Citation Nr: 20006512 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 15-25 318 DATE: January 28, 2020 ORDER Entitlement to service connection for nasal obstruction and deviated septum, claimed as contusion of nose, is granted. REMANDED Entitlement to service connection for left hip disability, to include a secondary to a back disability, is remanded. Entitlement to service connection for hearing loss is remanded. FINDING OF FACT The Veteran's chronic nasal obstruction and deviated septum disability was incurred in service. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for chronic nasal obstruction and a deviated septum disability, have been met. 38 U.S.C. §§ 1110, 1154 (b), 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2016). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July1970 to December 1996. The Board remanded the claims in July 2018. There has been substantial compliance with the remand in connection with claim decided here and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Service connection for nasal obstruction and deviated septum Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362 (Fed. Cir. 2009). The Veteran contends that current nasal obstruction and deviated septum disability are the result of a nose contusion suffered during service. The Board concludes that the Veteran has a current disability (nasal fracture with deviated septum) that is related to the in-service contusion. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a). The Veteran’s service treatment records (STRs) include a January 7, 1984, record where he sought treatment after being struck in the nose while playing basketball the evening before. Findings at time showed mild tenderness and swelling on the right side and a mild assymetry of distal part of nose. X-ray studies were not done. The question for the Board, whether there is a causal link between the current disability and the Veteran’s military service. The record includes both evidence for and against the claim. Evidence for the claim includes an October 2012 opinion from a private ear, nose, and throat (ENT) provider. That provider reviewed the history of the Veteran’s in-service injury and treatment and his report of no other trauma to his nose. The examiner said x-rays conducted as part of a recent examination showed “what looks like an old nasal fracture” and “what looks like an old healed fracture of the right nasal bones.” The provider concluded that the Veteran’s currently diagnosed nasal fracture with mild septal deformity was related to the in-service injury. The opinion was based on a review of the record and physical examination of the Veteran and included a rationale for the opinion provided. Evidence against the claim includes the negative nexus opinion provided by a June 2019 VA examiner. The rationale for the negative opinion was the absence of a diagnosed fracture in service and a normal clinical evaluation of the nose at separation examination. Both opinions were based on the Veteran’s history as detailed in the STRs and included rationale for the conclusions. The private examiner addressed current x-ray findings but did not address the separation examination. The VA examiner considered the separation examination, but did not comment on the private examiner’s description of current x-rays showing “an old fracture.” As a result, the Board finds the evidence is in relative equipoise. Resolving reasonable doubt in the Veteran's favor, service connection is warranted for the current nose fracture and deviated septum See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for left hip disability, to include a secondary to a back disability, is remanded. An April 2019 VA examination conducted pursuant to the July 2018 remand is inadequate and a new opinion is needed. Stegall, 11 Vet. App. at 268. The examiner provided opinions on direct service connection and secondary causation, but did not address aggravation. 2. Entitlement to bilateral hearing loss is remanded. An April 2019 VA examination conducted pursuant to the July 2018 remand is inadequate and a new opinion is needed. Stegall, 11 Vet. App. at 268. The examiner did not include an adequate rationale. The basis of the negative nexus opinion was the absence of hearing loss in service and no showing of hearing loss on a November 2011 VA examination. The examiner did address the significance of normal hearing at both separation from service and the November 2011 VA examination many years after service. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding VA treatment records regarding the Veteran dated from April 2019 to the present. 2. After completion of the above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his diagnosed left hip disability. Copies of all pertinent records should be made available for review by the examiner. Based on the examination and review of the record, the examiner must address the following questions: (a.) Is it as least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s left hip disability was caused by his service-connected chronic lumbar syndrome with degenerative disc disease? (b.) Is it as least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s left hip disability was aggravated (defined as any increase in disability) by his service-connected chronic lumbar syndrome with degenerative disc disease? A full rationale is to be provided for all stated medical opinions. If the examiner concludes that the requested opinion cannot be provided without resort to speculation, the examiner should so state and explain why this opinion would be speculative and what, if any, additional evidence would permit such an opinion to be made. 3. Then, schedule the Veteran for an audiological examination to determine the nature and etiology of his claimed bilateral hearing loss. Copies of all pertinent records should be made available for review by the examiner. Based on the examination and review of the record, the examiner must address the following questions: Is it at least as likely as not (i.e., 50 percent or greater probability) that any diagnosed hearing loss if related to the Veteran’s service, to include the Veteran’s conceded noise exposure? (Continued on the next page)   A complete rationale should be provided for any opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Leal, Law Clerk 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.