Citation Nr: 20004816 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 18-18 044 DATE: January 21, 2020 ORDER Entitlement to service connection for bilateral hearing loss is denied. REMANDED Entitlement to service connection for a right knee injury is remanded. Entitlement to service connection for pilonidal cysts is remanded. Entitlement to service connection for an acquired psychiatric disability, to include unspecified depressive disorder is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had bilateral hearing loss for VA purposes at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1977 to May 1984 and November 1990 to May 1991 in the United States Air Force. Entitlement to service connection for bilateral hearing loss is denied. The Veteran contends that she has a bilateral hearing loss disability etiologically related to active duty service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have current bilateral hearing loss that meets the criteria to be considered a disability for VA purposes and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The July 2015 VA examiner evaluated the Veteran and determined that, while she experienced subjective hearing impairment symptoms, she did not have a diagnosis of bilateral hearing loss for VA purposes. The Veteran’s Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: [July 2015] HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 5 5 5 10 6 98% LEFT 5 5 0 5 4 98% While the Veteran believes she has a current diagnosis of bilateral hearing loss, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. REASONS FOR REMAND 1. Entitlement to service connection for a right knee injury is remanded. 2. Entitlement to service connection for pilonidal cysts is remanded. The Board cannot make a fully-informed decision on the claims without a medical opinion. VA examinations scheduled for February 2018 were cancelled because the Veteran failed to appear. In March 2018 the Veteran submitted a statement pointing out that the notice for these examinations had been sent to a prior address and that she was not aware they had been scheduled. The Veteran updated her address in May 2018 and review of the VA’s request to schedule examination reveals notice was not sent to the new address provided by the Veteran. The Veteran’s February 1977 enlistment examination showed a scar from at pilonidal csystectomy. A May 1980 treatment record shows surgical excision of a recurrent pilonidal cyst. The opinion on remand must address whether the pre-existing pilonidal cyst disability was aggravated during service. The claims are remanded to obtain medical opinions. 3. Entitlement to service connection for an acquired psychiatric disability, to include unspecified depressive disorder is remanded. The claim is remanded to obtain an adequate medical opinion. The Veteran’s claim was originally characerized as entitlement to service connection for depression/PTSD. The Veteran underwent a VA examination for PTSD in April 2018 which found that she did not meet the diagnostic criteria for PTSD under the DSM-V. The examiner diagnosed unspecified depressive disorder, but did not offer an etiology opinion. The examination also does not appear to address the evidence submitted by the Veteran of a car bomb that was detonated on the base she was stationed at in Germany or the statement from the private physician Dr. KS. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all providers who treated her for right knee, pilonidal cyst or psychiatric complaints since service. Take all appropriate action to obtain all identified records. After completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right knee conditions. Copies of all pertinent records must be made available to the examiner for review. Based on the examination and review of the record, the examiner must answer the following: Is it at least as likely as not that any diagnosed right knee disability is related to an in-service injury, event, or disease, including the documented in-service right knee injury? 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any cysts. Copies of all pertinent records must be made available to the examiner for review. Based on the examination and review of the record, the examiner must answer the following: (a) Does the evidence of record clearly and unmistakably show (i.e., it is undebatable) that the Veteran had a pilonidal cyst disability that existed prior to her entry onto active duty? The examiner should consider the February 1977 enlistment examination. (b) If the answer to (a) is yes, does the evidence of record clearly and unmistakably show that the preexisting pilonidal cyst disability was not aggravated by service or that any increase in disability was due to the natural progression of the disease? In answering this question, the examiner should specifically address the circumstances of the May 1980 surgical removal of the “recurrent pilonidal cyst.” The examiner is requested to identify any clear and unmistakable evidence with specificity. The examiner is informed that aggravation here is defined as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms beyond its natural progression. (c) If the answer to either (a) or (b) is no, is it at least as likely as not that the Veteran’s pilonidal cyst had its onset in service? The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed psychiatric disorder. Copies of all pertinent records must be made available to the examiner for review. Based on the examination and review of the record, the examiner must answer the following: The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the 1985 car bomb attack outside the headquarters building o Rhein-Main Air Base. The examiner must address the statement from private physician Dr. KS, the articles submitted by the Veteran, and the Veteran’s competent descriptions of her experience with the event. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.S. McLeod 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.