Citation Nr: 21063117 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 20-10 842 DATE: October 13, 2021 ORDER As new and material evidence has been received, the petition to reopen the previously denied claim for service connection for bilateral hearing loss disability is granted. As new and material evidence has been received, the petition to reopen the previously denied claim for service connection for residuals of tonsillitis status post tonsillectomy is granted. As new and material evidence has been received, the petition to reopen the previously denied claim for service connection for residuals of nasal fracture is granted. Entitlement to service connection for bilateral hearing loss disability is granted. Entitlement to service connection for residuals of tonsillectomy, claimed as a throat condition, is denied. REMANDED Entitlement to service connection for a sinus disorder, to include as due to residuals of a nose fracture is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for bilateral foot disorder, to include pes planus is remanded. Entitlement to service connection for tinnitus is remanded. FINDINGS OF FACT 1. In January 2010 rating decision, the RO denied the Veteran's claims for service connection for bilateral hearing loss disability, residuals of nose fracture, and residuals of tonsillectomy; the Veteran did not appeal the denial of his claims for service connection for residuals of nose fracture and residuals of tonsillitis status post tonsillectomy. 2. The Veteran initiated an appeal as to the denial of his bilateral hearing loss claim but failed to submit a substantive appeal following issuance of a March 2012 statement of the case (SOC). 3. Additional evidence since the January 2010 rating decision is not cumulative or redundant and relates to an unestablished fact necessary to reopen the claims for service connection for bilateral hearing loss, residuals of nose fracture, and residuals of tonsillectomy. 4. Resolving any doubt in the Veteran's favor, the evidence of record demonstrates that his bilateral hearing loss disability is likely related to in-service acoustic trauma. 5. The preponderance of the evidence is against finding that the Veteran has had a throat disorder as result of in-service tonsillitis, status post tonsillectomy, at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The January 2010 rating decision denying claim for service connection for bilateral hearing loss is final; new and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5103, 5103A, 5108, 7105(c); 38 C.F.R. § 3.104, 3.156(a), 20.1103. 2. The January 2010 rating decision denying claim for service connection for residuals of tonsillitis status post tonsillectomy is final; new and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5103, 5103A, 5108, 7105(c); 38 C.F.R. § 3.104, 3.156(a), 20.1103. 3. The January 2010 rating decision denying claim for service connection for residuals of nasal fracture is final; new and material evidence has been received to reopen the claim. 38 U.S.C. §§ 5103, 5103A, 5108, 7105(c); 38 C.F.R. § 3.104, 3.156(a), 20.1103. 4. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for residuals of tonsillitis status post tonsillectomy, claimed as throat disorder, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1955 to April 1963. In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A hearing transcript has been associated with the claims folder. 1. Whether new and material evidence has been received to reopen the previously denied claim for service connection for bilateral hearing loss 2. Whether new and material evidence has been received to reopen the previously denied claim for service connection for residuals of tonsillitis status post tonsillectomy. 3. Whether new and material evidence has been received to reopen the previously denied claim for service connection for residuals of nasal fracture The Board concludes that the January 2010 rating decision denying the claims for entitlement to service connection for bilateral hearing loss, residuals of tonsillitis, and residuals of nasal fracture is final; and that new and material evidence has been received to reopen the claims. 38 U.S.C. §§ 5103, 5103A, 5108, 7105(c); 38 C.F.R. §§ 3.104, 3.156(a), 20.1103. A claim that has been denied in an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105 (c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. Generally, a claim that has been denied in an unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105 (c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented. Anglin v. West, 203 F.3d 1343, 1347 (2000). In deciding whether new and material evidence has been received, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Regardless of whether the RO found that new and material evidence had been submitted to reopen a claim for service connection, it is well established that the Board must determine on its own whether new and material evidence has been submitted to reopen a claim. