Citation Nr: 21068423 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-60 083 DATE: November 10, 2021 REMANDED Entitlement to service connection for left ear hearing loss is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from April 19, 1985 to August 31, 1992, December 1, 2001 to November 12, 2002, March 3, 2003 to March 1, 2004, and from August 28, 2012 to November 25, 2012, with additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). These matters come before the Board of Veterans' Appeals (Board) on appeal from July and August 2016 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified at virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for left ear hearing loss is remanded. The Veteran underwent VA audiology examination in July 2016 and the examiner diagnosed sensorineural hearing loss in the left ear. However, the examiner provided a negative nexus opinion, reasoning that there was no significant threshold shifts during service. An addendum opinion was obtained in August 2016 and the examiner provided an identical opinion. However, hearing loss in service need not be shown for service connection to be established; rather, service connection may be established for a current hearing disability with evidence that the current disability is causally related to service. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993). In light of the above, the Board finds that a new VA examination would assist in adjudicating the claim for service connection. 2. Entitlement to service connection for hypertension is remanded. The Veteran underwent VA hypertension examination in June 2016. At that time, the examiner provided a negative nexus opinion, reasoning in part that it appeared that the Veteran's hypertension was a pre-existing condition as he had hypertension on his September 1984 enlistment examination. However, the Board notes that hypertension was not noted on the Veteran's 1984 enlistment examination. Rather, his blood pressure reading was 158/70 at that time but hypertension was not diagnosed. An addendum opinion was obtained in November 2017. At that time, the examiner provided a negative nexus opinion, reasoning that the Veteran was not diagnosed with hypertension during service as he did not have elevated blood pressure readings consistent with a diagnosis of hypertension during service. The examiner stated that the Veteran's elevated blood pressure readings on an enlistment examination was subsequently followed by normal blood pressure readings in the 1980s. Among other things, the examiner stated that the earliest evidence of a diagnosis of hypertension were blood pressure readings from March 2013 into 2014. However, the Board notes that the Veteran's service treatment records do show that he was diagnosed with marginal hypertension in April 1991. Thus, the Board finds the opinion insufficient and based on an inadequate factual predicate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (once VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). In light of the above, the Board finds that the Veteran should undergo VA hypertension examination and an opinion should be obtained upon remand. Updated treatment records should also be obtained upon remand. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After records development is completed, the Veteran should be afforded a VA audiological examination to determine the nature of his left ear hearing loss and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current left ear hearing loss disability of the arose during service or is otherwise related to service. In rendering the opinion, the audiologist should explain why the Veteran's current hearing loss is/is not merely a delayed response to in-service noise exposure. Please explain why or why not, to include addressing the Veteran's lay assertions and the November 2017 statements from his wife and daughter. See November 2017 buddy statements. 3. Schedule the Veteran for a VA hypertension examination to determine the nature of his hypertension and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Does the record reflect that the Veteran undebatably had hypertension that existed prior to his entry into any period of active duty service? Please explain why or why not, to include addressing the elevated blood pressure reading of 158/70 on the Veteran's September 1984 enlistment examination. The examiner should also address the Veteran's argument that one elevated blood pressure reading does not equate to hypertension preexisting service. See June 2021 hearing transcript and service treatment records. (b.) If it is undebatable that the Veteran's hypertension pre-existed any period of active duty service, did the condition undergo a permanent worsening during a period of active duty? Please explain why or why not, to include addressing the significance, if any, of the in-service elevated blood pressure readings, to include 140/80 on May 12, 1986; 140/80 on January 22, 1987; 138/84 on February 11, 1988; 168/66 on March 28, 1990; 155/82 and 152/85 on April 16, 1991 with a diagnosis of marginal hypertension; 132/94 on June 10, 1991; 144/82 in [unknown month] 1991; 159/86, 155/90, and 160/80 on April 10, 1992; 132/84 on April 13, 1992; 134/88 on July 20, 1992; 136/84 on July 21, 1992; 135/88 in August 1998; 138/90 on June 30, 2003; and 132/98 on December 10, 2003. See service treatment records. (c.) If the examiner concludes the pre-existing hypertension was worsened, the examiner should explain whether the worsening was undebatably the result of natural progression rather than the result of activities and/or incidents of active service. Please explain why or why not, to include addressing the in-service elevated blood pressure readings. (d.) For any pre-existing hypertension that was permanently worsened beyond normal progression (aggravated) during service, please opine whether any current hypertension is at least as likely as not (50 percent or greater probability) related to that in-service aggravation. Please explain why or why not, to include addressing the significance, if any, of the in-service elevated blood pressure readings. (e.) For any hypertension that did not pre-exist service, state whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hypertension is etiologically related to service. Please explain why or why not, to include addressing the significance, if any, of the Veteran's lay statements as well as the in-service elevated blood pressure readings, to include 140/80 on May 12, 1986; 140/80 on January 22, 1987; 138/84 on February 11, 1988; 168/66 on March 28, 1990; 155/82 and 152/85 on April 16, 1991 with a diagnosis of marginal hypertension; 132/94 on June 10, 1991; 144/82 in [unknown month] 1991; 159/86, 155/90, and 160/80 on April 10, 1992; 132/84 on April 13, 1992; 134/88 on July 20, 1992; 136/84 on July 21, 1992; 135/88 in August 1998; 138/90 on June 30, 2003; and 132/98 on December 10, 2003. See service treatment records. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Medina 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.