Citation Nr: 21069457 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-41 291 DATE: November 18, 2021 ORDER Entitlement to an effective date earlier than April 28, 2014 for the grant of service connection for left ear hearing loss is dismissed. Entitlement to a compensable rating for left ear hearing loss is denied. New and material evidence having been received, reopening of the claim of entitlement to service connection for right ear hearing loss is granted. New and material evidence having been received, reopening of the claim of entitlement to service connection for lower extremity pain is granted. Entitlement to service connection for an acquired psychiatric disorder, to include unspecified schizophrenia spectrum and other psychotic disorder with other specified dissociative disorder, bipolar disorder, and multiple personality disorder, is granted. REMANDED Entitlement to service connection for right ear hearing loss is remanded. Entitlement to service connection for headaches is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a liver disorder, to include hepatitis C, is remanded. Entitlement to service connection for a traumatic brain injury (TBI) is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for a cervical spine is remanded. Entitlement to service connection for rheumatoid arthritis is remanded. Entitlement to service connection for left side numbness, to include as secondary to a cervical spine disorder, is remanded. Entitlement to service connection for a bilateral shoulder disorder, to include as secondary to a cervical spine disorder, is remanded. Entitlement to service connection for a bilateral lower extremity disorder characterized by numbness, to include as secondary to a lower back disorder, is Entitlement to special monthly compensation (SMC) based on a need for aid and attendance and due to being housebound is remanded. FINDINGS OF FACT 1. In a July 2015 rating decision, the Veteran was granted service connection for left ear hearing loss and assigned a noncompensable rating, effective April 28, 2014. 2. The Veteran did not appeal the July 2015 rating decision, nor has he asserted clear and unmistakable error (CUE) in that decision. 3. Throughout the appeal period, the Veteran's hearing impairment was no worse than Level I in the left ear. 4. In a rating decision that was issued in July 2015, the Regional Office (RO) denied entitlement to service connection for right ear hearing loss; the Veteran did not appeal the decision and new and material evidence was not received within the one-year appeal period. 5. Evidence associated with the record since the July 2015 decision relates to unestablished facts and raises a reasonable possibility of substantiating the claim of entitlement to service connection for right ear hearing loss. 6. In a rating decision that was issued in February 2016, the RO denied entitlement to service connection for bilateral lower extremity pain; the Veteran did not appeal the decision and new and material evidence was not received within the one-year appeal period 7. Evidence associated with the record since the February 2016 rating decision relates to unestablished facts and raises a reasonable possibility of substantiating the claim of entitlement to service connection for lower extremity pain. 8. The Veteran has an acquired psychiatric disorder that began during active service. CONCLUSIONS OF LAW 1. The Veteran's freestanding claim seeking an effective date prior to April 28, 2014 for the grant of service connection for left ear hearing loss lacks legal merit. 38 U.S.C. §§ 5109A, 7105; 38 C.F.R. § 20.101; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 2. The criteria for a compensable rating for left ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.10, 4.85, 4.86, Diagnostic Code 6100. 3. The July 2015 rating decision denying the claim for service connection for right ear hearing loss is final. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 20.1103. 4. New and material evidence has not been received sufficient to reopen the claim of entitlement to service connection for right ear hearing loss. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 5. The February 2016 rating decision denying the claim for service connection for bilateral lower extremity pain is final. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 20.1103. 6. New and material evidence has not been received sufficient to reopen the claim of entitlement to service connection for a lower extremity pain. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. 