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). The Veteran's claims for service connection were originally denied in a January 2010 rating decision on the basis that the evidence did not show a nexus between current hearing loss disability and in-service noise exposure; show evidence an in-service treatment or current diagnosis for nose fracture; or show a current disability as result of in-service tonsillitis status post tonsillectomy. The Veteran did not appeal the denial of his claims for service connection for residuals of tonsillitis and residuals of nasal fracture, and no new and material evidence was received within a year of that decision. Although the Veteran initiated an appeal as to the denial of his claim for service connection for bilateral hearing loss, he did not complete a substantive appeal. Essentially, VA received no appeal of theses matters or no new and material evidence prior to expiration of the appeal period. Therefore, the January 2010 rating decision is final as to each of these claims. See 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.156, 20.302, 20.1103. Evidentiary submissions received since the January 2010 rating decision includes new and material evidence. Specifically, a December 2018 VA examination shows diagnoses of acute sinusitis in 1976 and status post tonsillectomy in 1958 as well as the Veteran's medical history of similar sinus-related problems for "most of my life." In addition, VA treatment records that show the Veteran has been prescribed nasal spray. Together, this additional evidence constitutes new and material evidence as to the previously denied claims for residuals of nasal fracture and residuals of tonsillectomy. With respect to his previously denied bilateral hearing loss claim, the Veteran has submitted a private medical statement in May 2021, which contains a favorable opinion linking the Veteran's bilateral hearing loss to his in-service noise expose, coupled with the Veteran's testimony regarding onset and continuity of hearing loss symptoms, constitutes new and material evidence. The additional evidentiary submissions demonstrate possible sinus and throat/tonsil-related disabilities that may have had continuity of sinus-related symptoms since service as well as a favorable medical nexus opining linking his current bilateral hearing loss to service. These additional evidentiary submissions were not previously before VA adjudicators at the time of the prior final disallowance. The evidence tends to cure a prior evidentiary defect. Therefore, new and material evidence has been received when considering the "low threshold" required for reopening previously denied claims. Accordingly, the petition to reopen the claims for service connection for bilateral hearing loss, residuals of nasal fracture, and residuals of tonsillitis status post tonsillectomy is granted. In the February 2020 SOC, the RO determined that previously denied claims were reopened and adjudicated the underlying service connection claims on the merits. Consequently, the Veteran is not prejudiced by the Board also adjudicating the issues of service connection for bilateral hearing loss and a throat disorder below. The issue of service connection for a sinus disorder will be addressed in the remand portion. Service Connection Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Service connection basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d).Additionally, certain chronic disabilities, such as organic diseases of the nervous system, to include bilateral hearing loss, are presumed to have been incurred in service if manifested to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 4. Entitlement to service connection for bilateral hearing loss disability. The Veteran seeks entitlement to service connection for bilateral hearing loss disability. He asserts that his current bilateral hearing loss and tinnitus are a result of his exposure to loud noises during his period of service. See VA Form-9 (March 2020). The Veteran reported he had in-service acoustic trauma as result of his duties as a combat engineer while working with explosives as well as his use of firearms during service; and that he first experienced hearing loss following his detonation of over 300 pounds of explosives without any hearing protection during service. He reported he did not feel his hearing loss was significant enough to seek medical attention during service and did not complain about hearing problems until after service. The Veteran reports that he first realized the significance of his hearing loss in December 1964, when he started working in reservations for an airline company, and he was unable to hear in his right ear using a headset. He believes his current hearing loss is a result of his in-service acoustic trauma. See Hearing Transcript (July 2021). The Veteran has acknowledged that he had post-service occupational noise exposure when he worked as airline baggage loader for 16-months after his separation from service as well as recreational noise exposure from hunting. However, he maintains that he wore appropriate ear protection during his post-service occupation. See Correspondence (April 2009) and (April 2010). The Board concludes that the Veteran's current bilateral hearing loss disability is likely related to his in-service acoustic trauma, resolving any doubt in his favor. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Audiology testing standards were set by the American Standards Association (ASA) until November 1, 1967. After that date, audiometric tests were conducted using International Standards Organization (ISO) or American National Standards Institute (ANSI) measurement. Current VA regulations that define hearing loss for VA purposes are based on the dB measurement recorded in the ISO-ANSI units. Accordingly, VA uses a system to convert ASA units to ISO-ANSI units that adds 15 dB to 500 Hz, 10 dB to 1000, 2000, and 3000 Hz, and 5 dB to 4000 Hz. The Veteran's service personnel records confirm that he served as a combat engineer from 1956 to 1962. He is competent to testify as to his exposure to loud noises during service. