Citation Nr: 21000628 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 19-15 017 DATE: January 5, 2021 ORDER Service connection for a bilateral hearing loss disability is granted. REMANDED Service connection for peripheral neuropathy is remanded. Service connection for a disability resulting in discoloration of the hands is remanded. FINDING OF FACT The weight of the evidence supports a finding that a bilateral hearing loss disability is etiologically related to active duty service. CONCLUSION OF LAW The criteria for service connection for a bilateral hearing loss disability are met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1966 to June 1968, including service in the Republic of Vietnam (Vietnam) during the Vietnam War. The Veteran had additional service in the United States Army Reserve (Reserve). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision. The Veteran participated in a videoconference hearing before the undersigned in November 2020, and a transcript of this hearing has been associated with the record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 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, 1166-67 (Fed. Cir. 2004).  Additionally, hearing loss is a chronic disease for which service connection may be established based on a continuity of symptomatology. 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran has credibly contended that he was exposed to loud noises during service while repairing Howitzers as a vehicle mechanic. A June 2018 VA examination report indicates that the Veteran has bilateral hearing loss for VA purposes. See 38 C.F.R. § 3.385. However, the examiner opined that it was less likely than not that the bilateral hearing loss disability was related to service because there was no discernable shift in hearing acuity between the Veteran’s entrance into service and his separation from service. With that said, the examiner concluded that it was at least as likely as not that the Veteran’s tinnitus was caused by military noise exposure. As a rationale for this conclusion, the examiner considered the Veteran’s contentions of military noise exposure and the duration of his symptoms. Indeed, the June 2018 examiner’s etiological opinion served as the basis for an August 2018 grant of service connection for tinnitus.   The Board observes that the Veteran has made similarly credible reports regarding his in-service noise exposure and the onset and duration of his symptoms of hearing loss. Such evidence presents a continuity of symptomatology from the Veteran’s military service to the present.  This continuity of symptomatology serves as the necessary nexus between the Veteran’s bilateral hearing loss disability and his active duty service.   In making this determination, the Board acknowledges that the June 2018 examiner was unable to find a connection between the Veteran’s bilateral hearing loss disability and his military service. Such conclusion was based, however, largely upon the finding that there was no discernable shift in hearing acuity between the Veteran’s entrance into service and his separation from service. The presence of normal hearing in service is not necessarily a bar to service connection, and the probative value of the June 2018 opinion is lessened because of its reliance on the absence of an in-service hearing impairment.  See Hensley v. Brown, 5 Vet. App. 155, 159-60 (1993). REASONS FOR REMAND Further development is required before the Board may address the Veteran’s claims for service connection for peripheral neuropathy and a disability resulting in discoloration of the hands. A veteran who had active military service in Vietnam during the Vietnam War is presumed to have been exposed to an herbicide agent during such service, unless there is affirmative evidence to establish that the veteran was not so exposed. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). If such exposure occurred, the veteran is entitled to a presumption of service connection for certain disorders. 38 C.F.R. § 3.309(e). Early onset peripheral neuropathy, which manifests to a degree of 10 percent or more within a year after the last date of in-service exposure to an herbicide agent, is included among the disorders that are presumptively related to in-service herbicide exposure. 38 C.F.R. §§ 3.307(a)(6)(ii). Additionally, peripheral neuropathy, as an organic disease of the nervous system, is a chronic disease for which service incurrence may be established based upon a continuity of symptomatology. 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The record shows that the Veteran served in Vietnam during the Vietnam War, and he is thus presumed to have been exposed to herbicide agents during service. The Veteran has complained of symptoms of peripheral neuropathy and discoloration of the hands. In March 2004, a clinician noted that the Veteran had scattered actinic changes on the dorsum of the hands. In January 2019, the Veteran stated that he suffered from neuropathic symptoms extending down his legs into his knees and feet, either as the direct result of his active service or as the secondary result of his service-connected ankle disability. During the Veteran’s November 2020 hearing before the undersigned, the Veteran described experiencing symptoms such as tightness, coldness, and pain in his hands and legs. He stated that the skin on his hands was discolored and tore easily. The Veteran has not been afforded VA examinations addressing the nature and etiology of his claimed peripheral neuropathy and hand discoloration. Particularly given the subjective nature of the symptoms that the Veteran endorses, such examinations should be conducted on remand. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Additionally, the Board notes that the Veteran’s claims file contains VA treatment records dated from April 2001 to October 2005. The record does not indicate that he stopped receiving VA medical care in October 2005. On remand, the AOJ should ensure that all pertinent VA treatment records, including records dated after October 2005, have been associated with the Veteran’s claims file.   The matters are REMANDED for the following actions: 1. Ensure that all pertinent VA treatment records, including all such records dated after October 2005, have been associated with the Veteran’s claims file. 2. Then, afford the Veteran with examinations to address the nature and etiology of his claimed peripheral neuropathy and disability resulting in discoloration of the hands. The examiners should address the following questions: With respect to peripheral neuropathy: (a.) Does the Veteran have a diagnosis of peripheral neuropathy? When rendering this opinion, the examiner should consider the Veteran’s subjective accounts of experiencing symptoms such as coldness and pain in his extremities. (b.) If the Veteran has a diagnosis of peripheral neuropathy, is it at least as likely as not (that is, a probability of 50 percent or greater) that peripheral neuropathy (1) had its onset during active service, (2) is related to any in-service disease, event, or injury, (3) manifested within one year of the Veteran’s last exposure to herbicides in Vietnam, or (4) manifested within one year of the Veteran’s active duty? (c.) If the Veteran has a diagnosis of peripheral neuropathy, is it at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran’s peripheral neuropathy is caused by his service-connected ankle disability? (d.) If the Veteran has a diagnosis of peripheral neuropathy, is it at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran’s peripheral neuropathy underwent any incremental increase in disability, regardless of its permanence, due to the Veteran’s service-connected ankle disability?  An “incremental increase in disability” is an additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent.     With respect to a disability resulting in discoloration of the hands: (a.) Does the Veteran have a diagnosis with a disability resulting in discoloration of the hands? When rendering this opinion, the examiner should consider the Veteran’s subjective accounts of experiencing symptoms such as tightness, coldness, and discoloration of the hands. (b.) If the Veteran has a diagnosed disability resulting in discoloration of the hands, is it at least as likely as not (that is, a probability of 50 percent or greater) that such disability (1) had its onset during active service, or (2) is related to any in-service disease, event, or injury? When rendering this opinion, the examiner should consider the Veteran’s presumed exposure to herbicide agents during service, and the Veteran’s contentions that his hands were exposed to chemicals while serving as a vehicle mechanic. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Flynn, 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.