7. The criteria for service connection for an acquired psychiatric 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 had active air service from September 1976 to June 1981. This case comes before the Board of Veterans' Appeals (Board) on appeal from multiple rating decisions issued by the Department of Veterans Affairs (VA) RO. In his August 2016 substantive appeal, the Veteran requested a hearing before the Board; however, he cancelled his request in a December 2017 letter. Thus, the hearing request is considered withdrawn. In March 2021, the Veteran's attorney requested that the Board wait the complete 90 days following certification of the appeal to allow for the submission of additional evidence. The Veteran's attorney submitted a request for the Board to wait 90 days to allow for the submission of additional evidence in a May 2021 submission. Additional evidence and argument was received in August 2021. The Veteran asserts that he has a mental health condition as a result of in-service events. Post-service treatment records reveal diagnoses of unspecified schizophrenia spectrum and other psychotic disorder with other specified dissociative disorder, bipolar disorder, and multiple personality disorder, is granted. As the record reflects various psychiatric claims, the issues have been recharacterized to encompass all the Veteran's psychiatric diagnoses under a single claim for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Entitlement to an effective date earlier than April 28, 2014 for the grant of service connection for left ear hearing loss The Veteran has generally asserted that he is entitled to an effective date prior to April 28, 2014 for the grant of service connection for left ear hearing loss. Specific argument in support of this appeal has not been provided. An exception to that rule provides that the effective date of an award of an increase shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2); see also Harper v. Brown, 10 Vet. App. 125 (1997). The Court of Appeals for Veterans Claims (Court) held in Sears v. Principi, 16 Vet. App. 244, 248 (2002) that, "[t]he statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim." In order for the Veteran to be awarded an effective date based on an earlier claim, he has to show CUE in the prior denial of the claim. Flash v. Brown, 8 Vet. App. 332, 340 (1995). Moreover, there is no basis for a free-standing earlier effective date claim from matters addressed in a final and binding rating decision. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). By way of history, the Veteran filed his initial claim of service connection for left ear hearing loss on April 28, 2015. Entitlement to service connection for left ear hearing loss was granted in a July 2015 rating decision and assigned a noncompensable rating effective April 28, 2014, one year prior to filing his claim for entitlement to service connection for left ear hearing loss. The Veteran did not appeal this decision and it became final, and it is not subject to revision in the absence of CUE. 38 U.S.C. §§ 5109A, 7105; see Rudd, 20 Vet. App. 296 (2006). Then, in January 2017, the Veteran filed a claim the instant claim for entitlement to an increased rating for his left ear hearing loss. In a March 2017 rating decision, the RO denied an increased rating for left ear hearing loss. In his May 2017 Notice of Disagreement, the Veteran indicated he disagreed with the evaluation of disability and effective date of award for his left ear hearing loss. No specific argument in support of his claims was provided. Those facts are not in dispute. Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. However, the Board observes that there is no such thing as a freestanding claim for an earlier effective date, because to allow such a claim would be contrary to the principle of finality set forth in 38 U.S.C. § 7105. See Rudd v. Nicholson, supra. In other words, applicable law afforded the Veteran one year after the issuance of the July 2015 rating decision to file a formal appeal of that rating decision, which as stated above, granted service connection for left ear hearing loss, and assigned an effective date of April 28, 2014. 38 C.F.R. § 20.302. As the Veteran did not file a timely formal appeal, the effective date assigned by the July 2015 rating decision is final. A rating decision becomes final and binding if the Veteran does not timely perfect an appeal of the decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.302, 20.1103. Previous determinations that are final and binding, including decisions regarding service connection, will be accepted as correct in the absence of collateral attack by showing the decision involved CUE. In this case, the Veteran is precluded from filing an additional earlier effective date claim other than on the basis of CUE. Accordingly, the Board finds that the Veteran's freestanding claim of entitlement to an earlier effective date for left ear hearing loss is dismissed without prejudice to the Veteran filing a subsequent CUE claim. Sabonis v. Brown, 6 Vet. App. 426 (1994); Rudd v. Nicholson, supra. Entitlement to a compensable rating for left ear hearing loss Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. The Veteran asserts that he should have a compensable rating for his left ear hearing loss because his disability is worse than contemplated by the currently assigned rating. A July 2015 VA audiological evaluation was conducted. At that time, the examiner noted that the Veteran's left ear hearing loss did not impact ordinary conditions of daily life. Audiological testing results at that time were as follows: Hertz 1000 2000 3000 4000 Average Left Ear 35 45 50 50 45 Speech recognition ability was 94 percent in the left ear. Applying those values to the rating criteria results in a numeric designation of Level I in the left ear. 38 C.F.R. § 4.85, Table VI. Application of the level of hearing impairment in the left ear to Table VII at 38 C.F.R. § 4.85 produces a noncompensable rating. An exceptional pattern of hearing loss was not shown. 