Citation Nr: 21002965 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 19-16 072 DATE: January 19, 2021 REMANDED The claim of entitlement to service connection for a bilateral hearing loss disorder is remanded. The claim of entitlement to service connection for a bilateral foot disorder is remanded. The claim of entitlement to service connection for diabetes mellitus type 2 (diabetes) is remanded. The claim of entitlement to service connection for an eye disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1959 to June 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Veteran testified in a hearing before the Board. A transcript of the hearing has been included in the electronic record and has been reviewed. In the Board hearing, and in other statements of record, the Veteran has indicated an interest in seeking service connection for disorders of the ankles and ears (e.g., otitis media and residuals). The issues have not been adjudicated by the RO, so they are referred for appropriate consideration. A remand of the claims on appeal is necessary for additional development. The June 1959 report of medical examination notes bilateral pes planus, notes a defective audiogram, and notes that the Veteran had ear troubles prior to service and used hearing aids. The Veteran asserts that active duty aggravated pre-service hearing and foot disorders. He underwent VA examinations into the claims in September 2018. The reports of record note current hearing loss disability and bilateral pes planus. The examiners found it unlikely that the disorders related to service. The examiner did not address, however, whether it was at least as likely as not that the disorders increased in severity during service. Where a pre-existing disability is noted upon entrance examination and is shown to have increased in severity during service, it is presumed that such increase in severity caused aggravation of the pre-service disorder, unless clear and unmistakable evidence establishes that the increase represents the natural progression of the condition. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Addendum medical reports should be included in the record. The Veteran asserts that he incurred diabetes as the result of herbicide exposure in the Republic of Korea. He served there in the early 1960s. He contends that he sprayed herbicides to reduce vegetation growth around his base perimeter. The law provides that a veteran who, during active military, naval, or air service, served between April 1, 1968 and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iv). The record indicates that the Veteran served near the DMZ. But he did not serve there between 1968 and 1971. Nevertheless, the contentions regarding herbicide exposure should be researched pursuant to 38 C.F.R. §§ 3.307, 3,309 and the VA Adjudication Procedures Manual, M21-1, Part IV, Subpart ii, Chapter 1, Section H. The Veteran also asserts that he developed a vision disorder as the result of the diabetes. Inasmuch as this claim is intertwined with the claim regarding diabetes, it must be remanded as well. See Smith v. Gober, 236 F.3d 1370, 1372 (Fed. Cir. 2001). The matters are REMANDED for the following action: 1. Contact the U.S. Joint Services Records Research Center (JSRRC) for formal inquiry into the alleged exposure to herbicides in Korea. The evidence of record should be reviewed including the Veteran’s detailed statements during the Board hearing. 2. Return the case to the VA examiner who conducted the September 2018 audiology examination, or to a suitable substitute, for issuance of an addendum opinion. After reviewing the claims file, the examiner should address the following question(s). (a). Is it at least as likely as not (i.e., probability of 50 percent or greater) that that a pre-service hearing disorder increased in severity during service? (b). If so, is it clear and unmistakable (i.e., undebatable) that the hearing disorder WAS NOT aggravated (i.e., permanently worsened) by service? In other words, is it clear and unmistakable that any increase in severity during service of a pre-service hearing disorder was due to the natural progress of the disorder? Please explain in detail any opinion provided and the supporting rationale. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a basis to doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Return the case to the VA examiner who conducted the September 2018 examination of the feet, or to a suitable substitute, for issuance of an addendum opinion. After reviewing the claims file, the examiner should address the following question(s). (a). Is it at least as likely as not (i.e., probability of 50 percent or greater) that that a pre-service foot disorder increased in severity during service? (b). If so, is it clear and unmistakable (i.e., undebatable) that a foot disorder WAS NOT aggravated (i.e., permanently worsened) by service? In other words, is it clear and unmistakable that any increase in severity during service of a pre-service foot disorder was due to the natural progress of the disorder? Please explain in detail any opinion provided and the supporting rationale. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. (Continued on the next page)   In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a basis to doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee, 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.