Citation Nr: 21063302 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 16-49 525 DATE: October 13, 2021 ORDER The claim of entitlement to service connection for left ear sensorineural hearing loss (SNHL) is reopened; to this extent only, the claim is granted. The claim of entitlement to service connection for a low back condition is reopened: to this extent only, the claim is granted. The claim of entitlement to service connection for a right knee condition is reopened; to this extent only, the claim is granted. Severance of service connection for a right eyebrow scar was improper; restoration of service connection for a right eyebrow scar is granted. Entitlement to an initial compensable disability rating for a right eyebrow scar is denied. REMANDED Entitlement to service connection for bilateral SNHL is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a right ankle condition is remanded. Entitlement to service connection for a low back condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for residuals of a right wrist fracture is remanded. Entitlement to service connection for residuals of a fracture of the pubic ramus is remanded. Entitlement to service connection for a bilateral foot condition is remanded. Entitlement to service connection for residuals of a closed head injury is remanded. Entitlement to service connection for a headache condition is remanded. Entitlement to a total disability rating based on individual unemployability as due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Evidence received since the unappealed and final June 2006 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for left ear SNHL and raises a reasonable possibility of substantiating such claim. 2. Evidence received since the unappealed and final June 2006 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for a low back condition and raises a reasonable possibility of substantiating such claim. 3. Evidence received since the unappealed and final July 2008 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for a right knee condition and raises a reasonable possibility of substantiating such claim. 4. The grant of service connection for a right eyebrow scar, pursuant to a March 2012 rating decision, was not clearly and unmistakably erroneous. 5. The Veteran has a one and one fourth-inch scar above his right eyebrow; throughout the appeal period, the scar has never been painful or unstable and has not exhibited any characteristics of disfigurement. CONCLUSIONS OF LAW 1. New and material evidence has been received, and the claim of service connection for left ear SNHL may be reopened. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.104, 3.156. 2. New and material evidence has been received, and the claim of service connection for a low back condition may be reopened. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.104, 3.156. 3. New and material evidence has been received, and the claim of service connection for a right knee condition may be reopened. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. §§ 3.104, 3.156. 4. The severance of service connection for a right eyebrow scar was improper; the criteria for restoration of service connection for prostate cancer have been met. 38 U.S.C. § 5112; 38 C.F.R. § 3.105. 5. The criteria for entitlement to an initial compensable disability rating for a right eyebrow scar have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7800. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1982 to March 1985. These matters were last before the Board in December 2019, whereupon they were remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record. Following the issuance of a June 2021 supplemental statement of the case continuing the denial of the request to open the claims of service connection for a right ankle condition, left ear hearing loss, a low back condition, and a right knee condition, as well as continuing the denial of the other service connection claims listed above, the case was returned to the Board for its adjudication. The Board notes that, during the pendency of the underlying appeal of the above-listed issues, the AOJ separately promulgated an April 2018 rating decision severing service connection for a right eyebrow scar. Following the Veteran's submission of a March 2019 notice of disagreement, that severance was affirmed in a March 2020 statement of the case. The Veteran then appealed the affirmation of the severance via submission of a May 2020 VA Form 9; however, the appeal of the severance was not certified to the Board until October 2021. In light of the fact that the claim seeking an increased rating of the right eyebrow scar is directly implicated by the separate severance of service connection for the same claimed disability, the distinct appeal has been merged with the appeal currently before the Board so that the Board may address the highly relevant issue of whether severance of service connection for a right eyebrow scar was proper. That issue has been added to those that were previously remanded by the Board in December 2019 and is addressed below. Reopening Previously Denied Claims Final decisions may only be reopened if new and material evidence is received. 