Citation Nr: 21069532 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-56 461 DATE: November 18, 2021 REMANDED Entitlement to service connection for a recurrent ear disability, to include ear infections residuals, is remanded. REASONS FOR REMAND The Veteran had active service from August 1979 to August 1982; from September 1982 to September 1992; and from February 2003 to July 2003. She served in Iraq. The Veteran had additional duty with the Army Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, April 2021, and August 2021, the Board remanded the issue currently on appeal to the agency of original jurisdiction (AOJ) for additional development. Although the Board sincerely regrets the additional delay, there has not been substantial compliance with the Board's remand directives regarding the issue on appeal. As such, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran asserts that she experiences issues with her ears including pain, becoming dizzy and getting motion sickness while she is walking. She reports on her November 2016 Form 9 that she is taking medication for these symptoms. As to the ear pain, the Veteran specifically points to her repeated inservice exposure to noise including from heavy equipment like cranes and forklifts and from ammunition. This incessant exposure, according to her, led to her developing earaches. While she was seen in service, she states that it was "frowned upon" to continue go to the doctors. Yet when she did, she explained that she was prescribed antibiotics or steroids. She reports this has affected her work and social functioning. While the Veteran is already service-connected for tinnitus, it is not presently clear if the Veteran's described symptoms are a consequence of her tinnitus disorder or a separate and compensable disorder. Notably, the past three Board decisions have inquired as to whether the Veteran has a separate ear disorder that results in pain. The most recent September 2021 VA opinion from a VA nurse practitioner stated that there was no current diagnosis of vertigo or a recurrent/chronic ear condition other than tinnitus because the Veteran was found to be normal on examination. While the examiner generally noted the Veteran has had vertigo "in the past," the examiner found that the Veteran did not have a current diagnosis of vertigo as the Veteran was not undergoing treatment for a vertigo disorder. The Board's prior remand requested an opinion as to whether the Veteran has had an ear condition, including one that caused pain, since November 2015. While the examiner relied on the Veteran not presently showing symptoms, this opinion does not comply with the Board's prior remand as it did not take into account whether or not the Veteran has had a separate ear condition that causes pain during the period on appeal. This inquiry is pertinent because the Veteran has described this condition as being episodic and productive of flares (See April 2021 Statement in Support of Claim). Moreover, the VA has received medical evidence dated within the period on appeal indicating the Veteran becomes dizzy and has experienced numerous falls. Also, the opinion goes on to explain that the is no additional history of work-up, evaluations, and referrals for the Veteran's assertions as to the statements that she experienced a chronic ear condition that occurred during activity duty dates. Yet, there are numerous medical records in the Veteran's service treatment records (STRs) indicating ear pain and ear problems "recurring each year" where the Veteran experienced fluid build-up and treated the issues with ear drops. This evidence is consistent with the Veteran's statements, but it was not noted in the evidence review of the opinion or in the opinion itself. The prior remand instructions included a direction that the examination was to be conducted by a medical doctor. The examination in question was not performed by a medical doctor. This needs to be addressed. Accordingly, a remand is needed for an addendum opinion consistent with the Board's prior remand instructions. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Schedule the Veteran for a VA examination. As per the instructions of the April 2021 Board remand, the examination should be conducted by a medical doctor. The examiner must review the claims file. The doctor should note whether the Veteran has had a disability of the ear(s), other than tinnitus, at any point during the relevant period on appeal from November 2015, as well as the current nature of any identified ear disability, including ear infection residuals, vertigo, or dizziness . If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. After reviewing the record, together with the results of any testing deemed necessary, the examiner is asked to opine as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that a disability of the ear(s) had its onset in, or is otherwise related to, the Veteran's active duty service. In providing the requested opinion, consider the Veteran's description of her in-service injury and symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? In providing the opinion, the examiner should note that the Veteran had exposure to loud noise on the shooting range during service, and that she had in-service ear infection. The examiner should also note that the Veteran reported right ear pain twice in April 1987, complained of painful ears in November 1987, and reported painful ears or earache twice in September 1988. The Veteran also complained of right ear pain in October 1988, and her September 1992 separation examination indicates she had recurring bilateral ear problems each year. The examiner is also requested to address the significance of the Veteran's reports that she has had ear problems since she was in service. The examiner must provide a comprehensive rationale for all opinions expressed. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. Specifically, the examiner must indicate whether there was a further need for information or testing, or whether an opinion could not be rendered due to limitations of knowledge in the medical community at large. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Wade 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.