Citation Nr: 21068035 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 16-63 335 DATE: November 8, 2021 REMANDED The claim of entitlement to service connection for a hearing loss disorder is remanded. The claim of entitlement to service connection for muscle myalgia and fatigue in the right lower extremity is remanded. The claim of entitlement to service connection for muscle myalgia and fatigue in the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1989 to April 1992. This matter comes to the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Veteran testified in a hearing before the Board. A transcript of the hearing is included in the electronic claims file and has been reviewed. In March 2020, the Board remanded the claims on appeal for additional development. Another remand is warranted. Pursuant to the March 2020 remand, the Veteran underwent VA examinations in July 2020. Addendum reports are necessary to decide the claims. With regard to the VA report addressing hearing loss: the record is clear that the Veteran experienced acoustic trauma during service, as is evidenced by his lay statements and by the fact that he worked around grenades, automatic weapons, and stinger missiles during service. But the examiner appeared to express doubt about his in-service exposure. In an addendum report, the examiner should revisit the opinion with the proper foundation of in-service noise exposure. Further, the examiner based the negative nexus opinion on the absence of evidence of hearing loss at discharge from service, without adding details to the rationale. The examiner should discuss other evidence of record, to include evidence dated following service, in determining whether hearing loss was incurred in service, despite the negative audiogram noted in the April 1992 discharge report of medical examination. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993) ("when audiometric test results at a veteran's separation from service do not meet the regulatory requirements for establishing a 'disability' at that time, he or she may nevertheless establish service connection for a current hearing disability by submitting evidence that the current disability is causally related to service.") With regard to the VA report addressing lower extremity problems: the examiner did not address the gist of the Board's March 2020 remand inquiry whether the Veteran has celiac disease and, if so, whether the disorder affects the lower extremities. VA treatment records dated in 2019-20 are unclear on whether celiac disease is present. Evidence indicates diagnosis of the disorder in 2019 but also indicates a negative biopsy for the disorder in 2020. Other evidence indicates that the Veteran has antibodies for celiac disease. In sum, the evidence is not clear regarding whether the Veteran has had celiac disease during the appeal period. Cf. McLain v. Nicholson, 21 Vet. App. 319 (2007). Further, if it is determined that he has had the disorder during the appeal period, the examiner should comment on whether the disorder relates to the Veteran's lower extremity myalgias, neuralgias, arthralgias, fibromyalgia, and radiculopathy. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the claims to the extent possible. Include in the record any outstanding VA treatment records, the most recent of which are dated in June 2020. All records/responses received must be associated with the electronic claims file. 2. Return the case to the examiner who wrote the July 2020 VA report addressing hearing loss, or to a suitable substitute, for issuance of an addendum opinion. After reviewing the electronic claims file, the examiner should again address the following question: Is it at least as likely as not (i.e., probability of 50 percent or more) that a hearing loss disorder is related to a disease, event, or injury during service? In answering this question, accept as true in-service noise exposure. Also, do not rely solely on the negative audiogram conducted at separation from service. Consider evidence dated from service and whether that evidence indicates that a hearing loss disorder may have developed after service as the result of noise exposure during service. In particular, address the significance, if any, of the following the March 1992 audiogram, conducted one month prior to discharge, a November 2002 VA audiology examination report, and a December 2013 VA audiology examination report, each of which indicates elevated thresholds in each ear at 500 Hertz. 38 C.F.R. § 3.385. Please explain in detail any opinion provided and the supporting rationale. 3. Return the case to the examiner who wrote the July 2020 VA report addressing lower extremity pain, or to a suitable substitute, for issuance of an addendum opinion. After reviewing the electronic claims file, the examiner should again address the following questions: a. Has the Veteran had celiac disease during the appeal period (since August 2013)? b. If so, is it at least as likely as not (i.e., probability of 50 percent or more) that the diagnosed myalgia, fibromyalgia, neuralgia, or arthralgia is due to celiac disease? In answering this question, address the issue raised by medical evidence in late 2019, that the Veteran's lower extremity symptoms may relate to celiac disease. In doing so, determine whether the record supports a finding that the Veteran had this disorder at one time, despite the negative biopsy in February 2020. Please explain in detail any opinion provided and the supporting rationale. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.