Citation Nr: 21070555 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 12-24 390A DATE: November 24, 2021 REMANDED Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from December 1967 to December 1971. The Veteran filed a claim for benefits in February and March 2011. An August 2011 rating decision denied entitlement to service connection for hearing loss, tinnitus, hypertension, and diabetes. After initiating an appeal to this denial, statement of the case (SOC) was issued in September 2012 that continued to deny the claims. The Veteran submitted a timely substantive appeal (VA Form 9) in September 2012; however, no further action was taken on the claim and the issues were not forwarded to the Board for adjudication. The Veteran applied for benefits again in November 2019. A February 2020 rating decision continued to service connection for bilateral hearing loss, tinnitus, and hypertension because new and relevant evidence had not been submitted. The Board finds that new and relevant evidence is not necessary as the August 2011 rating decision never became final because the claim was never forwarded to the Board. The claim will be evaluated on a de novo basis. 1. Entitlement to service connection for hearing loss is remanded. 2. Entitlement to service connection for tinnitus is remanded. The Veteran underwent a VA examination in June 2011. The examiner determined that an opinion addressing the etiology of the Veteran's hearing loss and tinnitus could not be provided without resorting to mere speculation. Emphasis was placed on there being a lack of evidence of hearing loss in service. Such a finding is inadequate. Notably, if an examiner finds that based on the available information, an opinion cannot be rendered without resort to mere speculation, a complete rationale must be provided that identifies what data is missing that would enable a non-speculative opinion, or explains why current medical knowledge does not allow for a non-speculative opinion. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). Another VA examination is necessary to fully, and clearly, address the Veteran's conceded in-service noise exposure and whether it has caused his current bilateral hearing loss and tinnitus. 3. Entitlement to service connection for hypertension is remanded. The Veteran contends his hypertension is related to his exposure to Agent Orange or is secondary to a service-connected disability. The Veteran is presumed to have been exposed to Agent Orange. While hypertension is not a disability which is presumed to be related to Agent Orange exposure, there is current medical literature from the National Academy of Sciences (NAS) indicating there is sufficient evidence linking hypertension to Agent Orange exposure. Accordingly, there is an indication that the current diagnosed disability may be related to service, but there is insufficient competent evidence in the file to decide the claim. A VA examination is warranted to determine the etiology of the Veteran's hypertension. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Further, the Veteran has been service-connected for diabetes type II. An opinion is required to determine whether the Veteran's hypertension was caused by or aggravated by his now service-connected diabetes. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hearing loss or tinnitus disability. After reviewing the claims file and examining the Veteran, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran's hearing loss or tinnitus disability: (a.) had its onset in service or is otherwise etiologically related to active service, to include conceded in-service noise exposure. (b.) If the examiner finds that the information in the claims file or any limits in current medical knowledge prevent rendering an opinion without resort to mere speculation, a complete explanation must be provided that is specific to the appellant's medical history, and which discusses why the available information is not sufficient, or identifies the nature of the limits in current medical knowledge, such as whether there are multiple possible etiologies of the appellant's hearing loss and/or tinnitus, with none more likely than not the cause. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hypertension disability. After reviewing the claims file and examining the Veteran, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran's hypertension disability: (a.) had its onset in service or is otherwise etiologically related to active service, to include exposure to herbicide agents. The examiner should also review the findings of the National Academy of Sciences (NAS) Institute of Medicine that there is "sufficient evidence of an association" between exposure to herbicide agents and hypertension. See Veterans and Agent Orange: Update 11 (2018), Chapter 12, p. 565; https://www.nap.edu/catalog/25137/veterans-and-agent-orange-update-11-2018. The examiner should comment on its relevance, if any, to the Veteran's claim. (b.) was proximately due to the Veteran's service-connected diabetes. (c.) underwent any incremental increase in disability, regardless of its permanence, due to the service-connected diabetes disability. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rekowski 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.