Citation Nr: 21069481 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 19-21 080 DATE: November 18, 2021 REMANDED Entitlement to service connection for bilateral sensorineural hearing loss is remanded. Entitlement to service connection for a colon disorder, to include as secondary to service-connected malaria or herbicide exposure, is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to a left knee disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to November 1965. 1. Entitlement to service connection for bilateral sensorineural hearing loss is remanded. The Veteran's military occupational specialty (MOS) was infantry indirect fire crewman and had a high probability of noise exposure. In a September 2014 statement, the Veteran noted exposure to combat-related noise including gunfire. Additionally, service treatment records reflect a shift in puretone thresholds from the September 1963 audiological entrance examination to the October 1965 separation audiological examination, and a further shift in a May 1967 audiological examination. In September 2012, a VA examiner diagnosed the Veteran with bilateral hearing loss, but determined it was less likely than not related to service because the Veteran had normal hearing at separation, and because noise induced hearing loss begins immediately. The examiner did not address the Veteran's in-service traumatic noise exposure, or the in- and post-service audiological examinations reflecting a shift in puretone thresholds. The September 2012 examination is inadequate for rating purposes. A remand is needed to obtain an additional VA medical opinion concerning the nature and etiology of the Veteran's bilateral hearing loss. 2. Entitlement to service connection for a colon disorder, to include as secondary to service-connected malaria or herbicide exposure, is remanded. In May 2020, the Board remanded the issues of entitlement to service connection for a colon disorder to the AOJ to obtain a VA examination. The Board instructed the examiner to determine whether any diagnosed colon disorder is etiologically related to service, herbicide exposure, or service-connected disorders, specifically addressing VA and private medical records indicating treatment for various conditions including colitis, ulcerative proctitis, internal hemorrhoids, and polyps. In August 2021, a VA examiner appears to have diagnosed the Veteran with irritable bowel syndrome, but then indicating the Veteran reported no active disease for many years and opining that the Veteran currently has no chronic diagnosis of a colon disorder. The August 2021 VA examiner's opinion is inadequate for rating purposes. As noted in the remand instructions, VA and private medical records indicate treatment for various colon disorders during the course of the appeal. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, VA treatment records added to the claims file subsequent to the Board's remand indicate that the Veteran underwent private colonoscopy in January 2018, and a private colonoscopy from Dr. A sometime in 2016. See October 2020 and June 2016 VA Treatment Records. A remand is needed to obtain a VA medical opinion that is adequate to determine the nature and etiology of any diagnosed colon disorders. Additionally, the AOJ should attempt to obtain the private colonoscopy records from 2018 and 2016. 3. Entitlement to service connection for a left knee disorder is remanded. 4. Entitlement to service connection for a right knee disorder, to include as secondary to a left knee disorder, is remanded. In May 2020, the Board remanded the issues of entitlement to service connection for left and right knee disorders to the AOJ to obtain a VA examination. The Board instructed the examiner to determine whether any diagnosed knee disorders are etiologically related to service, specifically addressing the Veteran's in-service Jeep accident and parachute jumps, the Veteran's claim of symptoms subsequent to service, and VA treatment records reflecting arthritis of the knees. In August 2021, a VA examiner determined that the Veteran has bilateral knee strain based on subjective factors, and the strains are unrelated to the Veteran's service, including the in-service Jeep accident. The examiner noted that no imaging had been done of either knee and determined that treatment records do not reflect chronicity of care since service. The August 2021 VA examiner's opinion is inadequate for rating purposes. As noted in the remand instructions, April 2014 VA treatment records indicate treatment for arthritis of both knees. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, subsequent to the Board's remand, but prior to the August 2021 VA opinion, the Veteran submitted private medical records that reflect treatment for bilateral knee degenerative joint disease and indicate the diagnosis is based on imaging of the knees. See February and March 2020 Private Medical Records. A remand is needed to obtain a VA examination, including imaging, to determine the nature and etiology of the Veteran's left and right knee disorders. Additionally, the AOJ should attempt to obtain the actual imaging results that served as the basis for the diagnosis and treatment reflected in the Veteran's private medical records. The matters are REMANDED for the following action: 1. Obtain VA treatment records since July 2021 and associate them with the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for the following: the 2020 results of the left and right knee imaging conducted by Dr. MB (see February and March 2020 Private Medical Records); the January 2018 private colonoscopy records (see October 2020 VA Treatment Records); and 2016 private colonoscopy records from Dr. A (see June 2016 VA Treatment Records). If the records cannot be obtained, any negative responses should be associated with the claims file, and the Veteran and his representative should be notified of unsuccessful attempts to obtain the records, in order to allow the Veteran the opportunity to obtain and submit those records for review. 