Citation Nr: 21064951 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 16-60 403 DATE: October 22, 2021 REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded REASONS FOR REMAND The appellant is a Veteran who served on active duty in the United States Air Force from November 1961 to August 1966 and on active duty in the United States Army from December 1990 to July 1991. Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 1. Service connection for bilateral hearing loss. First, the Board notes that the Veteran has current bilateral hearing loss that meets the criteria of 38 C.F.R. § 3.385 to be considered a disability for VA purposes. See October 2019 VA audiometric examination. The Board also notes that the Veteran's military occupation specialty (motor transport operator) exposed him to moderate levels of noise in service. Further, service treatment records (STRs) indicate that an April 1991 audiogram evaluation notes that the Veteran was routinely exposed to hazardous noise. This issue was previously remanded in December 2018 for a VA medical opinion and examination regarding service connection for bilateral hearing loss. A subsequent VA medical opinion was provided in October 2019; however, it was accompanied by inadequate rationale. The VA examiner's rationale stated that the Veteran had mild hearing loss in service and listed the dates of three audiograms taken in service. Then the examiner indicated that the Veteran's hearing loss appeared to have been transient as post service audiograms revealed hearing was within normal limits, bilaterally. Thus, the examiner opined that the Veteran's bilateral hearing loss is less likely than not related to service. The Board finds the October 2019 VA examiner's rationale inadequate for several reasons. First, the VA examiner's rationale discussed various audiogram examinations and stated there was no significant positive threshold shifts, however it did not mention the April 1991 audiogram which stated that the Veteran was routinely exposed to hazardous noise during service. The VA examiner also did not address the Veteran's lay statement that he was exposed to loud noise in service from jet engines and heavy army trucks. See April 2015 Notice of Disagreement (NOD). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, the Board finds the October 2019 VA audiological evaluation and opinion inadequate for adjudication purposes. An addendum VA medical opinion is necessary with regard to full and fair consideration of the Veteran's lay statements for his service connection claim for bilateral hearing loss. 2. Service connection for a low back disability. This issue was also previously remanded in December 2018 for a VA examination and medical opinion regarding the etiology of the Veteran's low back disability. A subsequent VA examination and medical opinion was provided in February 2021; however, it was also accompanied by inadequate rationale. The examiner opined that the Veteran's low back disability was less likely than not related to service. The examiner stated that post service treatment records do not establish chronicity of care and STRs are silent for back complaints. Thus, the examiner concluded their rationale by stating that a nexus was not established. The examiner mentioned findings in STRs and also post-service treatment records but did not explain how those findings relate to not establishing a nexus. A complete rationale was not provided. Further, the VA examiner did not discuss or comment on the Veteran's lay statement that he injured his low back in service while jumping down from the cab of a truck. See April 2015 correspondence letter. Additionally, the Board notes that the February 2021 VA examiner reported on the Veteran's VA examination that the Veteran's low back pain came from repetitive bending, twisting, and lifting while in service. The Veteran also asserted that his back pain has progressively gotten worse. Nonetheless, the VA examiner, when providing the nexus medical opinion, did not discuss or comment on the assertions made by the Veteran during the examination. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Therefore, since the VA examination and opinion did not address all of the evidence and did not provide a complete rationale, a further addendum opinion for service connection for a low back disability is necessary. 