38 U.S.C. § 5108. "New evidence" is defined as existing evidence not previously submitted to agency decision makers; "material evidence" is defined as existing 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 of record at the time of the most recent final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For the singular purpose of determining whether new and material evidence has been submitted that is sufficient to reopen a claim, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). This presumption does not extend to the weight of the evidence, however. Id. The presumption of credibility is rebuttable when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19, 21 (1993). The United States Court of Appeals for Veterans Claims (the Court) has endorsed a low threshold standard for reopening a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). As the Court stated in Shade, when making a determination whether the submitted evidence meets the definition of new and material evidence, the Board should consider whether the evidence could, if the claim was reopened, reasonably result in substantiation of the claim, either by triggering the VA's duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. The AOJ denied the Veteran's claims of entitlement to service connection for a low back condition, right knee condition, and left ear in a June 2006 rating decision. In support thereof, the AOJ noted that there was no evidence that the Veteran had a current diagnosis of any of these three conditions. The Veteran did not file a notice of disagreement, nor was new and material evidence received within one year of the rating decision. Thus, the June 2006 rating decision became final by operation of law, except that the claims may be reopened if new and material evidence is received. 38 U.S.C. § 7105(c); 38 C.F.R. § 3.156. Regarding the left ear hearing loss, since that denial, the Veteran has undergone two VA audiology examinations, one in October 2010 and again in August 2015, which at least raise the suggestion that he may have diagnosable left ear hearing loss for VA benefits purposes. Similarly, since the June 2006 denial, the Veteran underwent a May 2011 VA general medical examination, during which he was diagnosed with right knee patellofemoral pain syndrome and a mild lumbar strain manifested by some impairment of forward flexion. These examination results raise a reasonable possibility of substantiating the service connections claims, and as such those claims are reopened. The reopened claims of service connection for a low back condition, right knee condition, and left ear hearing loss are addressed in the REMAND section below, with the separate single-ear hearing loss claims now merged as one bilateral hearing loss claim. Propriety of the Severance of Service Connection for a Right Eyebrow Scar The AOJ originally granted service connection for a right eyebrow scar in a March 2012 rating decision. In support thereof, the AOJ referred to no evidence other than the opinion of an October 2010 VA examiner, who determined that the Veteran's right eyebrow scar was a residual of an in-service injury when the Veteran fell out of a window. The AOJ issued a rating decision in September 2016 proposing to sever service connection for the right eyebrow scar condition. The AOJ explained that service connection had been granted for a right eyebrow scar as a residual of an in-service injury when the Veteran fell out of a window. However, the AOJ noted that the injury was determined to be the result of the Veteran's own willful misconduct as he was recorded as having a blood alcohol level at the time of the incident that reflected intoxication. As detailed by the AOJ, service connection cannot be established for a disability that is found to be the result of the Veteran's own willful misconduct; thus, the AOJ determined that the August 2013 rating decision was clearly in error for granting service connection based on Agent Orange exposure. The AOJ thereafter issued an April 2018 rating decision severing service connection. Service connection will be severed only where evidence establishes that it is clearly and unmistakably erroneous (CUE) (the burden of proof being on the Government). 38 C.F.R. § 3.105(d). When severance of service connection is considered warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The claimant will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(d). A change in diagnosis may be accepted as a basis for severance action if the examining physician or physicians or other proper medical authority certifies that, in the light of all accumulated evidence, the diagnosis on which service connection was predicated is clearly erroneous. This certification must be accompanied by a summary of the facts, findings, and reasons supporting the conclusion. 38 C.F.R. § 3.105(d). To establish that a grant of service connection was the product of CUE, VA must show that (1) either the correct facts as they were known at the time were not before the adjudicator, the adjudicator made an erroneous factual finding, or the statutory or regulatory provisions were incorrectly applied; (2) the alleged error was undebatable, not merely a disagreement as to how the facts were weighed or evaluated; and (3) the error manifestly changed the outcome of the prior decision. See Allen v. Nicholson, 21 Vet. App. 54, 58-59 (2007); Stallworth v. Nicholson, 20 Vet. App. 482, 487-88 (2006); cf. Bustos v. West, 179 F.3d 1378, 1380-81 (Fed. Cir. 1999); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14, 319 (1992) (en banc). A clear and unmistakable error is one about which reasonable minds could not differ. See, e.g., 38 C.F.R. § 20.1403(a). In most respects, the CUE standard for severing service connection under § 3.105(d) is equivalent to the CUE standard for reversing or revising a prior final decision under 38 C.F.R. § 3.105 (a). See Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). Section 3.105(d) places at least as high a burden of proof on VA when it seeks to sever service connection as § 3.105(a) places upon an appellant seeking to have an unfavorable previous determination overturned. However, the determination is not limited to the law and the record that existed at the time of the original decision. VA may consider medical evidence and diagnoses that postdate the original award of service connection to demonstrate that the diagnosis on which service connection was predicated is clearly erroneous. Stallworth, 20 Vet. App. at 488. The Secretary's burden is not to prove clear and unmistakable error in the original decision in the same manner a claimant would show CUE under applicable laws and regulations. A decision that is reversed or amended on the basis