3. Forward the Veteran's claims file to an appropriate VA examiner for opinion regarding the nature and etiology of the Veteran's bilateral hearing loss. The examiner should determine whether it is at least as likely as not that the diagnosed hearing loss had its onset during active duty, was aggravated by active duty, or is otherwise etiologically related to his active duty service. In answering this question, the examiner should note that that the Veteran has a current diagnosis of bilateral hearing loss and was exposed to hazardous noise levels during service. See September 2012 VA Examination; September 2014 Veteran Statement; January 2020 Hearing Testimony. The examiner should also specifically address the puretone threshold shifts in the Veteran's September 1963 audiological entrance examination, October 1965 separation audiological examination, and May 1967 audiological examination. If an examination is needed, one should be scheduled. A complete rationale must be provided for any opinion offered. 4. Forward the Veteran's claims file to an appropriate VA examiner for opinion regarding the nature and etiology of any diagnosed colon disorders. The examiner should note that the Veteran's in-service exposure to herbicides is conceded. The examiner must answer the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed colon disorder began in service, was caused by service, or is otherwise etiologically related to active duty service, to include exposure to herbicides? (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed colon disorder is caused or aggravated beyond the normal progress of the disorder by service-connected malaria and/or PTSD with alcohol use disorder? In answering these questions, the examiner should address the following: any relevant private medical records obtained by the AOJ regarding the Veteran's 2018 and 2016 private colonoscopies; private medical records reflecting treatment for various conditions including colitis, ulcerative proctitis, internal hemorrhoids, and polyps (see, e.g., July 1981, September 1996, February 1997, May 1998, March 2008, October 2012 Private Medical Records); articles submitted by the Veteran indicating a relationship between malaria and colon disorders (see, e.g., October 2012 submission of MedicineNet.com article); and VA treatment records reflecting treatment for ulcerative colitis (see, e.g., April 2014 VA Treatment Records). If an examination is needed, one should be scheduled. A complete rationale must be provided for any opinion offered. 5. Schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of any diagnosed left and right knee disorders. Any imaging of the knees required for diagnostic purposes should be obtained. The examiner must answer the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed right and/or left knee disorder began in service, was caused by service, or is otherwise etiologically related to active duty service? The examiner is requested to specifically discuss whether there is any medical reason to accept or reject a theory that any current disability of the right and/or left knee is attributable to trauma from a March 1965 jeep accident injury and/or the cumulative effects of parachute jumps in service while wearing full combat gear. See Veteran statement of circumstances received in January 2013. (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed right knee disorder is caused or aggravated beyond the normal progress of the disorder by a diagnosed left knee disorder? In answering these questions, the examiner should address the following: any relevant private medical records obtained by the AOJ regarding the Veteran's 2020 left and right knee imaging reflecting knee arthritis; the Veteran's statements that he injured his left knee in March 1965 automobile accident (see October 1965 Separation Report of Medical History; November 1965 Claim); photographs of the Jeep subsequent to the automobile accident; VA treatment records reflecting treatment for arthritis of the knees (see, e.g., April 2014 VA Treatment Records); February and March 2020 private medical records reflecting a diagnosis of bilateral knee degenerative joint disease; Veteran testimony and lay statements regarding in-service left knee trauma from the automobile accident; bilateral knee trauma from in-service parachute jumps; and symptoms subsequent to service including swelling and pain (see, e.g., January 2013 Lay Statement; January 2020 Hearing Testimony); and the Veteran's January 2020 testimony that his left knee disorder has caused his right knee disorder. A complete rationale must be provided for any opinion offered. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Howell, 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.