38 C.F.R. § 4.86. A February 2017 VA audiological evaluation was conducted. At that time, the examiner noted that the functional impact of the Veteran's hearing loss on his daily life included difficulty understanding speech. Audiological testing results at that time were as follows: Hertz 1000 2000 3000 4000 Average Left Ear 25 20 35 45 31 Speech recognition ability was 96 percent in the left ear. Applying those values to the rating criteria results in a numeric designation of Level I in the left ear. 38 C.F.R. § 4.85, Table VI. Application of the level of hearing impairment in the left ear to Table VII at 38 C.F.R. § 4.85 produces a noncompensable rating. An exceptional pattern of hearing loss was not shown. 38 C.F.R. § 4.86. In addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in the final report. Martinak v. Nicholson, 21 Vet. App. 447 (2007). The July 2015 and February 2017 VA examiners clearly identified the effects that the Veteran's left ear hearing loss had on his daily life, to include asking people to repeat themselves often. Therefore, the Board finds that the audiology evaluation reports are in compliance with the requirements of Martinak. The Board also finds that the Veteran is not entitled to a compensable rating for his left ear hearing loss. There is no indication from the record that the Veteran's hearing impairment was worse than Level I in the left ear. 38 C.F.R. § 4.86. The result of the Veteran's VA examinations falls within the schedular criteria for, at worst, a noncompensable rating. Therefore, the criteria for a compensable rating have not been met. 38 C.F.R. § 4.85, Diagnostic Code 6100. To the extent that the Veteran and contends that his hearing loss is more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his hearing acuity is of sufficient severity to warrant higher evaluations under VA's tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board finds that the remainder of his symptomatology has been stable throughout the appeal. Therefore, assigning a staged rating is not warranted. In Doucette v. Shulkin, 28 Vet. App. 366 (2017), the Court of Appeals for Veterans Claims (Court) held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday environment as these are the effects that VA's audiometric tests are designed to measure. The Veteran has not otherwise described functional effects that are considered exceptional or, that are not otherwise contemplated by the assigned rating. Id. Thus, his complete disability picture is compensated under the rating schedule. Further, neither he nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Id. (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Accordingly, the Board finds that the preponderance of the evidence is against the claim of entitlement to a compensable rating for left hearing loss. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Petitions to Reopen Generally, a claim which has been denied in an unappealed Board decision or an unappealed agency of original jurisdiction (AOJ) decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 7105(c). Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means evidence not previously submitted to agency decisionmakers. Material evidence means evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). Material evidence is: (1) evidence on an element where the claimant initially failed to submit any competent evidence; (2) evidence on an element where the previously submitted evidence was found to be insufficient; (3) evidence on an element where the appellant did not have to submit evidence until a decision of the Secretary determined that an evidentiary presumption had been rebutted; or (4) some combination or variation of the above three situations. Kent v. Nicholson, 20 Vet. App. 1 (2006). In order to be new and material evidence, the evidence must not be cumulative or redundant, and must raise a reasonable possibility of substantiating the claim, which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). When VA fails to consider new and material evidence submitted within the one-year appeal period pursuant to § 3.156(b), and that evidence establishes entitlement to the benefit sought, the underlying RO decision does not become final. Young v. Shinseki, 22 Vet. App. 461, 466 (2009); see also Buie v. Shinseki, 24 Vet. App. 242, 252 (2011) (remanding for the Board to consider the application of 38 C.F.R. § 3.156(b) and whether the regional office correctly viewed the statements in question as new claims). That is, when statements are received within one year of the rating decision, the Board's inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156(b). Right Ear Hearing Loss The AOJ denied the Veteran's claim for service connection for right ear hearing loss in a July 2015 rating decision, finding that right ear hearing loss did not occur in and were not caused by service. Evidence considered in this decision included service treatment records as well as post-service VA and private treatment records. The Veteran was provided notice of this decision and his appellate rights in an August 2015 letter, but he did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no relevant evidence pertaining to the Veteran's claim for service connection was received prior to the expiration of the appeal period stemming from rating decision dated in July 2015. See also Long v. Wilkie, 33 Vet. App. 167 (2020); Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011); Roebuck v. Nicholson, 20 Vet. App. 307, 316 (2006); Muehl v. West, 13 Vet. App. 159, 161-62 (1999). Moreover, no additional relevant service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156(c). Evidence received since the July 2015 rating decision includes a February 2017 VA audiological examination as well as relevant lay statements. This new evidence addresses the reason for the previous denial; that is, that the Veteran's left ear hearing loss is not etiologically related to active service. The credibility of this evidence is presumed for purposes of reopening the claims. