Citation Nr: 20021130 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 17-57 133 DATE: March 24, 2020 REMANDED Service connection for a left ear hearing loss disability is remanded. Service connection for a bilateral foot and ankle disability is remanded. Service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1982 to March 1985 in the United States Army. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified before the undersigned during a hearing at the RO. A transcript of the hearing is included in the electronic claims file. As a matter of clarification, the Board has recharacterized the bilateral foot claim on appeal to include a disability of both the feet and ankles based on medical evidence submitted by the Veteran. Specifically, he submitted an August 2016 private medical report in support of his claim, which documents a current foot/ankle disability that the examiner linked to service. A claimant is not required in filing a claim for benefits to identify a precise medical diagnosis or the medical cause of his condition; rather, he sufficiently files a claim for benefits "by referring to a body part or system that is disabled or by describing symptoms of the disability." Brokowski v. Shinseki, 23 Vet. App. 79, 86 (2009). Left Ear Hearing Loss Left ear hearing loss for VA purposes is documented in a February 2016 VA examination report. Although the VA examiner noted the Veteran’s in-service noise exposure and linked both his right ear hearing loss and tinnitus to service, a negative nexus opinion was rendered for left ear hearing loss. The examiner stated that because the Veteran had normal hearing in the left ear on separation from service, and there were no significant in-service threshold shifts at any frequency in the left ear, there was no evidence on which to conclude that the current disability was caused by or a result of military service. In reaching this conclusion, however, the examiner failed to note or discuss the abnormality of the left tympanic membrane noted on the January 1985 separation examination report. While the handwriting is difficult to decipher, the examiner noted a whitish patch on both tympanic membranes and marked the eardrums as “abnormal.” Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Reonal v. Brown, 5 Vet. App. 458, 460 (1993) (medical opinions have no probative value when they are based on an inaccurate factual predicate). Bilateral Feet/Ankles The Veteran has a current bilateral foot strain, documented on VA examination in February 2016. Service treatment records document complaints and treatment related to the feet and ankles in April 1982, December 1982, April 1983, and May 1984. On the matter of the etiology of the disability, the February 2016 VA examiner provided a negative nexus opinion, however, the opinion rested on a finding that foot pain was only shown in 1985. Barr, 21 Vet. App. at 312; Reonal, 5 Vet. App. at 460. By contrast, in an August 2016 private medical report, Dr. B. opined that the Veteran’s current foot/ankle disability was directly related to his military duties, but did not provide a rationale for this opinion. As such, a further medical opinion must be obtained. Bilateral Knees The August 2016 report of Dr. B. documents a current right knee disability. As for the left knee, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit held that pain alone, when causing functional impairment, may constitute a "disability" for VA compensation purposes, even if the pain is not with an accompanying diagnosis. While the record does not indicate a specific left knee diagnosis, in light of the Veteran’s reports of pain causing functional impact, the Board finds the requirement for a current disability has been met. Service treatment records show that on three occasions in May 1982 and once in May 1983, the Veteran sought treatment for problems in his lower legs. At the October 2019 hearing he testified that he sustained numerous falls from trees in the course of his duties as a tactical wire operations specialist, and that his knee pain began in service and has persisted to the present. His personnel records and DD Form 214 corroborate his training in tactical wire operations. On the matter of the etiology of the disability, in August 2016 Dr. B. attributed the Veteran’s current right knee disability to service but did not provide a rationale for his conclusion. Dr. B. did not specifically mention the left knee, but given the report combined with the Veteran’s military occupational specialty and hearing testimony, the Board finds there is an indication that the left knee disability may also be related to service. A VA medical opinion has not been obtained for the bilateral knee claim and must be provided. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to obtain an opinion addressing the nature and etiology of his left ear hearing loss disability. A complete explanation should be provided for all opinions rendered. The examiner must address whether it is at least as likely as not that the current left ear hearing loss began during active service or is related to an in-service injury, event, or disease, to include exposure to excessive noise in service and/or the abnormal left tympanic membrane documented on the Veteran’s January 1985 separation examination. 2. Schedule the Veteran for a VA examination to obtain an opinion addressing the nature and etiology of bilateral feet/ankle disability and bilateral knee disability. A complete explanation should be provided for all opinions rendered. The examiner must address whether it is at least as likely as not that the current bilateral feet/ankle disability and bilateral knee disability began during active service or are related to an in-service injury, event, or disease, to include falls sustained as a tactical wire operations specialist. In rendering this opinion, the examiner must consider: • Service treatment records of April 1982, December 1982, April 1983, and May 1984 documenting treatment of the feet/ankles (Continued on the next page)   • Service treatment records of May 1982 and May 1983 documenting treatment of the lower legs • August 2016 private medical report of Dr. B. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith, 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.