Citation Nr: 21062996 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 16-02 461 DATE: October 12, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a back disorder is remanded. Entitlement to a TDIU is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1992 to September 1993. In June 2020, the Board remanded, in part, for VA examinations. Unfortunately, the Board finds that the obtained medical opinions are not adequate, and another remand is necessary. 1. Entitlement to service connection for tinnitus is remanded. 2. Entitlement to service connection for hearing loss is remanded. The Board finds that the issues must be remanded again for an addendum medical opinion because the August 2020 medical opinion is inadequate. The examiner's based his negative opinion on the 2005 IOM report, in part, and stated that "there is no scientific basis on which to concluded that normal hearing upon discharge is causally related ot hearing loss that develops later in life." The examiner did not address the qualifying findings in that report which state that there is insufficient evidence to determine whether permanent noise-induced hearing loss can develop later. See McCray v. Wilkie, 31 Vet. App. 243 (2019). Accordingly, a remand is necessary. 3. Entitlement to service connection for a left knee disorder is remanded. The Board finds that a remand is necessary for an adequate medical opinion. In November 2011, a VA examiner opined that the Veteran's left knee disorder was less likely than not related to service and pointed to the Veteran's left knee injuries in 2001 and 2002. Some of the Veteran's private physicians have opined that he had severe left knee arthritis that preexisted his 2001 injury. These opinions were not considered in the 2011 medical opinion and a remand is necessary for an addendum medical opinion that addresses this evidence. 4. Entitlement to service connection for a back disorder is remanded. The Board finds that a remand is necessary for an adequate medical opinion. In March and June 2020, the Board remanded for a medical opinion that addressed the Veteran's in-service complaint of low back pain. In August 2020, the VA examiner opined the Veteran's back disorder was not related to service because in-service complaints "involved the upper rather than lower portion of the spine" and the current disorder involves the lower portion of the spine. As noted in previous remands, however, the Veteran sought treatment for low back pain in July 1993. Accordingly, a remand is necessary. 5. Entitlement to a TDIU is remanded. The claim for a TDIU must be remanded because it is inextricably intertwined with the remanded claims. The matters are REMANDED for the following action: 1. Forward the claims file to the August 2020 VA examiner, or another appropriate VA examiner if he is unavailable, for an addendum medical opinion regarding the Veteran's hearing loss and tinnitus claims. An in-person examination is unnecessary unless determined otherwise by the examiner. After reviewing the file, the examiner should respond to the following: (a.) Is it at least as likely as not that the Veteran's current tinnitus and/or hearing loss of either ear began during or is otherwise related to service? (b.) The examiner should explain why or why not and is advised that an opinion based solely on the fact the conditions were not shown in service or at separation is NOT a sufficient rationale. (c.) If relying to any extent upon the 2005 IOM study, the examiner must acknowledge that the study states the following: "There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure. Although the definitive studies to address that issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur." 2. Forward the claims file to an appropriate VA examiner if he is unavailable, for an addendum medical opinion regarding the Veteran's left knee claim. An in-person examination is unnecessary unless determined otherwise by the examiner. After reviewing the file, the examiner should respond to the following: (a.) Is it at least as likely as not that the Veteran's current left knee disorder(s), to include arthritis, began during or is otherwise related to service? (b.) The examiner should consider the following medical opinions which state the Veteran had severe arthritis that preexisted his 2001 work injury: i. Dr. Cappello's opinion dated March 4, 2014 and received on January 6, 2016 (titled "Medical Treatment Record Non-Government Facility"). ii. Dr. Holladay's independent medical examination report dated March 25, 2010 and received on March 25, 2013 (titled "Medical Treatment Record Non-Government Facility"). 3. Forward the claims file to the August 2020 VA examiner, or another appropriate VA examiner if he is unavailable, for an addendum medical opinion regarding the Veteran's back claim. An in-person examination is unnecessary unless determined otherwise by the examiner. After reviewing the file, the examiner should respond to the following: (a.) Is it at least as likely as not that the Veteran's current back disorder began during or is otherwise related to service? (b.) The examiner must address the July 1993 service treatment record that documents lower back pain. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lavan 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.