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469-470 (1994). His lay statements are found to be credible as they have been consistent and are supported by the circumstances of his service. The Board concedes the Veteran's exposure to acoustic trauma during active service. In addition, a December 2018 VA examination shows that the Veteran has current bilateral hearing loss disability pursuant to 38 C.F.R. § 3.385. The first and second prongs, a current disability and an in-service injury, have been shown. The remaining question is whether a medical nexus exists between the diagnosis and in-service noise exposure. Here, the Board finds that after resolving doubt in the Veteran's favor, the competent evidence demonstrates his current bilateral hearing loss disability is likely a result of his in-service acoustic trauma. The Veteran's August 1955 enlistment report of medical examination (ROME) documents a whisper voice test which revealed bilateral hearing of 15/15, which is considered normal. See Smith v. Derwinski, 2 Vet. App. 137, 140 (1992). On his corresponding August 1955 Report of Medical History (ROMH) at enlistment, the Veteran denied any ear, nose, or throat trouble. See STR-Medical (November 2009). The Veteran's April 1963 separation ROME contains audiometric results with pure tone thresholds from 500 to 4,000 Hertz as follows (after conversion from ASA to ISO): 20, 10, 0, NA, 0 in the right ear, and 20, 10, 0, NA, -5 in the left ear. See STR-Medical (November 2009). Although the audiometric results from his April 1963 separation examination do not indicate hearing loss during service, they do suggest a possible decline in hearing acuity when compared to his normal whisper voice results at his enlistment. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (the threshold for normal hearing is from 0 to 20 decibels; thus, higher threshold levels indicate some degree of hearing loss.) The first medical evidence of bilateral hearing loss comes from a July 1983 private audiogram report. See Medical Treatment Record - Government Facility (October 2018). The Veteran originally filed a claim for service connection for bilateral hearing loss in February 2009. In conjunction with his claim, he submitted lay statements in which he attested to an onset of decreased hearing acuity in service. See Correspondence (April 2009). He later reiterated that his hearing loss had an onset during service. See Correspondence (March 2011) and Hearing Transcript (July 2021). In a November 2009 VA audiology examination report, the VA examiner opined that the Veteran's hearing loss was not caused by or result of noise exposure during service. The rational was that the Veteran's STRs showed he had normal hearing on his separation examination. In the December 2018 VA audiology examination report, the VA examiner opined that the Veteran's bilateral hearing loss was less likely than not related to acoustic trauma in service. The VA examiner found it significant that: the Veteran's separation examination was silent for hearing loss; the Veteran reported the onset of decreased hearing post-service after exposure to recreational and/or occupational noise exposure; and there was no treatment for hearing problems until the early 1980s. It is unclear whether either VA examiner considered the conversions from ASA to ISO standards for the Veteran's April 1963 separation audiometric results. The Board reiterates that it is Board policy to assume metrics conducted prior to January 1, 1967, were made using ASA units. There is no indication that the VA examiners considered the converted results nor addressed the possibility of hearing shift from the August 1955 induction whisper voice results to the April 1963 separation audiometric results. See Reonal v. Brown, 5 Vet. App. 458 (1993) (stating that "[a]n opinion based upon an inaccurate factual premise has no probative value"). The VA examiners also failed to consider the Veteran's reported history of hearing difficulties since service. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (finding a medical examination inadequate where the examiner impermissibly ignored the appellant's lay assertions regarding onset of symptoms or injury during service). Pertinently, the Board finds the Veteran has consistently reported the onset of decreased hearing during service and his statements are considered credible. Consequently, the VA examiners' medical opinions have diminished probative value. In support of his claims, the Veteran has submitted private medical statements from Dr. S. M., a retired United States Air Force (USAF) Chief Otologist. In an April 2010 medical statement, Dr. M. noted that the Veteran had been patient and friend for many years, and he has profound hearing loss in left ear and total loss in right. He also noted that the Veteran reported a history of noise exposure during military service. Dr. M. further noted that he had examined many individuals with moderate to severe hearing losses as result of military service, but rarely had he seen one with as severe hearing loss as the Veteran. Dr. M. concluded that "[i]t is my professional opinion that his hearing loss was caused by noise exposure while serving on active duty in the US Army." See Buddy/Lay Statement (medical statement) (May 2010). Similarly, in a medical statement received in May 2021, Dr. M. concluded that the Veteran's has current bilateral sensorineural hearing loss was "more likely than not" caused by his reported in-service events and acoustic injuries. It was noted that his medical opinion was based on clinical interview with the Veteran, which included his reported history of onset of decreased hearing acuity in service as well as noise exposure from performing duties as combat engineer, including detonation of 300 pound explosive device. See Medical Treatment Record - Government Facility (May 2021). Although Dr. M.'s private medical opinion was not based on a review of the claims folder, it is based on the Veteran's reported medical