Citation Nr: 20004861 Decision Date: 01/23/20 Archive Date: 01/21/20 DOCKET NO. 16-57 723 DATE: January 23, 2020 REMANDED Entitlement to a rating in excess of 10 percent for a left knee meniscal tear and arthritis is remanded. Entitlement to a rating in excess of 20 percent for a right knee meniscal tear, patellar fracture, and arthritis is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to January 1980. This matter is before the Board of Veterans’ Appeals (Board) on appeal from September 2016 and October 2016 rating decisions. The Veteran testified before the undersigned during a November 2019 hearing. 1. Entitlement to a rating in excess of 10 percent for a left knee meniscal tear and arthritis is remanded. 2. Entitlement to a rating in excess of 20 percent for a right knee meniscal tear, patellar fracture, and arthritis is remanded. In his November 2019 hearing testimony, the Veteran asserted his bilateral knee disabilities have increased in severity since the Veteran was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of the bilateral knee disabilities. 3. Entitlement to service connection for a low back disability is remanded. At his November 2019 hearing, the Veteran asserted he experienced back pain for several weeks following his initial sports injury to his right knee and back during service in 1977, resulting in being put on a limited profile. The service records currently in his file do not contain any documentation of a limited profile related to this back injury. A remand is necessary to allow VA to ensure all potentially relevant service records are obtained and associated with the Veterans file. 4. Entitlement to service connection for bilateral hearing loss is remanded. VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). A September 2016 VA examiner opined the Veteran’s current bilateral hearing loss disability was not at least as likely as not related to service. As rationale, the examiner indicated this opinion was based on normal hearing tests performed at enlistment and separation with no shifts noted. This rationale fails to explain why the factors support the examiner’s opinion, nor does it address the Veteran’s reported noise exposure during service, to include his duties as a motor transport operator driving on a flight line, as well as his denial of significant post-service noise exposure. For these reasons, a remand is necessary to obtain an adequate medical opinion regarding the nexus between the Veteran’s current hearing loss and noise exposure during service. The matters are REMANDED for the following action: 1. Obtain and associate with the file the Veteran’s complete service personnel records and any outstanding service treatment records from the appropriate records depository. Efforts should be made to obtain records reflecting any limitations placed on the Veteran’s duty. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. 2. Schedule the Veteran for appropriate VA examinations to determine the current nature and severity of his bilateral knee disabilities. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The examiner should identify all knee pathology found to be present. The examiner should conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should 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. Forward the claims file to an appropriate clinician to determine whether the current hearing loss is related to the Veteran’s military service. The need for an examination is left to the discretion of the clinician selected to provide the opinion. Following review of the claims file, the clinician should opine whether it is at least as likely as not (50 percent or greater probability) that the current disability began in or is otherwise caused by the Veteran’s active service. The clinician must specifically address the Veteran’s lay statements regarding onset of his hearing loss. The clinician should address all other pertinent evidence in the claims file, including the Veteran’s military occupational specialty as a heavy vehicle operator and his reports of noise exposure during service, to include driving motor transports on a flight line. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Pitman, 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.