of CUE is revised to conform to the true state of the facts or the law that existed at the time of the original adjudication. Allen, 21 Vet. App. at 62. The first question for the Board is whether the AOJ followed the due process requirements of 38 C.F.R. § 3.105(d) for severing service connection. In the Board's estimation, the AOJ did follow the proper due process steps for severing service connection. The AOJ issued the proposed rating in September 2016, the Veteran was notified at the latest address of record of this contemplated action in a letter dated in January 2018 and furnished detailed reasons therefor, and was given 60 days for the presentation of additional evidence to show that service connection should be maintained. The January 2018 notice letter also informed the Veteran that he had the opportunity for a hearing if such a request for a hearing was received within 30 days from the date of the notice. See 38 C.F.R. § 3.105(i). The Veteran did not present any new evidence, nor did he request a hearing in opposition to the severance. The AOJ issued the April 2018 rating decision, which severed service connection for a right eyebrow scar prospectively effective July 1, 2018. Notice of this rating decision, plus appeal rights, was sent to the Veteran in April 2018. The July 1, 2018 effective date was greater than the last day of the month in which a 60-day period from the date of the April 2018 notice expired. Thus, all due process requirements were met in the severance of service connection for a right eyebrow scar. See 38 C.F.R. § 3.105(d). Having met the due process requirements, the remaining question before the Board in this case is whether the grant of service connection for a right eyebrow scar was clearly and unmistakably erroneous. Regarding the characteristics of clear and unmistakable evidence, the word 'unmistakable' means that an item cannot be misinterpreted and misunderstood, i.e., it is undebatable. Vanerson v. West, 12 Vet. App. 254, 258 (1999) (citing Webster's New World Dictionary 1461 (3rd Coll. ed. 1988) (other citations omitted). The Board concludes that the severance of service connection for a right eyebrow scar was improper because the evidence is not clear and unmistakable, as the term is understood in law, that the Veteran's in-service injury that occurred when he fell out of a window was due to his own willful misconduct. Without detailing the entirety of the record and the legal guidelines underlying the analysis of whether the Veteran's in-service injury was due to his own willful misconduct, the Board notes simply that relevant development is still pending concerning whether the Veteran had a psychiatric disorder during service which contributed to his development of an alcohol abuse disorder which in turn led to the in-service injury of which the right eyebrow scar is a residual. Indeed, this pending development forms the basis of the Board's below-detailed remand instructions. Under these circumstances, the Board does not find that the AOJ's determination that the Veteran's in-service injury was due to his own willful misconduct was "clear and unmistakable," but was instead premature. As such, the severance of service connection for a right eyebrow scar was improper, and restoration is warranted. Entitlement to a Compensable Rating for a Right Eyebrow Scar As detailed above, the Board has determined that severance of service connection for a right eyebrow scar was improper and so service connection for the disability has been restored. The Veteran seeks entitlement to a compensable rating for the right eyebrow scar for the entirety of the appeal period. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. During the appeal period the skin disorder has been evaluated pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7800, pertaining to scars of the head, face, or neck. VA amended the rating criteria for skin conditions during the period on appeal, effective August 13, 2018. See 83 Fed. Reg. 32,597 (July 13, 2018); 83 Fed. Reg. 38,663 (Aug. 7, 2018). Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7800 lists the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. Note (3) specifies that unretouched photographs should be taken into consideration. Note (4) instructs to separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply § 4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code. Note (5) specifically instructs that the characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. Diagnostic Code 7804 states in relevant part that: one or two scars that are unstable or painful warrant a 10 percent evaluation. Three or four scars that are unstable or painful warrant a 20 percent evaluation. Note (1) to the diagnostic code states that "An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar." Note (2) to the diagnostic code states that "If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars." Note (3) provides that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804. Diagnostic Code 7805 allows for the evaluation of any disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code. The relevant evidence of record includes only the October 2010 VA scar examination, during which the Veteran reported that he had a residual scar above his right eyebrow attributable to a laceration injury he received when he fell through a window during service. He did not exhibit any skin breakdown and endorsed experiencing only slight discomfort around the scar on an occasional basis. Upon physical examination, the examiner noted that the scar was about one and one-fourth inches long, well-healed, superficial, and stable, with no keloid formation. The examiner further noted that the scar was not deep, did not exhibit any edema or inflammation, and did not contribute to any limitation of motion or function. As for the eight characteristics of disfigurement, the examiner answered in the negative for all eight except that she acknowledged that the right eyebrow