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). Based on the foregoing, the Board also finds that new and material evidence has been presented and will reopen the claim. Bilateral Lower Extremities The AOJ denied the Veteran's claims of service connection for lower extremity pain in a February 2016 rating decision, finding that there was no diagnosed lower extremity disability. Evidence considered in this decision included service treatment records as well as post-service VA and private treatment records. The Veteran was provided notice of this decision and his appellate rights in a subsequent February 2016 letter but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 C.F.R. §§ 3.104, 20.302, 20.1103. In this regard, the Board has considered the applicability of 38 C.F.R. § 3.156(b), which provides that, when new and material evidence is received prior to the expiration of the appeal period, it will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. However, in the instant case, such regulation is inapplicable as no relevant evidence pertaining to the Veteran's claim for service connection was received prior to the expiration of the appeal period stemming from rating decision dated in July 2015. See also Long v. Wilkie, supra; Bond v. Shinseki, supra; Roebuck v. Nicholson, supra; Muehl v. West, supra. Moreover, no additional relevant service records (warranting reconsideration of the claim) have been received at any time. See 38 C.F.R. § 3.156(c). In connection with the current claims, the AOJ reopened the claims for service connection for lower extremity pain based in part on new treatment records as well as an October 2016 VA examination related to the Veteran's back and neck disorders. The Board also finds that new and material evidence has been presented and will reopen the claim. Service Connection Acquired Psychiatric Disorder The Veteran asserts that he has an acquired psychiatric disorder that is related to her active service or had its onset during service. Post-service treatment records reflect diagnoses of unspecified schizophrenia spectrum and other psychotic and bipolar disorder. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303(a). Turning to the question of whether there is an etiological relationship between the Veteran's acquired psychiatric disorder and service, the Board notes that the record contains several opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). See also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (stating that the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board will consider each of these opinions below. A November 2020 VA examiner opined that the claimed acquired psychiatric disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that although the Veteran's schizophrenia spectrum and other psychotic disorders had its initial break during active service, it is an inherited illness not caused by external factors such as the military. The Board finds that the November 2020 VA medical opinion is inadequate for adjudication purposes. In this regard, the examiner does not provide an opinion relating to the Veteran's bipolar disorder. Moreover, the examiner indicated that the Veteran's schizophrenia spectrum began during active service but opined that it was not related to service and hence is internally inconsistent. This opinion is therefore afforded little, if any, probative weight. In April 2019 and August 2021 private opinions, Dr. H. H. opined that it was more likely than not that the Veteran's schizoaffective disorder and bipolar disorders began during active service. The provided commented on the Veteran's service treatment records, which show a clear mental decline during the course of his active service. The examiner stated that evidence did not show that the Veteran's acquired psychiatric disorders pre-dated his period of active service. In this regard, there was no notation of a mental health disorder at entrance and a letter from the Veteran's childhood friend indicated that the Veteran did not experience any mental health conditions prior to service. This opinion reflects an adequate rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). This opinion is therefore probative weight. