Citation Nr: 20056657 Decision Date: 08/27/20 Archive Date: 08/27/20 DOCKET NO. 15-37 965A DATE: August 27, 2020 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to service connection for hypertension is granted. REMANDED Entitlement to service connection for toxic nephropathy is remanded. Entitlement to service connection for spinal stenosis is remanded. Entitlement to service connection for cervical radiculopathy of the bilateral upper extremities is remanded. FINDINGS OF FACT 1. Resolving any reasonable doubt in the Veteran’s favor, his tinnitus began during active service. 2. Resolving any reasonable doubt in the Veteran’s favor, his hypertension began during active service CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303t. 2. The criteria for service connection for hypertension are met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army National Guard on active duty for training from September 5, 2006 to March 20, 2007. Service Connection In order to obtain service connection, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, i.e., a “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Entitlement to service connection for tinnitus The Veteran contends that his tinnitus is the result of his active service. A November 2018 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ) examination indicated both a diagnosis of tinnitus and an opinion that it was as least as likely as not caused by or the result of military noise exposure. Indeed, the examiner’s rationale stated: The claimant specifically remembers tinnitus beginning with weapons firing activities. This noise exposure is capable of causing his lasting tinnitus. He denies outside sources of noise exposure from this time. Therefore, it is at least as likely as not, based on service history and timing of symptom onset, that his tinnitus is the result of military noise exposure. Further, a September 2013 Independent Medical Expert (IME) nexus opinion by Dr. C.N.B. Md. indicated, in pertinent part, “It is my opinion considering every possible sound medical etiology/principle, to at least the 50% level of probability that [the Veteran’s] current hearing loss/tinnitus problems are due to his experiences/trauma that the [he] had during military service…” The remaining medical evidence of record is silent for any further discussion on the Veteran’s tinnitus etiology. Based on the previous evidence of record, the Board finds that service connection for tinnitus is warranted. Indeed, the only medical opinions of record, both by VA and a private examiner, indicate that the Veteran’s tinnitus is the result of military noise exposure. Resolving all doubt in the Veteran’s favor, service connection for tinnitus is granted. Entitlement to service connection for hypertension The Veteran contends that his hypertension is the result of his active service. STRs are silent for any complaints, diagnosis, or treatment of hypertension as defined by VA. An October 2015 private treatment record indicates a diagnosis of hypertension but no discussion on its etiology. A September 2013 IME nexus opinion by Dr. C.N.B. Md. indicated, in pertinent part, “It is my opinion considering every possible sound medical etiology/principle, to at least the 90% level of probability that his current cardiac problems are due to his experiences/trauma that the patient had during military service…” The rationale provided was: 1. Per his military records he entered the service fit for duty without any doctor-diagnosed illnesses of HTN. 2. He had medical visits for cardiac problems while in service. 3. His current symptoms are per the attached lay statements, which show chronicity of symptoms. 4. His records do not support another more plausible etiology for his current cardiac pathology or other risk factors (in or out of service) to explain his problems other than his service time experiences. 5. The time lag between injury in service and current pathology is consistent with known medical principles and the natural history of this disease. 6. No other physician has made a controverting opinion. 7. This opinion is consistent with the patient’s subjective lay statements, the objective findings/imaging tests/diagnoses 8. This illness is permanent in nature and thus is not expected to improve with time. The remaining medical evidence of record is silent for any further discussion on the Veteran’s hypertension etiology. Based on the previous evidence of record, the Board finds that service connection for hypertension is warranted. Indeed, the only medical opinion of record indicates that the Veteran’s hypertension is the result of military noise exposure. Resolving all doubt in the Veteran’s favor, service connection for hypertension is granted. REASONS FOR REMAND Entitlement to service connection for toxic nephropathy is remanded. The Veteran contends that his toxic nephropathy is the result of his active service. To that end, his representative provided a November 2018 IME opinion indicating “nephropathy due to his motrin use at 3-4000 mgs/day x 5 years and/or his HTN and/or his diabetes and thus his nephropathy should be service connected as a secondary condition to his service induced HTN or diabetes or Motrin use need to treat his ankle condition.” However, no rationale was provided in support of his opinion. Nevertheless, the Board finds that a remand is warranted to allow for an examination and associated opinion with accompanying rationale as to whether the Veteran’s nephropathy is due to medication prescribed to him during his active service, specifically Motrin and/or his now service-connected hypertension. Entitlement to service connection for spinal stenosis is remanded. Entitlement to service connection for cervical radiculopathy of the bilateral upper extremities is remanded. The Veteran contends that his spinal stenosis and cervical radiculopathy of the bilateral upper extremities are the result of his active service. Records indicate an August 2008 VA diagnosis of cervical strain. However, in a November 2018 IME opinion submitted by the Veteran’s representative, the examiner indicates that the Veteran “currently likely has spinal stenosis in his cervical spine” and that “he likely has radicular signs and symptoms.” Further, a December 2018 VA Cervical spine examination indicated a diagnosis of cervical strain, intervertebral disc syndrome, and bilateral upper radiculopathy. No opinion on etiology was provided. Based on the inadequacy of the November 2018 private opinion with regards to its failure to indicate an actual diagnosis along with the failure of the December 2018 VA examiner to provide an opinion on etiology, the Board finds that a remand for an opinion on etiology is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed nephropathy. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the contention that it is the result of medication received while on ACDUTRA. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s spinal stenosis and cervical radiculopathy of the bilateral upper extremities are at least as likely as not related to the Veteran’s active service. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.A. Elliott II, 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.