scar was slightly hypopigmented compared to the surrounding skin. There is no indication, however, that this hypopigmentation covered an area exceeding six square inches. A review of available VA medical records does not reflect that the Veteran has received any specific treatment for his right eyebrow scar or has asserted that any symptomatology associated with the disability has worsened in severity since the October 2020 examination. In summation, the evidence of record, to specifically include the October 2010 VA examination, fails to show any compensably disabling effects resulting from this scar. The 2010 examination showed that the Veteran has a one and one fourth inch long scar above his right eyebrow that is not painful or unstable. According to the examiner, the scar did not result in any limitation of function. Furthermore, the examiner did not document that the Veteran exhibited any of the eight characteristics of disfigurement, and the Veteran has not otherwise asserted that this is so. There are no additional medical records available in the claims file which detail the severity of the right eyebrow scar. The Veteran has not contended that his scar is painful or unstable, or that he experiences any of the symptomatology that would warrant a compensable rating. Considering that no disabling effects associated with the scar have been shown, there exists no basis for a compensable scar rating under the applicable diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7800. Furthermore, as there is no basis for assigning a compensable rating under any other potential diagnostic codes, entitlement to a compensable rating for the right eyebrow scar is denied. 38 C.F.R. § 4.118, Diagnostic Codes 7800, 7801, 7802, 7804. The appeal is denied as to this claim. REASONS FOR REMAND 1. Service connection for bilateral SNHL and tinnitus is remanded. The Veteran was last afforded a VA examination to evaluate the likely etiology of his bilateral SNHL in October 2010, during which it was determined that he did not meet the criteria for a diagnosis of hearing loss in either ear for VA compensation purposes. As a reminder, for the purposes of applying the laws administered by VA, impaired hearing will be considered 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 threshold for at least three of the frequencies 500, 1000, 2000, 3000, 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. On this basis, the AOJ denied entitlement to service connection for bilateral SNHL in the March 2012 rating decision, the appeal of which is presently before the Board. Since that March 2012 rating decision, the Veteran underwent a VA audiometric examination in August 2015 which raises the suggestion that he may have hearing loss in the left ear. Although the results of the audiometric testing were not detailed in the examination report, the examiner did determine that the Veteran had normal hearing in his right ear through 4000 Hz as well as normal hearing in his left ear through 2000 HZ and a mild to moderate SNHL. In light of this evidence in support of a diagnosis of SNHL, in addition to the over 10 year span of time since the last examination, the Board finds that the Veteran is entitled to a contemporary VA audiology examination to evaluate the nature and likely etiology of the claimed bilateral SNHL. Hart v. Mansfield, 21 Vet. App. 505, 508 (2007). The Board further notes that the Veteran has never been afforded a VA examination to evaluate the nature and likely etiology of the claimed tinnitus condition. As the Veteran will be afforded an audiology examination in support of his bilateral SNHL claim that may produce evidence in support of his tinnitus claim, the Board finds that the tinnitus claim must also be remanded and reevaluated in light of the pending VA audiology examination to be afforded to the Veteran. 2. Service connection for a right ankle condition, a low back condition, a right knee condition, residuals of a right wrist fracture, residuals of a fracture of the public ramus, a bilateral foot condition, residuals of a closed head injury, and a headache condition are each remanded. The Veteran seeks service connection for the conditions listed above as attributable to an in-service injury that occurred in October 1984 when he fell out of a window. The AOJ in the January 2018 statement of the case denied the service connection claims listed above on the grounds that the Veteran's injury was due to his own willful misconduct in consuming a significant amount of alcohol prior to his injury as evidenced by his blood alcohol content taken during the immediate treatment following the injury. To that end, the Board in its prior October 2017 remand instructions requested that the AOJ secure an opinion as to whether the injury sustained in October 1984 was incurred in the line of duty. In addition, the AOJ was instructed to take reasonable steps to secure a Line of Duty (LOD) determination regarding whether the Veteran's October 1984 injury was due to his own willful misconduct. Upon remand, the AOJ was unsuccessful in its attempts to secure the requested LOD determination. There was no indication from the record that the AOJ attempted to contact any specific repositories of service records. The AOJ then procured an opinion in July 2019, wherein the chosen examiner found that it was less likely than not that the Veteran had a psychiatric disorder that was incurred in or caused by service. The only rationale provided was that the Veteran did not have a current mental disorder diagnosis. After the matter was returned to the Board, in a December 2019 decision the case was remanded again in order to take all reasonable steps to secure the requested LOD determination as well as an opinion addressing whether the Veteran had a psychiatric disorder in service that contributed to the alcohol abuse symptomatology that was documented in service and which ostensibly led to the October 1984 accident and subsequent injuries. After