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current acquired psychiatric disorder began during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND The Board finds that additional development is required before the remaining claims on appeal are decided. Service Connection Right Ear Hearing Loss The Veteran asserts that his current right ear hearing loss is a result of in-service noise exposure. In July 2015, the Veteran was afforded a VA audiology examination, and showed bilateral sensorineural hearing loss for VA purposes. The examiner opined that the Veteran's right ear hearing loss less likely than not caused by his active military service. The Board finds that the July 2015 VA examination report is inadequate to decide the claim. In this regard, the examiner heavily based the negative opinion on the fact that the Veteran had normal hearing at separation. That alone is not a sufficient basis for a negative conclusion. The Board notes that the absence of in-service evidence of a hearing disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385) is not always fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability and a medically sound basis for attributing that disability to service may serve as a basis for a grant of service connection for hearing loss where there is credible evidence of acoustic trauma due to significant noise exposure in service, post-service audiometric findings meeting the regulatory requirements for hearing loss disability for VA purposes, and a medically sound basis upon which to attribute the post-service findings to the injury in service as opposed to intercurrent causes. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's right ear hearing loss. Headaches In a February 2017 VA opinion, the examiner opined that the Veteran's diagnosed migraine headaches was not related to service. In reaching this conclusion, the examiner commented that the Veteran's service treatment records were silent for complaints or treatment of a headaches or dizziness, and that the Veteran did not seek treatment for headaches until several years following his separation from service. The Board finds that the February 2017 VA medical opinion is inadequate for adjudication purposes. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a Veteran's reports of in-service injury and instead relied on the absence of evidence in a Veteran's service treatment records to provide a negative opinion). In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's headaches. Hypertension In a February 2017 VA opinion, the examiner opined that the Veteran's diagnosed hypertension was not related to service. In reaching this conclusion, the examiner commented that the Veteran's service treatment records were silent for complaints or treatment of a headaches or dizziness, and that the Veteran did not seek treatment for hypertension until several years following his separation from service. The Board finds that the February 2017 VA medical opinion is inadequate for adjudication purposes. See Dalton v. Nicholson, supra. In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's hypertension. Liver Disorder The Veteran asserts that he has a liver disorder as a result of his active duty service. Post-service treatment notes show a diagnosis of chronic hepatitis C. To date, a VA medical opinion has not been obtained with regard to the Veteran's liver disorder. Therefore, the Board finds that a VA medical opinion is warranted to address the nature and etiology of his liver disorder. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). TBI The Veteran asserts that he has residuals of a TBI as a result of his active duty service. Specifically, the Veteran asserts that he fell and hit his head during a 1977 in-service fall on ice and that he has experienced residuals of a TBI since that time. To date, a VA medical opinion has not been obtained with regard to the Veteran's liver disorder. Therefore, the Board finds that a VA medical opinion is warranted to address the nature and etiology of his residuals of a TBI. See McLendon v. Nicholson, supra. Lumbar Spine At an October 2016 VA examination, the examiner diagnosed degenerative arthritis of the spine and cervical instability. In a corresponding VA opinion, the examiner opined that the Veteran's diagnosed degenerative arthritis of the spine was less likely than not related to service. In reaching this conclusion, the examiner commented that although the Veteran's service treatment records show recurring back pain at separation, there are no records to show a definitive diagnosis. The examiner also reported that there was no evidence of post-service back treatment for more than 30 years following service separation. The Board finds that the October 2016 VA medical opinion is inadequate for adjudication purposes. See Dalton v. Nicholson, supra. In this regard, the examiner relied solely on the absence of in-service treatment, and post-service treatment for several years as the rationale for the negative nexus opinion. Moreover, the examiner did not address statements that he injured his neck during a 1977 in-service fall on ice and did not seek medical treatment, and that pain has been continuous since that time. Additionally, the Board notes that in his June 1981 separation examination Report of Medical History, the Veteran reported that he slipped on ice in 1977 and that he experienced lower back pain since that time, but that he did not seek medical treatment. Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's lumbar spine disorder. Cervical Spine At an October 2016 VA examination, the examiner diagnosed degenerative arthritis of the spine and cervical instability. In a corresponding VA opinion, the examiner opined that the Veteran's diagnosed cervical instability was less likely than not related to service. In reaching this conclusion, the examiner commented that the Veteran's service treatment records were silent for evidence of a neck condition, and that the Veteran was in a motor vehicle accident in 1997 that required cervical vertebrae. The Board finds that the October 2016 VA medical opinion is inadequate for adjudication purposes. See Dalton v. Nicholson, supra. In this regard, the examiner relied solely on the absence of in-service treatment. Moreover, the examiner did not address statements that he injured his neck during a 1977 in-service fall on ice and did not seek medical treatment, and that pain has been continuous since that time. Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's cervical spine disorder. Rheumatoid Arthritis, Bilateral Lower Extremities, Bilateral Shoulders Left Side Numbness The Board notes that the issues of entitlement to service connection for rheumatoid arthritis, bilateral lower extremity disorder, bilateral shoulder disorder, and left side numbness are inextricably intertwined with the claims remanded herein, as these claims is predicated on the claims for entitlement to service connection for a lower back disorder and cervical spine disorder. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claims of rheumatoid arthritis, bilateral lower extremity disorder, bilateral shoulder disorder, and left side numbness should be deferred pending final disposition of the claims for entitlement to service connection for a lower back disorder and cervical spine disorder. Entitlement to SMC The Board notes that the issue of entitlement to SMC is inextricably intertwined with the claims remanded herein, as the Veteran's SMC claim is predicated on those claims. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claim for entitlement to SMC should be deferred pending final disposition of the each of the Veteran's claims on appeal. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an audiologist or other qualified medical examiner, to determine the nature and etiology of the Veteran's right ear hearing loss. The need for further physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's right ear hearing loss had its onset during his active service, or is otherwise etiologically related to such service, to include whether any injury due to loud noise exposure experienced therein contributed to his current right ear hearing loss The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's headaches. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present headaches, to include migraine headaches, had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing lower back pain in service. The examiner should also address the Veteran's report that he experienced sensitivity to light and headaches during service. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 4. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's hypertension. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that hypertension had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his reports that he has experienced hypertension for several years prior to his diagnosis. The examiner should also address the Veteran's report that he experienced sensitivity to light and headaches during service. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 5. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's liver disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present liver disorder, to include hepatitis C, had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. The examiner should also address the Veteran's report that he experienced sensitivity to light and headaches during service. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 6. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's residual disability from a claimed in-service TBI. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present TBI disability or residuals had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his reports that he hit his head following a 1977 in-service fall on ice. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 7. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's lumbar spine disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present lumbar spine disorder, to include degenerative arthritis, had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing lower back pain in service following a 1977 fall on ice and that pain has been continuous since that time. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 8. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's cervical spine disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present cervical spine disorder, to include cervical instability, had its onset during his active service or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms, to include his reports that he began experiencing lower back pain in service following a 1977 fall on ice and that pain has been continuous since that time. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 9. Following the completion of the above, the Agency of Original Jurisdiction should consider whether additional development is warranted as a result of the above (e.g., development for rheumatoid arthritis, bilateral lower extremity disorder, bilateral shoulder disorder, and left side numbness, and entitlement to SMC). KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.