3. Service connection for right and left knee conditions. This issue was also previously remanded in December 2018 for a VA examination and medical opinion regarding the etiology of the Veteran's bilateral knee conditions. A subsequent VA examination and medical opinion was provided in February 2021; however, further opinion is necessary. First, the February 2021 VA examiner opined that the Veteran's bilateral knee conditions were less likely than not related to service. For both knees, the examiner stated that in April 2015, the Veteran was diagnosed with a bilateral knee sprain and that currently the Veteran still has a bilateral knee strain. The examiner also stated that the April 2015 x-rays did not show any acute findings. The examiner concluded their rationale by stating that there was nothing to show complaints of knee pain starting in service and continuing to the present, showing no nexus has been established. The examiner did comment on STRs indicating that in February 1991, medical notes stated that the Veteran had swelling in the left leg-calf area. The examiner mentioned findings in STRs and also post-service treatment records but did not explain how those findings relate to not establishing a nexus. Additionally, the VA examiner did not discuss or comment on the Veteran's lay statements provided in September 2015 that he injured both knees in service jumping down from the cab of a truck. Further the Board notes that the Veteran was provided with two VA knee examinations: one in February 2021 and another in June 2021. Significantly, both examinations provided different diagnoses. The February 2021 examination listed that the Veteran had a bilateral knee strain, diagnosed in February 2021, and the June 2021 examination listed that the Veteran had arthritis in both knees, diagnosed in 2002. The June 2021 VA examination was not accompanied with a VA medical opinion, regarding the arthritis diagnosis. Additionally, the Board notes that at the February 2021 examination the Veteran reported that the frequency of his bilateral knee pain was 3-4 times monthly, with a duration lasting 2-3 days. At the June 2021 examination, the Veteran reported that the frequency of his bilateral knee pain was daily, with a constant duration of pain, indicating the Veteran's symptoms have potentially worsened since his last examination. The Veteran also asserted at both examinations that his knee pain began in service and has continued since. As the VA examinations and opinions did not address all of the evidence and did not provide a complete rationale, a further addendum opinion is necessary. See Bowling v. Principi, at 12. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the current etiology of any bilateral hearing loss. The Veteran should receive another in-person VA examination if the clinician deems it to be necessary. The examiner must provide a complete written history, including all statements and reports made by the Veteran as to his military service. The VA examiner should offer the following opinion: Is it at least as likely as not (50 percent or greater probability) that any bilateral hearing loss had onset in service or is otherwise related to his periods of active service, to include noise exposure. In rendering the opinion requested above, the examiner MUST discuss and comment on: (a.) The Veteran's lay statements in his 2015 NOD that he had loud noise exposure in service from jet engine and heavy army truck noise, (b.) The Veteran's military occupation specialty (motor transport operator); and (c.) An April 1991 STR audiogram note that the Veteran was routinely exposed to hazardous noise. 2. Obtain an addendum opinion from an appropriate clinician to determine the current etiology of the low back disability. The Veteran should receive another in-person VA examination if the clinician deems it to be necessary. The examiner must provide a complete written history, including all statements and reports made by the Veteran as to his military service. The VA examiner should offer the following opinion: Is it at least as likely as not (50 percent or greater probability) that the low back disability had onset in service or is otherwise related to his periods of active service. In rendering the opinion requested above, the examiner MUST discuss and comment on: (a.) The Veteran's lay statement during the February 2021 VA examination that the low back pain came from repetitive bending, twisting, and lifting while in service and that his back pain has progressively gotten worse; and (b.) The April 2015 correspondence letter where the Veteran asserted that he injured his low back in service while jumping down from the cab of a truck. 3. Obtain an addendum opinion from an appropriate clinician to determine the current etiology of the right knee condition and left knee condition. The Veteran should receive another in-person VA examination if the clinician deems it to be necessary. The examiner must provide a complete written history, including all statements and reports made by the Veteran as to his military service. All diagnoses related to the Veteran's bilateral knee conditions should be listed. The VA examiner should offer the following opinion: Is it at least as likely as not (50 percent or greater probability) that the right knee condition and/or left knee condition had onset in service or is otherwise related to his periods of active service. In rendering the opinion requested above, the examiner MUST discuss and comment on: (a.) The Veteran's lay statements provided in September 2015 that he injured both knees in service jumping down from the cab of a truck; and (b.) The Veteran's bilateral arthritis knee diagnosis at the June 2021 examination. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. The entire claims file, including a copy of this REMAND, must be reviewed. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.