history, which the Board has determined to be credible. Given the foregoing, and resolving any doubt in the Veteran's favor, the Board finds that evidence of record is at least in equipoise on whether the Veteran's bilateral hearing loss is related to his acoustic trauma during service. Accordingly, the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to service connection for residuals of tonsillitis status post tonsillectomy, claimed as a throat disorder. The Veteran asserts that service connection is warranted for a throat disorder as residuals of a tonsillectomy. While he has reported continuity of sinus-related problems, he has not articulated what current symptomatology is associated with his claimed throat disorder as residuals of tonsillectomy. The Veteran provided no argument or evidence in conjunction with his claim for service connection for residuals of tonsillectomy during his July 2021 Board hearing. See Hearing Transcript (July 2021). The Board finds that the preponderance of the evidence is against finding that the Veteran has had a throat disorder as result of in-service tonsillitis, status post tonsillectomy, at any time during or approximate to the pendency of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013). Service treatment record (STRs) reflect that the Veteran was seen for chronic tonsillitis in May 1958 and that he underwent tonsillectomy in June 1958. STRs reflect no complaints or abnormal pathology of the throat or associated with tonsillitis or tonsillectomy. The Veterans April 1963 report of medical history at service separation noted the Veteran's removed tonsil, but did not show any history for sequelae or residuals associated with either tonsillitis or tonsillectomy. The first indication of a throat/tonsil problem is in February 2009 on the Veteran's VA disability application. See VA Form 21-526 (February 2009). However, the private and VA treatment records associated with the claims file do not show any lay or medical indication of disability. Neither VA nor private treatment records show that the Veteran receives care for or has complained of a throat disorder or residuals from tonsillitis status post tonsillectomy. Indeed, a December 2018 VA examination report shows that the Veteran reported an in-service tonsillectomy, but he denied any current symptoms or treatment. The examiner did not mark any current findings of a nose, throat, larynx, or pharynx condition. The VA examiner determined that the Veteran had a history of tonsillitis, status post tonsillectomy in 1958. The VA examiner found that the Veteran's tonsillitis in service was acute in nature and resolved with tonsillectomy, and there was no evidence of chronic throat disorder related to his status-post tonsillectomy. The VA examiner concluded that the Veteran's claimed throat disorder was less likely than not related to his in-service tonsillectomy or a residual of tonsillectomy. See C&P Exam (December 2018). The Board finds there is no credible persuasive evidence indicating that the Veteran suffers from a disability of the throat as a residual of tonsillitis or tonsillectomy. Importantly, neither the lay nor the medical evidence shows that the Veteran has any functional impairment of the throat. The Board accepts that symptoms, even without an underlying diagnosis, can still constitute a current disability for VA compensation purposes if it reaches the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, here, the Veteran has not asserted, nor does the medical evidence reflect, that he has throat symptoms that have caused any functional impairment of earning capacity. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. There is simply no competent evidence of that the Veteran has any residual throat disability associated with his in-service tonsillitis or tonsillectomy. Given the above, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The Board expressly defers a credibility determination in these matters until the development has been completed to the extent feasible. 1. Entitlement to service connection for a sinus disorder, including as due to the residuals of a nose fracture is remanded. The Veteran seeks entitlement to service connection for a sinus disorder. He reports that he has experienced sinus-related problems all his life, and he asserts that his sinus symptomatology was aggravated by multiple nose fractures he sustained during his military service. He reports that he underwent sinus surgery in late 1960's to clean out his sinuses after his nose had been broken three different times during fights while on active duty. See Correspondence (April 2009) and C&P Exam (December 2018). The Veteran's STRs show that he reported a medical history of mild hay fever at the time of his August 1955 enlistment, but he did not report any similar complaints at his separation from service. While his April 1963 ROMH shows a positive history of ear, nose, and throat problems, the Veteran only reported a history of tonsillitis, status post tonsillectomy, and he did not indicate any specific history of broken nose or nasal fractures. See STR-Medical (July 2009). Post-service, sinus-related problems are first documented in January 1976. A paranasal x-ray report revealed clouding of both maxillary sinuses, and the Veteran was treated for acute sinusitis. There was no history sinus or nose surgery at that time. A 1993 private medical record does show a history of nose repair. See Medical Treatment Record - Non-Government Facility (March 2009). VA treatment records reflect that the Veteran receives private treatment from an Ear, Nose, and Throat (ENT) specialist, for his sinus disorder. See CAPRI However, the record does not reflect efforts to obtain these relevant, reasonably identified, and outstanding private treatment records. Thus, a remand is needed to afford the Veteran an opportunity to authorize release of these relevant records to VA or otherwise provide copies to VA. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). 2. Entitlement to service connection for a lumbar spine disorder is remanded. The Veteran asserts that his lumbar spine disorder was aggravated by his military service. See VA 21-526EZ (October 2018). The Veteran reports an onset of chronic low back pain in 1964, although he did not seek medical attention until 1970s due to continued symptoms. See C&P Exam (December 2018). The Veteran's STR reflect a finding of mild lordosis on both his August 1955 enlistment and April 1963 separation examination reports. In October 1956, he also reported a history of back trouble since he had spinal meningitis in 1952, prior to his enlistment. See STR-Medical (July 2009). The December 2018 VA examination report shows a current diagnosis of lumbosacral strain. A December 2018 VA medical opinion reflects that it is less likely than not that the Veteran's current lumbar spine disorder was incurred in or caused by in-service injury, event, or illness. The rational was "there is no objective evidence of a chronic back condition that was incurred in or caused by back pain during service. A nexus has not been established." The Board finds that a remand is necessary as the December 2018 VA medical opinion (VAMO) is inadequate. 38 C.F.R. § 3.159 (c). An adequate medical opinion must be "accurate and fully descriptive," 38 C.F.R. § 4.1, and based on an accurate factual premise and consideration of a veteran's prior medical history, Ardison v. Brown, 6 Vet. App. 405, 407 (1994). In addition, the opinion "must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see Nieves-Rodriguez, 22 Vet. App. at 304 ("most of the probative value of a medical opinion comes from its reasoning"). An adequate medical examination report or opinion must also "sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion." Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012). In sum, although an examiner need not discuss all potentially favorable or unfavorable evidence in order to render an adequate opinion, see Monzingo, 26 Vet. App. at 105, it must be clear that the examiner was "informed of sufficient facts upon which to base an opinion relevant to the problem at hand." Nieves-Rodriguez, 22 Vet. App. at 303. Here, the December 2018 VAMO is inadequate because it appears to be based on an inaccurate medical premise. See Reonal v. Brown, 5 Vet. App. 460, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). The opinion notes a lack of chronic back disorder in service, and but fails to provide any discussion of the mild lordosis finding noted on both his August 1955 enlistment and April 1963 separation examination reports, as well as his complaints of continued back pain since his pre-service 1952 spinal meningitis. Moreover, the essential rationale of the examiner's opinions is not discernable. Monzingo, 26 Vet. App. at 106. The VAMO made no attempt to connect the lack of treatment to its conclusion that his current lumbar spine disorder was not incurred in service. Also, the VAMO does not adequately address whether the Veteran's mild lordosis, noted on service entry, was permanently aggravated beyond its natural progression by his service. Therefore, remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate). 3. Entitlement to service connection for bilateral foot disorder, to include pes planus is remanded. The Veteran asserts that his bilateral pes planus was aggravated by his military service. See VA 21-526EZ (October 2018). He reports that he first experienced heel pain during military service, and he was treated for plantar fasciitis in 2005. See C&P Exam (December 2018). The Veteran's STR reflect finding of pes planus, grade II, asymptomatic, on his August 1955 enlistment examination report, but he did not report any foot problems on the associated ROMH. STRs do not show that the Veteran sought treatment for any foot-related problems. On his April 1963 examination prior to separation, he was assessed with bilateral pes planus, first degree, and he reported a history of foot trouble on the associated ROMH. See STR-Medical (July 2009). The December 2018 VA examination report shows current diagnoses of bilateral pes planus and hallux valgus. The December 2018 VA examiner concluded that it is less likely than not that the Veteran's claimed foot disorder was incurred in or caused by in-service injury, event, or illness. The rational was "there is no objective evidence of a chronic bilateral foot condition that is at least as likely as not incurred in or cause by pes planus during service. A nexus has not been established." The Board finds that a remand is necessary as the December 2018 VAMO is inadequate. 38 C.F.R. § 3.159(c). First, the December 2018 VAMO appears to be based on an inaccurate factual premise and present with internal incongruities, and it is inadequate. See Reonal, supra. While the examination lists the date of onset of the Veteran's pes planus during service, the opinion appears to be based on the absence of chronic foot disorder in service. Moreover, there is no indicate that the examiner reviewed and considered the findings of pes planus on the August 1955 enlistment and April 1963 separation examination reports as well as his positive history of foot trouble prior to separation. Next, the essential rationale of the opinion is not discernable. Monzingo, 26 Vet. App. at 106. The VAMO does not provide the Board a reasoned rationale explaining that supports the negative conclusions. Lastly, VAMO is inadequate because it does not reflect a meaningful discussion of the Veteran's lay statements. See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016). In this regard, the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology such as foot pain. If there is a medical basis to support or doubt the history provided by the Veteran, the clinician should provide a fully reasoned explanation. For instance, while the examination noted the Veteran's reports of the onset of heel pain, which began during service and has continued, the opinion itself did not address the Veteran's reports. Therefore, remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate). 