded, the Board requests that the AOJ contact the Veteran to ensure all available medical records have been obtained and associated with the claims file. The VA’s duty to assist includes obtaining records of relevant VA medical treatment. 38 U.S.C. § 5103A(c)(2); 38 C.F.R. § 3.159(c)(2), (c)(3). See also Bell v. Derwinski, 2 Vet. App. 611 (1992) (The VA is charged with constructive, if not actual, knowledge of evidence generated by the VA). Therefore, the AOJ should obtain and associate with the claims file any outstanding VA medical records, assuming they are adequately identified by the Veteran after any necessary clarification. Accordingly, the matters are REMANDED for the following action: 1. The AOJ should contact the Veteran, and, with his assistance, identify any additional outstanding records of pertinent medical treatment for any right shoulder disability and bilateral hearing loss disability. In obtaining these records, the AOJ is instructed to follow the procedures for obtaining the records set forth by 38 C.F.R. § 3.159(c). If the AOJ’s attempts to obtain any outstanding records results in a finding that such records are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 2. After any additional records are associated with the claims file, the AOJ should schedule the Veteran for a VA medical examination with an appropriate qualified physician. All necessary diagnostic testing and evaluation should be performed, and all findings set forth in detail. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an opinion as to the following questions: (a.) Please identify any right shoulder disability that is currently manifested. (b.) For any right shoulder disability identified, is it at least as likely as not (i.e. probability of 50 percent or greater) that the disability was incurred during the Veteran’s active military service? (c.) Please identify any bilateral hearing loss disability that is currently manifested. (d.) For any bilateral hearing loss disability identified is it at least as likely as not (i.e. probability of 50 percent or greater) that the disability was incurred during the Veteran’s active military service? Explanations for all opinions must be provided. In providing the requested rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran’s statements regarding the onset of his symptoms. 3. After completing the above development, the AOJ should review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. See Stegall v. West, 11 Vet. App. 268 (1998). 4. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the claim on appeal. If the benefit sought is not granted, issue a Supplemental Statement of the Case (“SSOC”) and allow the Veteran and his representative an opportunity to respond. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor 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.