taking reasonable steps to attempt to obtain a copy of the in-service LOD determination, the AOJ was not able to secure any LOD determination that was made at the time of the injury. Copies of memoranda documenting the AOJ's attempts to secure the in-service LOD are of record and show that the AOJ did contact those record repositories explicitly mentioned by the Board in its prior remand. That being said, a copy of a September 2016 LOD determination by VA has been added to the claims file; the conclusion of that administrative decision was that the Veteran's injury was due to his own willful misconduct. As such, the Board acknowledges that the AOJ has fulfilled its duties with regards to its attempts to obtain a copy of the in-service LOD determination. In a February 2020 opinion, the chosen VA examiner found that it was less likely than not that the Veteran had a psychiatric disorder other than an alcohol abuse disorder that was incurred in or is otherwise attributable to service. Although the examiner noted that the Veteran had documented treatment for psychiatric symptomatology in service as well as substance abuse treatment, she highlighted the lack of a diagnosis of a psychiatric disorder both during service and thereafter. According to the examiner, the Veteran may have met the criteria for an adjustment disorder in service stemming from the deaths of both his mother and sister; however, the examiner found that to make such a determination would be speculative and limited to the time period in the aftermath of those deaths. The Board cannot rely on this opinion as the examiner has unfortunately not addressed the question at issue. It is clear that she understandably attempted to fit the query within the traditional framework for substantiating a claim of service connection; that is, the February 2020 examiner concluded that the Veteran did not have a currently diagnosed psychiatric disorder that was incurred in or is otherwise attributable to service. However, the operative query is instead whether the Veteran had a psychiatric disorder at the time of the 1984 injury that contributed to his alcohol abuse, as this question is necessary for resolution of the issue of whether the October 1984 injury occurred in the line of duty. Moreover, the February 2020 examiner's statement that it would be speculative to conclude that the Veteran had an adjustment disorder in service that led to his abuse of alcohol and resulting injury further complicates the Board's evaluation as it raises at least a small suggestion that the Veteran did indeed have a psychiatric disorder in service, however fleeting. Accordingly, the Board must regrettably remand this matter once again in order to secure an addendum opinion responsive to the Board's prior remand instructions, which are copied in large part below. Stegall v. West, 11 Vet. App. 268 (1998). Each of the service connection claims listed above are remanded and further adjudication must be deferred pending the results of this requested opinion. 3. Entitlement to TDIU is remanded. Entitlement to TDIU is intertwined with the service connection claims that are being remanded as the development requested by the Board may result in the grant of some or all of those service connection claims, thereby impacting the evaluation of the Veteran's TDIU claim. As such, the claim of entitlement to TDIU is remanded along with the above-detailed service-connection claims. Harris, supra. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA audiological examination to evaluate the nature and etiology of the Veteran's purported bilateral SNHL and tinnitus. The entire claims file, to include a complete copy of this REMAND, must be made available to the individual designated to examine the Veteran, and the examination report should include discussion of the Veteran's documented medical history and assertions. All necessary special studies or tests must be accomplished. The examiner is asked to first determine whether the Veteran has hearing loss in either ear pursuant to the diagnostic criteria as set out in 38 C.F.R. § 3.385. If SNHL is confirmed in either ear, the examiner must provide an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the SNHL is related to the Veteran's active service. Similarly, the examiner must also provide an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran has tinnitus that it related to service. In setting forth these opinions, the examiner should take into consideration the Veteran's account of noise exposure while in service. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion expressed. 2. Provide the claims file to the individual who issued the February 2020 opinion, or to another qualified VA medical professional if that individual is not available, in order to elicit an addendum opinion concerning the likelihood that the Veteran had a psychiatric disorder in service that contributed to his alcohol abuse. The claims file must be reviewed by the examiner, and the examiner must note that they have reviewed the claims file prior to issuing any opinion. After review of the entire record, the examiner is asked to specifically address whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran had a diagnosable psychiatric disorder during service, and, if so, whether that disorder contributed to his abuse of alcohol and the October 1984 injury when he fell out of a window. In rendering the opinion, the examiner must provide a rationale and consider and discuss all relevant medical and other objective evidence, to specifically include evidence in the Veteran's service medical records stating that he was assessed with alcohol abuse with psychologic dependence, that he had begun episodic binge drinking along with frequent alcohol abuse since the onset of personal and family problems, that he did not have symptoms of physical dependence, and stating that his alcohol abuse was secondary to loss. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.