4. Entitlement to service connection for tinnitus is remanded. The Veteran seeks entitlement to service connection for tinnitus. He contends that he developed tinnitus as result of exposure to loud noises during service. As discussed above, the Board has already conceded in-service acoustic trauma. During his Board hearing, the Veteran testified that he first experienced ringing in ears following his detonation of over 300 pounds explosives without any hearing protection during service. He did not seek treatment for the ringing in his ears during service because he was advised that the tinnitus would dissipate in a few days. Although it did not fully resolve as he experienced intermittent ringing, he did not feel it was significant enough to seek medical attention. See Hearing Transcript (July 2021). The record does not show that the Veteran has consistently reported tinnitus symptomatology. The Veteran had denied any history of "running ear" on his April 1963 ROMH. See STR-Medical (November 2009). He also denied any tinnitus symptoms during the November 2009 VA audiology examination, and during his December 2018 VA audiology examination, the Veteran reported his tinnitus had an onset in the 1980s. See VA examination (November 2008) and C&P Exam (December 2018). Moreover, in the December 2018, the VA examiner concluded that the Veteran's tinnitus is less likely than not caused by or result of military noise exposure. The rational in support of the opinion was the Veteran reported a post-service onset of his tinnitus, and there is no report of tinnitus in STRs, at separation, or in medical records prior to date of claim. Further, a review of the current medical literature did not support late onset noise-induced tinnitus. See C&P Exam (December 2018). However, the Veteran has also indicated that his tinnitus is secondary to his bilateral hearing loss disability. See VA 21-4138 Statement in Support of Claim (May 2010). As his bilateral hearing loss disability is now service-connected, an addendum medical opinion regarding new medical opinion regarding secondary service connection must be obtained on remand. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for signs, symptoms, or treatment of his claimed back, sinus, and tinnitus disorders, including from Dr. T. W. Winford, Ear, Nose, and Throat specialist. Make two requests for the authorized records from all identified sources unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum medical opinion from an appropriate physician that addresses the Veteran's low back disorder. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that there was an increase in severity of the pre-existing lumbar lordosis during service? (b.) If the examiner finds that there was an increase in severity during service, the examiner should further render an opinion as to whether any such increase was clearly and unmistakably (obvious and manifest) due to the natural progress of the disorder. NOTE (1): The term "clear and unmistakable evidence" means that the evidence cannot be misinterpreted or misunderstood, i.e., the evidence is undebatable. NOTE (2): This examiner should consider and discuss the diagnosis of lordosis, mild at both service entry and separation, as well as in-service complaints of low back pain. (c). Whether the Veteran's current lumbosacral strain at least as likely as not began in or is otherwise related to service, to include in-service complaints of low back pain. A complete rationale must be provided for all opinions expressed. 3. Obtain an addendum medical opinion from an appropriate physician that addresses the Veteran's bilateral foot disorder. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that there was an increase in severity of the pre-existing bilateral pes planus during service? (b.) If the examiner finds that there was an increase in severity during service, the examiner should further render an opinion as to whether any such increase was clearly and unmistakably (obvious and manifest) due to the natural progress of the disorder. NOTE (1): The term "clear and unmistakable evidence" means that the evidence cannot be misinterpreted or misunderstood, i.e., the evidence is undebatable. NOTE (2): This examiner should consider and discuss the diagnosis pes planus, grade II, asymptomatic at service entry, in-service complaints of foot pain, and assessment of pes planus, first degree at service separation. (c.) Whether the Veteran's current hallus valgus at least as likely as not began in or is otherwise related to service, to include in-service complaints of foot trouble. A complete rationale must be provided for all opinions expressed. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's tinnitus is at least as likely as not (a) proximately due to service-connected hearing loss disability, or (b) aggravated beyond its natural progression by service-connected bilateral hearing loss disability. 5. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M., 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.